Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like G*

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
60	Fee-for-Service	1417194234	1417194234	1	1	GUPTA, MONIKA MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105120	41	Internal Medicine	0	In state provider	None	1180 EAST SHAW AVE	#125	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
64	Fee-for-Service	1255812806	1255812806	1	1	GEETHA PURI, MD. PC.	7/30/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	12830 HESPERIA ROAD	SUITE A	VICTORVILLE	CA	92395	7788	36	06071	34.48395212	-117.2903629	San Bernardino County
79	Fee-for-Service	1528278561	1528278561	1	1	GOODLOW, NATHAN V PSYD	12/26/2018	103TP0016X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	433 CALLAN AVENUE	SUITE 307	SAN LEANDRO	CA	94577	4641	01	06001	37.72706807	-122.1519034	Alameda County
96	Fee-for-Service	1164702817	1164702817	1	1	GARCIA SCHIFFMAN, MARICELA	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117939	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
103	Fee-for-Service	1609546068	1609546068	1	1	GLOVER, TERESA T	9/23/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	31850 ENGLISH COURT	None	MENIFEE	CA	92584	3833	33	06065	33.659028	-117.2051685	Riverside County
113	Fee-for-Service	1407240757	1407240757	1	1	GOMES, ANASTASIA LCSW	3/20/2023	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
148	Fee-for-Service	1902826894	1902826894	2	1	GENOBAGA, CHRISTOPHER G MD F	9/30/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	63752	15	Obstetrics (D.O. only)	0	In state provider	ACOG	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
175	Fee-for-Service	1447810668	1447810668	1	1	GLENOAKS HOME HEALTH INC	5/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1524 W GLENOAKS BLVD	STE A	GLENDALE	CA	91201	1913	19	06037	34.16885904	-118.2867863	Los Angeles County
195	Fee-for-Service	1912071481	1912071481	1	1	GONZALEZ HIDALGO, HAYDEE	10/8/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	155495	41	Internal Medicine	0	In state provider	None	11550 INDIAN HILLS RD	SUITE 330	MISSION HILLS	CA	91345	1203	19	06037	34.28024575	-118.4588775	Los Angeles County
203	Fee-for-Service	1184671513	1184671513	1	1	GONG, DEREK P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66344	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
208	Fee-for-Service	1730312224	1730312224	1	1	GITESH DHIRAJ CHHEDA, M.D.	1/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4021 AVE B	None	SCOTTSBLUFF	NE	69361	4602	00	None	41.886845	-103.6658169	Scotts Bluff County
249	Fee-for-Service	1861554735	1861554735	1	1	GOLDBERG, ROSS T MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	34477	30	Radiology	0	In state provider	None	1329 22ND ST	None	SANTA MONICA	CA	90404	2031	19	06037	34.03138374	-118.4798035	Los Angeles County
268	Fee-for-Service	1336606243	1336606243	1	1	GASTROENTEROLOGY AND LIVER I	4/10/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	NSTITUTE PC	935 PENNSYLVANIA AVE	None	ESCONDIDO	CA	92025	3425	37	06073	33.12805404	-117.0700077	San Diego County
276	Fee-for-Service	1083731228	1083731228	1	1	GRETHER-JONES, KENDRA L MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120993	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
280	Fee-for-Service	1245805308	1245805308	1	1	GLOM SUBSTANCE ABUSE PROGRAM	11/6/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	10898 BOESSOW RD	None	GALT	CA	95632	8451	34	06067	38.254374	-121.282596	Sacramento County
291	Fee-for-Service	1912551433	1912551433	1	1	GROZDEV, KALOYAN BOJIDAROV	8/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PT	8800 STOCKDALE HWY	150	BAKERSFIELD	CA	93311	1012	15	06029	35.35448783	-119.0995578	Kern County
303	Fee-for-Service	1245240209	1245240209	1	1	GOLEMBESKY, HENRY E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25735	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
321	Fee-for-Service	1760474555	1760474555	1	1	GALANOPOULOS, CHRISTOS M	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	51854	02	General Surgery	0	In state provider	None	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
326	Fee-for-Service	1689622045	1689622045	1	1	GABILAN RADIOLOGY MED	12/31/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP	911 SUNSET DR	None	HOLLISTER	CA	95023	5602	35	06069	36.83504962	-121.3858245	San Benito County
379	Fee-for-Service	1689861502	1689861502	1	1	GOLLENDER, PAUL R OD	9/5/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1263 PLEASANT GROVE BLVD	STE 100	ROSEVILLE	CA	95747	5858	31	06061	38.77233838	-121.3143437	Placer County
384	Fee-for-Service	1366599367	1366599367	1	1	GORMAN, JENNIFER A LMFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	35787	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
387	Fee-for-Service	1326367673	1326367673	1	1	GAUDETTE, TONJA M LCSW	7/12/2018	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
391	Fee-for-Service	1609546068	1609546068	1	1	GLOVER, TERESA T	9/23/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	31850 ENGLISH COURT	None	MENIFEE	CA	92584	3833	33	06065	33.659028	-117.2051685	Riverside County
398	Fee-for-Service	1154495760	1154495760	1	1	GOODMAN, GRANT R MD	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72194	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
401	Fee-for-Service	1528147287	1528147287	1	1	GIBRAN, S NICOLE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HARBORVIEW MEDICAL CENTE	325 9TH AVE	# MS359110	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
407	Fee-for-Service	1023271004	1023271004	1	1	GUPTA, ADEETI MD	4/6/2022	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	100594	None	None	0	In state provider	None	852 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	1601	19	06037	34.06139351	-118.3835652	Los Angeles County
415	Fee-for-Service	1497307813	1497307813	1	1	GARCIA, IVONNE J	10/28/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9800 MARKLEIN AVE	None	NORTH HILLS	CA	91343	2131	19	06037	34.24830635	-118.4708258	Los Angeles County
433	Fee-for-Service	1407897382	1407897382	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 E ALAMEDA AVE	None	BURBANK	CA	91502	2004	19	06037	34.17398187	-118.3003458	Los Angeles County
449	Fee-for-Service	1225461403	1225461403	1	1	GOMEZ, INDIA B PHD	8/13/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2940 SUMMIT ST	SUITE 2C	OAKLAND	CA	94609	3416	01	06001	37.81849213	-122.2647718	Alameda County
453	Fee-for-Service	1700405172	1700405172	1	1	GUTIERREZ, KEVIN MD	8/13/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
483	Fee-for-Service	1912071481	1912071481	1	1	GONZALEZ HIDALGO, HAYDEE	10/8/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	155495	68	Hematology	0	In state provider	None	11550 INDIAN HILLS RD	SUITE 330	MISSION HILLS	CA	91345	1203	19	06037	34.28024575	-118.4588775	Los Angeles County
491	Fee-for-Service	1184671513	1184671513	1	1	GONG, DEREK P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66344	40	Pediatrics	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
509	Fee-for-Service	1902255870	1902255870	1	1	GLUCKSTEIN, JEFFREY A MD	9/17/2022	207WX0109X	NA	Ophthalmology	026	PHYSICIANS	179128	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 2505	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
515	Fee-for-Service	1457374282	1457374282	1	1	GORDON, LYNN K MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57153	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
530	Fee-for-Service	1417241357	1417241357	1	1	GRANILLO, MICHELLE LMFT	6/3/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	101100	-	NOT APPLICABLE	0	In state provider	None	83-912 AVENUE 45	SUITES 3 5 7 8 9	INDIO	CA	92201	7351	33	06065	33.722208	-116.2097446	Riverside County
538	Fee-for-Service	1386044709	1386044709	1	1	GARCIA, MAYRA LCSW	11/7/2023	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
559	Fee-for-Service	1275704009	1275704009	1	1	GALLACI, JOHN M LMFT	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50386	-	NOT APPLICABLE	0	In state provider	None	710 E 111TH PLACE	None	LOS ANGELES	CA	90059	1518	19	06037	33.93454026	-118.2626368	Los Angeles County
582	Fee-for-Service	1215008289	1215008289	1	1	GIRVIGIAN, MICHAEL R MD	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68225	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
597	Fee-for-Service	1154308070	1154308070	1	1	GAMMON,BRUCE ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	375 MUNICIPAL DR	STE 218	RICHARDSON	TX	75080	0000	00	None	32.97335157	-96.72587826	Dallas County
601	Fee-for-Service	1326072604	1326072604	1	1	GHOBRIAL, RAFIK M MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	56109	02	General Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
686	Fee-for-Service	1154495760	1154495760	1	1	GOODMAN, GRANT R MD	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72194	68	Hematology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
703	Fee-for-Service	1497307813	1497307813	1	1	GARCIA, IVONNE J	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	9800 MARKLEIN AVE	None	NORTH HILLS	CA	91343	2131	19	06037	34.24830635	-118.4708258	Los Angeles County
713	Fee-for-Service	1013677145	1013677145	1	1	GARCIA, JANET LCSW	1/5/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1656 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1604668	Los Angeles County
734	Fee-for-Service	1891400883	1891400883	1	1	GRANTCHAROV, TEODOR P MD	11/6/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	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
754	Fee-for-Service	1891899373	1891899373	1	1	GUTOWICZ, MATTHEW F DO	5/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	4090	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
755	Fee-for-Service	1801381504	1801381504	1	1	GLOVER, KYLE R MD	10/1/2021	207R00000X	NA	Other	026	PHYSICIANS	174517	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
765	Fee-for-Service	1295956092	1295956092	1	1	GREIN, JONATHAN D MD	8/20/2009	207R00000X	NA	Other	026	PHYSICIANS	94549	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
805	Fee-for-Service	1912412420	1912412420	1	1	GALEA CENTER, LLC.	10/28/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	RGERY	20360 SW BIRCH STREET	SUITE 160	NEWPORT BEACH	CA	92660	1531	30	06059	33.65637389	-117.8783246	Orange County
830	Fee-for-Service	1245690494	1245690494	1	1	GMH HOSPICE AND PALLIATIVE	2/7/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	16200 VENTURA BLVD	SUITE 303	ENCINO	CA	91436	2205	19	06037	34.15659457	-118.485532	Los Angeles County
864	Fee-for-Service	1215921333	1215921333	1	1	GLEASON, COLLEEN M NP	8/1/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5319 W HILLSDALE AVE	None	VISALIA	CA	93291	5118	54	06107	36.329139	-119.3500755	Tulare County
906	Fee-for-Service	1881210847	1881210847	1	1	GHC OF TEM-SNF LLC	7/13/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	44280 CAMPANULA WAY	None	TEMECULA	CA	92592	7902	33	06065	33.48396315	-117.1002276	Riverside County
915	Fee-for-Service	1982246575	1982246575	1	5	GOLDEN STATE HEART & VASCULA	7/10/2024	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	R ASSOCIATES	15075 LOS GATOS BLVD	SUITE 150	LOS GATOS	CA	95032	2048	43	06085	37.24911284	-121.9556101	Santa Clara County
920	Fee-for-Service	1821128224	1821128224	1	1	GUPTA, ANIL MD INC	4/17/1989	193400000X	NA	Other	026	PHYSICIANS	46009	None	None	0	In state provider	None	1535 W. MERCED AVE	301	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
950	Fee-for-Service	1407800246	1407800246	1	1	GOLDSTEIN, PAUL MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	18938	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9999 MIRA MESA BLVD	STE 104	SAN DIEGO	CA	92131	1006	37	06073	32.91668328	-117.1118001	San Diego County
956	Fee-for-Service	1376937524	1376937524	1	1	GISHEN, KRIYA E MD	2/19/2021	208200000X	NA	General Surgery	026	PHYSICIANS	171276	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
964	Fee-for-Service	1356734859	1356734859	1	1	GOMEZ-MIRA, CHRISTINA E MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134563	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
971	Fee-for-Service	1710128558	1710128558	1	1	GINSBERG, MICHAEL L MD	2/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106486	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
976	Fee-for-Service	1154495760	1154495760	1	1	GOODMAN, GRANT R MD	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72194	78	Neoplastic Diseases/Oncology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
988	Fee-for-Service	1427195734	1427195734	1	1	GIBBS, JOSHUA G DO	7/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9958	03	Allergy	0	In state provider	None	9220 HAVEN AVENUE	STE 101	RANCHO CUCAMONGA	CA	91730	8551	36	06071	34.08525	-117.5758875	San Bernardino County
1096	Fee-for-Service	1790836153	1790836153	1	1	GROVER, RAKESH K	4/12/1995	208600000X	NA	General Surgery	026	PHYSICIANS	52860	None	None	0	In state provider	None	16018 TUSCOLA RD	STE 2	APPLE VALLEY	CA	92307	1329	36	06071	34.542207	-117.269316	San Bernardino County
1097	Fee-for-Service	1558319426	1558319426	1	1	GOLDFINE, MONA S, MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71982	05	Anesthesiology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
1100	Fee-for-Service	1770558686	1770558686	1	1	GOLLER, DAVID E MD	8/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85137	30	Radiology	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
1106	Fee-for-Service	1326003013	1326003013	1	1	GARRETT, VALERIE D MD	4/13/2022	207R00000X	NA	Other	026	PHYSICIANS	171118	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
1116	Fee-for-Service	1245690494	1245690494	1	1	GMH HOSPICE AND PALLIATIVE	2/7/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	16200 VENTURA BLVD	SUITE 303	ENCINO	CA	91436	2205	19	06037	34.15659457	-118.485532	Los Angeles County
1127	Fee-for-Service	1548248065	1548248065	1	1	GORDON, LOWELL A MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	44724	40	Pediatrics	0	In state provider	None	36320 INLAND VALLEY DR	SUITE 203	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
1133	Fee-for-Service	1992074058	1992074058	1	1	GILL, KANWALJIT MD INC	10/1/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	53800	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	38656 MEDICAL CENTER DR	SUITE A	PALMDALE	CA	93551	4483	19	06037	34.58533737	-118.1437927	Los Angeles County
1180	Fee-for-Service	1669203949	1669203949	1	1	GRANT, KENDRA LPCC	10/9/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 6TH ST	108	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
1200	Fee-for-Service	1144730151	1144730151	1	1	GONZALEZ, LAUREN R NP	5/28/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
1239	Fee-for-Service	1598339723	1598339723	1	1	GARCIA, SONIA LMFT	8/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
1274	Fee-for-Service	1427195734	1427195734	1	1	GIBBS, JOSHUA G DO	7/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9958	41	Internal Medicine	0	In state provider	None	9220 HAVEN AVENUE	STE 101	RANCHO CUCAMONGA	CA	91730	8551	36	06071	34.08525	-117.5758875	San Bernardino County
1337	Fee-for-Service	1487071114	1487071114	1	1	GARCIA, BEATRIZ LMFT	12/13/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	113315	-	NOT APPLICABLE	0	In state provider	None	401 W CIVIC CENTER DR	UNIT 100, 500 & 700	SANTA ANA	CA	92701	4515	30	06059	33.75157353	-117.870921	Orange County
1343	Fee-for-Service	1366074676	1366074676	1	1	GARFIELD BEACH CVS LLC	3/9/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	415 S LA BREA AVE	None	LOS ANGELES	CA	90036	3523	19	06037	34.06619253	-118.3440631	Los Angeles County
1393	Fee-for-Service	1588742290	1588742290	1	1	GOGIA, HARJINDER S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33903	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
1407	Fee-for-Service	1598817868	1598817868	1	1	GHARIB, MEHRY N MD	9/21/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53533	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	19	06037	34.08896256	-118.2917211	Los Angeles County
1500	Fee-for-Service	1598706475	1598706475	1	1	GARFIELD BEACH CVS LLC	11/2/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5101 RODEO RD	None	LOS ANGELES	CA	90016	5225	19	06037	34.0210031	-118.3570502	Los Angeles County
1510	Fee-for-Service	1831203652	1831203652	1	1	GACOTE, APOLINAR F	5/19/2008	207R00000X	NA	Other	026	PHYSICIANS	84872	41	Internal Medicine	0	In state provider	None	32270 ALVARADO BLVD	None	UNION CITY	CA	94587	4004	01	06001	37.58837251	-122.0670466	Alameda County
1541	Fee-for-Service	1861465114	1861465114	1	1	GESNER,MATTHEW	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
1546	Fee-for-Service	1588171938	1588171938	1	1	GARFIELD BEACH CVS, LLC	6/15/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7170 DAY CREEK BLVD	None	RANCHO CUCAMONGA	CA	91739	8821	36	06071	34.12332593	-117.5369625	San Bernardino County
1547	Fee-for-Service	1255862710	1255862710	1	1	GADDAM, BHAGYA LAXMI MD	9/2/2020	207R00000X	NA	Other	026	PHYSICIANS	169824	41	Internal Medicine	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
1560	Fee-for-Service	1932182185	1932182185	1	1	GAUTREAU, MARC A MD	4/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147866	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
1589	Fee-for-Service	1619923588	1619923588	1	1	GOLDSTEIN, STEWART N MD	11/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	59839	05	Anesthesiology	0	In state provider	None	43500 RIDGE PARK DR	STE 102	TEMECULA	CA	92590	3691	33	06065	33.49620804	-117.1602133	Riverside County
1607	Fee-for-Service	1538336573	1538336573	1	1	GLUCK, JOSHUA S MD	3/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135683	20	Orthopedic Surgery	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
1611	Fee-for-Service	1255362539	1255362539	1	1	GOTTHEINER, TOBY I MD	1/1/1982	207RN0300X	NA	Nephrology	026	PHYSICIANS	34141	45	Nephrology (Renal-Kidney)	0	In state provider	None	770 WELCH RD	STE 250	PALO ALTO	CA	94304	1513	43	06085	37.43748087	-122.1759625	Santa Clara County
1634	Fee-for-Service	1093393415	1093393415	1	1	GO NORTH HOSPICE CARE INC	9/2/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	SUITE 200A	NORTH HILLS	CA	91343	4353	19	06037	34.232355	-118.467768	Los Angeles County
1646	Fee-for-Service	1023570215	1023570215	1	1	GRACIA, MICHAEL L MD	11/12/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179553	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
1695	Fee-for-Service	1598817868	1598817868	1	1	GHARIB, MEHRY N MD	9/21/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53533	01	General Practice	0	In state provider	None	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	19	06037	34.08896256	-118.2917211	Los Angeles County
1712	Fee-for-Service	1336235092	1336235092	1	1	GOEL, ABHA MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44119	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
1770	Fee-for-Service	1558982967	1558982967	1	1	GASAWAY, EMILY A LCSW	9/26/2024	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
1789	Fee-for-Service	1023237260	1023237260	1	1	GIRGIS, CHERIF E MD	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105162	08	Family Practice	0	In state provider	None	1201 SOUTH ORANGE AVE	None	EL CAJON	CA	92020	7521	37	06073	32.77914448	-116.9639444	San Diego County
1793	Fee-for-Service	1417120783	1417120783	1	2	GARCHA, KHUSHWINDER	9/25/2023	207R00000X	NA	Other	026	PHYSICIANS	121889	None	None	0	In state provider	None	568 N SUNRISE AVE	STE 100	ROSEVILLE	CA	95661	3035	31	06061	38.7576732	-121.2534645	Placer County
1827	Fee-for-Service	1295780674	1295780674	1	1	GILPATRICK, DONNA M 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
1832	Fee-for-Service	1053690743	1053690743	1	2	GARCIA-MONDRAGON, ESBEIDE L	2/2/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27851 BRADLEY RD	STE 102	MENIFEE	CA	92586	2213	33	06065	33.71630969	-117.1904696	Riverside County
1881	Fee-for-Service	1982800199	1982800199	1	1	GHAHRAMANI, EDMOND MD	11/13/2010	261QP2300X	NA	Other	026	PHYSICIANS	98996	08	Family Practice	0	In state provider	None	2121 COLORADO AVE	STE C	TURLOCK	CA	95382	2011	50	06099	37.5117454	-120.8353096	Stanislaus County
1894	Fee-for-Service	1407333222	1407333222	1	1	GREEN TRANSPORTATION INC	8/25/2020	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1180 HORIZON DR STE C	None	FAIRFIELD	CA	94533	1693	48	06095	38.27617642	-122.0090805	Solano County
1895	Fee-for-Service	1609116458	1609116458	1	1	GUTIERREZ, ELVA LMFT	7/14/2020	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
1946	Fee-for-Service	1811199987	1811199987	1	1	GATEWOOD, JUSTIN S MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55864	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
1999	Fee-for-Service	1760014120	1760014120	1	1	GERIHEAL PC	7/6/2020	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3828 DELMAS	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
2055	Fee-for-Service	1285678557	1285678557	1	1	GARFIELD BEACH CVS LLC	6/2/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3670 S NOGALES ST	None	WEST COVINA	CA	91792	2714	19	06037	34.01033531	-117.8867716	Los Angeles County
2074	Fee-for-Service	1982637849	1982637849	1	1	GONZALEZ,OMAR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3330 N 2ND STREET	STE 300	PHOENIX	AZ	85012	0000	00	None	33.486606	-112.071654	Maricopa County
2087	Fee-for-Service	1336745546	1336745546	1	1	GLENWOOD HOME INC	12/7/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	425 S VICTORY BLVD	STE D	BURBANK	CA	91502	2394	19	06037	34.16991731	-118.314141	Los Angeles County
2090	Fee-for-Service	1851336820	1851336820	1	1	GREELY, THOMAS E MD	5/28/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74271	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
2154	Fee-for-Service	1750774923	1750774923	1	1	GHASEMIESFE, AHMADREZA MD	7/12/2020	390200000X	NA	Other	026	PHYSICIANS	166996	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
2175	Fee-for-Service	1982246575	1982246575	1	2	GOLDEN STATE HEART & VASCULA	5/13/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	ENTER, INC.	1850 EL CAMINO REAL	SUITE 200	BURLINGAME	CA	94010	3102	41	06081	37.59600871	-122.384453	San Mateo County
2191	Fee-for-Service	1336287440	1336287440	1	1	GULESSERIAN, DICKRAN H	10/25/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	43475	44	Public Health	0	In state provider	None	5151 N PALM AVE	STE 200	FRESNO	CA	93704	2221	10	06019	36.81119879	-119.808555	Fresno County
2207	Fee-for-Service	1205865383	1205865383	2	1	GALLANT MEDICAL SUPPLY INC	7/24/2013	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	27740 ENCANTO DR	None	SUN CITY	CA	92586	4521	33	06065	33.71834072	-117.1885492	Riverside County
2211	Fee-for-Service	1396827358	1396827358	1	1	GROSS, ROBERT L DO	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7951	41	Internal Medicine	0	In state provider	None	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
2257	Fee-for-Service	1811937600	1811937600	1	1	GHARIB, SAYEDMORTEZA MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	92941	05	Anesthesiology	0	In state provider	None	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
2265	Fee-for-Service	1720295231	1720295231	1	1	GANT, JONATHAN A MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122003	20	Orthopedic Surgery	0	In state provider	None	3 MEDICAL PLAZA DRIVE	None	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
2289	Fee-for-Service	1649707456	1649707456	1	1	GABRIEL TUKIAINEN, ERICA S M	4/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158514	08	Family Practice	0	In state provider	D	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
2303	Fee-for-Service	1154999522	1154999522	1	1	GAITE, MICHAELLA DO	10/31/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22539	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
2306	Fee-for-Service	1538182340	1538182340	1	1	GUSTIN, BARRY E MD	3/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52596	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
2353	Fee-for-Service	1912137423	1912137423	1	1	GILTAJI, VANUI PSYD	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	28626	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
2379	Fee-for-Service	1942228093	1942228093	1	1	GRABER, MATTHEW N MD	1/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	76478	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
2385	Fee-for-Service	1568407450	1568407450	1	1	GARFIELD BEACH CVS LLC	10/26/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8850 VALLEY VIEW STREET	None	BUENA PARK	CA	90620	3562	30	06059	33.833988	-118.0282915	Orange County
2392	Fee-for-Service	1124601398	1124601398	1	1	GRATITUDE HOME HEALTH INC	9/28/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18625 SHERMAN WAY	STE 204B	RESEDA	CA	91335	4184	19	06037	34.20121398	-118.5393529	Los Angeles County
2404	Fee-for-Service	1508899725	1508899725	1	1	GABA, SUNITA MD	9/13/2023	207R00000X	NA	Other	026	PHYSICIANS	185035	None	None	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
2410	Fee-for-Service	1083790513	1083790513	1	1	GHALY, GAMAL F MD	10/30/1989	207R00000X	NA	Other	026	PHYSICIANS	44392	41	Internal Medicine	0	In state provider	None	27350 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.897402	-117.1860255	Riverside County
2416	Fee-for-Service	1659852119	1659852119	1	1	GIMAG HEALTHCARE	4/8/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4049 1ST ST	SUITE 135	LIVERMORE	CA	94551	4986	01	06001	37.6934302	-121.7483657	Alameda County
2434	Fee-for-Service	1861670184	1861670184	1	1	GODBY, SAMANTHA A	7/25/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1240 S WESTLAKE BLVD	STE 113	WESTLAKE VILLAGE	CA	91361	1977	56	06111	34.14966879	-118.8378084	Ventura County
2465	Fee-for-Service	1154314417	1154314417	1	1	GRABER, GAIL R	9/1/1995	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	HEARING SERVICES CENTER	1101 W TOKAY ST	STE 4	LODI	CA	95240	3808	39	06077	38.12636749	-121.2861105	San Joaquin County
2471	Fee-for-Service	1851504690	1851504690	1	1	GOLDEN VALLEY HEALTH CTR	10/1/2002	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1717 LAS VEGAS ST	None	MODESTO	CA	95358	5500	50	06099	37.6052798	-121.0027523	Stanislaus County
2479	Fee-for-Service	1336287440	1336287440	1	1	GULESSERIAN, DICKRAN H	10/25/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	43475	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5151 N PALM AVE	STE 200	FRESNO	CA	93704	2221	10	06019	36.81119879	-119.808555	Fresno County
2499	Fee-for-Service	1396827358	1396827358	1	1	GROSS, ROBERT L DO	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7951	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
2502	Fee-for-Service	1598813446	1598813446	1	1	GONZALEZ, RAFAEL A MD	8/31/1993	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	67868	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
2567	Fee-for-Service	1801952478	1801952478	1	1	GELERMAN, SUSAN S LCSW	3/12/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	6052	-	NOT APPLICABLE	0	In state provider	None	10501 MILLS AVE	None	WHITTIER	CA	90604	2440	19	06037	33.93829436	-118.0378493	Los Angeles County
2594	Fee-for-Service	1538182340	1538182340	1	1	GUSTIN, BARRY E MD	3/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52596	08	Family Practice	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
2656	Fee-for-Service	1881447043	1881447043	1	1	GORMAN LEARNING CHARTER	7/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1826 ORANGE TREE LANE	None	REDLANDS	CA	92374	2821	36	06071	34.06784748	-117.2170215	San Bernardino County
2683	Fee-for-Service	1609051101	1609051101	1	1	GAMINO-BUZO, LUIS F LCSW	12/24/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1501 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31757851	-119.0195685	Kern County
2684	Fee-for-Service	1609385756	1609385756	1	1	GONZALEZ, ABRAHAM I CRNA	2/13/2018	367500000X	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
2704	Fee-for-Service	1659852119	1659852119	1	1	GIMAG HEALTHCARE	4/8/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4049 1ST ST	SUITE 135	LIVERMORE	CA	94551	4986	01	06001	37.6934302	-121.7483657	Alameda County
2728	Fee-for-Service	1740813443	1740813443	1	1	GALVEZ, CAITLIN E PT	4/6/2020	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
2735	Fee-for-Service	1740208586	1740208586	2	1	GUZMAN, DAVID L DPM	8/28/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3379 BEARD RD	None	NAPA	CA	94558	3407	28	06055	38.32334976	-122.295933	Napa County
2761	Fee-for-Service	1780665166	1780665166	1	1	GLATTER, KATHRYN A MD	6/5/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83099	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
2813	Fee-for-Service	1154756955	1154756955	1	1	GUTOVICH, JORDAN M MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132864	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
2831	Fee-for-Service	1528281953	1528281953	1	1	GOLDKORN, AMIR	4/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71867	78	Neoplastic Diseases/Oncology	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
2842	Fee-for-Service	1336235092	1336235092	1	1	GOEL, ABHA MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44119	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
2867	Fee-for-Service	1477017481	1477017481	1	1	GARFIELD BEACH CVS LLC	5/15/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11800 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2202	19	06037	34.04244223	-118.4589758	Los Angeles County
2872	Fee-for-Service	1669528923	1669528923	1	1	GOODMAN, STUART B MD	5/31/1985	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	41841	02	General Surgery	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
2883	Fee-for-Service	1538182340	1538182340	1	1	GUSTIN, BARRY E MD	3/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52596	01	General Practice	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
2940	Fee-for-Service	1699161927	1699161927	1	1	GUPTA, SASHA MD	6/4/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	146441	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
2941	Fee-for-Service	1174555981	1174555981	1	1	GROSS, ANDREW J MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81793	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
2955	Fee-for-Service	1326126939	1326126939	1	1	GJEDSTED, ALAN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45633	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
2962	Fee-for-Service	1245445360	1245445360	1	1	GALURA, JOSEPH P DO	11/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9836	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
3047	Fee-for-Service	1780665166	1780665166	1	1	GLATTER, KATHRYN A MD	6/5/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83099	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
3063	Fee-for-Service	1962434134	1962434134	1	1	GENTIVA CERTIFIED HEALTHCARE	10/22/1997	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CORP	10100 TRINITY PARKWAY	STE 425	STOCKTON	CA	95219	7236	39	06077	38.04685186	-121.3715134	San Joaquin County
3094	Fee-for-Service	1609262047	1609262047	1	1	GEDEON, DAVID N MD	5/5/2020	390200000X	NA	Other	026	PHYSICIANS	147728	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
3119	Fee-for-Service	1528281953	1528281953	1	1	GOLDKORN, AMIR	4/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71867	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
3150	Fee-for-Service	1851406029	1851406029	1	1	GOLDWEBER, ROBERT T MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	39892	None	None	0	In state provider	None	100 CONGRESS ST	None	PASADENA	CA	91105	0000	19	06037	34.13395172	-118.1534955	Los Angeles County
3159	Fee-for-Service	1639775166	1639775166	1	1	GONZALES, PATRICK J NP	4/11/2023	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
3179	Fee-for-Service	1386617421	1386617421	1	1	GANDOTRA, GAURAV MD	4/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158794	36	Psychiatry	0	In state provider	None	5900 BROCKTON AVE	None	RIVERSIDE	CA	92506	1862	33	06065	33.96263615	-117.395639	Riverside County
3183	Fee-for-Service	1639151350	1639151350	2	1	GHANIAN, REZA MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	74550	41	Internal Medicine	0	In state provider	None	824 E CARSON ST	STE 201	CARSON	CA	90745	2262	19	06037	33.83159904	-118.2605506	Los Angeles County
3196	Fee-for-Service	1265650964	1265650964	1	1	GAUTAM, NEETA V MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54881	08	Family Practice	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3200	Fee-for-Service	1467435107	1467435107	1	1	GOWTHAMAN, BHUVANESWA MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88829	41	Internal Medicine	0	In state provider	None	25775 MCBEAN PKWY	None	VALENCIA	CA	91355	3708	19	06037	34.40042013	-118.5511416	Los Angeles County
3207	Fee-for-Service	1659833473	1659833473	1	1	GIPSON, CHELSEA DO	1/24/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21976	None	None	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
3254	Fee-for-Service	1548411218	1548411218	1	1	GEZERSEH, MOHAMMAD	5/14/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	STE 550	IRVINE	CA	92612	2694	30	06059	33.650775	-117.838296	Orange County
3278	Fee-for-Service	1104896174	1104896174	1	1	GABA, MAHENDER	11/8/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	176676	None	None	0	In state provider	None	999 S FAIRMONT AVE	STE 200	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
3281	Fee-for-Service	1356639595	1356639595	1	1	GUPTA, AAMISHA E MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151188	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
3335	Fee-for-Service	1780665166	1780665166	1	1	GLATTER, KATHRYN A MD	6/5/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83099	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
3347	Fee-for-Service	1598341687	1598341687	1	1	GAUBATZ, MATTHEW	9/9/2024	207P00000X	NA	Other	026	PHYSICIANS	183642	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
3352	Fee-for-Service	1750687000	1750687000	1	1	GREWAL, DEVINDER K OD	7/7/2011	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
3355	Fee-for-Service	1437273687	1437273687	1	2	GARCIA, PETER L	1/8/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	112173	36	Psychiatry	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
3357	Fee-for-Service	1811156763	1811156763	1	1	GOREAL, WAMDA MD	2/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118823	22	Pathology (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
3359	Fee-for-Service	1720494768	1720494768	1	1	GILL, VIKRAM S MD	11/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186734	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
3392	Fee-for-Service	1598302655	1598302655	1	1	GOLDEN VALLEY HEALTH CENTERS	8/9/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	2401 E ORANGEBURG AVE	STE 330	MODESTO	CA	95355	3396	50	06099	37.66358653	-120.955122	Stanislaus County
3430	Fee-for-Service	1205049467	1205049467	1	1	GOLDEN VALLEY HEALTH CTR	4/8/1996	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	637 MERCED STREET	None	NEWMAN	CA	95360	9603	50	06099	37.31481158	-121.0162228	Stanislaus County
3434	Fee-for-Service	1215072673	1215072673	1	1	GENAUER, RONALD OD	9/15/1982	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	172 E LAUREL DR	None	SALINAS	CA	93906	2860	27	06053	36.69866366	-121.6489815	Monterey County
3443	Fee-for-Service	1326094897	1326094897	1	1	GARDUNO, CAROLYN M MD	8/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86702	05	Anesthesiology	0	In state provider	None	CLAY & BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
3473	Fee-for-Service	1124079066	1124079066	1	1	GUILLAUMOT, JULIEN PHD	1/10/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	650 E TAHQUITZ CANYON WA	2	PALM SPRINGS	CA	92262	6714	33	06065	33.8232273	-116.5408916	Riverside County
3511	Fee-for-Service	1760676936	1760676936	1	1	GUFFEY, SUSANNE M LCSW	2/2/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29645 RANCHO CALIFORNIA	STE 209	TEMECULA	CA	92591	5285	33	06065	33.50627123	-117.1431728	Riverside County
3514	Fee-for-Service	1114214566	1114214566	1	1	GREENFIELD, ARIELE L MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122857	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
3569	Fee-for-Service	1356639595	1356639595	1	1	GUPTA, AAMISHA E MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151188	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
3610	Fee-for-Service	1427276518	1427276518	1	1	GANDHI, SHRUTI B MD	9/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97543	41	Internal Medicine	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
3626	Fee-for-Service	1326123951	1326123951	1	1	GRIMM, ALEXANDER MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76025	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
3648	Fee-for-Service	1356645386	1356645386	1	1	GUERRE-AGUILAR, BRITT MD	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
3671	Fee-for-Service	1477850675	1477850675	1	1	GONG, ALICE J MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133823	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	SUITE 200	LAFAYETTE	CA	94549	3736	07	06013	37.8898926	-122.1304235	Contra Costa County
3705	Fee-for-Service	1861459877	1861459877	1	1	GERVASIO, CLARISSA T MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	657 TOWN CENTER DR	None	LAS VEGAS	NV	89144	0000	00	None	36.180999	-115.3174815	Clark County
3717	Fee-for-Service	1023223062	1023223062	1	1	GEARHART, JULIA A	5/30/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
3732	Fee-for-Service	1992039317	1992039317	1	1	GILBERTSON, ANNETTE F LCSW	3/14/2011	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1885 THE ALAMEDA	STE 204	SAN JOSE	CA	95126	1747	43	06085	37.34036183	-121.9227298	Santa Clara County
3779	Fee-for-Service	1467550954	1467550954	1	1	GARFIELD BEACH CVS LLC	10/13/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7400 RESEDA BLVD	None	RESEDA	CA	91335	2818	19	06037	34.205175	-118.536022	Los Angeles County
3807	Fee-for-Service	1922042985	1922042985	1	1	GUTIERREZ,CARLOS 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	10301 GATEWAY WEST	None	EL PASO	TX	79925	0000	00	None	31.75604417	-106.3501944	El Paso County
3816	Fee-for-Service	1336868736	1336868736	1	1	GENATO, EDGAR C	9/20/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1430 ESPLANADE	STE 8	CHICO	CA	95926	3366	04	06007	39.74156774	-121.8480966	Butte County
3836	Fee-for-Service	1730592148	1730592148	1	1	GORE, JEANINE	12/8/2019	261QU0200X	NA	Other	026	PHYSICIANS	156169	66	Emergency Medicine (Urgent Care)	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
3839	Fee-for-Service	1013488279	1013488279	1	1	GARDEN OF ANGELS HOSPICE INC	3/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5530 CORBIN AVE	218	TARZANA	CA	91356	6020	19	06037	34.171812	-118.5621935	Los Angeles County
3840	Fee-for-Service	1285295741	1285295741	1	1	GHEZAVATI, ALIREZA MD	7/17/2024	207ZP0102X	NA	Other	026	PHYSICIANS	180795	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
3860	Fee-for-Service	1790772465	1790772465	1	1	GREENFIELD CARE CENTER	10/16/2002	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	OF SOUTH GATE, LLC	8455 STATE ST	None	SOUTH GATE	CA	90280	2339	19	06037	33.95901106	-118.2116136	Los Angeles County
3863	Fee-for-Service	1548540586	1548540586	1	1	GILL, JAPJEET OD	7/5/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
3865	Fee-for-Service	1104060425	1104060425	1	1	GALVAN-TURNER, VALERIE B MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124662	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
3872	Fee-for-Service	1467584276	1467584276	1	1	GIORDANO, ANGELIQUE D LCSW	5/26/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
3891	Fee-for-Service	1760410757	1760410757	1	1	GALLENO, HUMBERTO A MD	9/6/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	38401	20	Orthopedic Surgery	0	In state provider	None	315 N 3RD AVE	STE 302	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
3914	Fee-for-Service	1295002079	1295002079	1	1	GHADERI, NEELUFAR MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116807	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
3924	Fee-for-Service	1982442331	1982442331	1	1	GALLAWAY, MELODY S	10/15/2024	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
3950	Fee-for-Service	1972957686	1972957686	1	1	GIBNEY, JOSHUA M MD	1/1/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	172569	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
3976	Fee-for-Service	1629495833	1629495833	1	1	GODFREY, BRANDON	7/1/2023	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
3982	Fee-for-Service	1255523916	1255523916	1	1	GRIGOR, LAURA M MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101630	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
3987	Fee-for-Service	1568989093	1568989093	1	1	GARFIELD BEACH CVS LLC	1/10/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	443 COLLEGE BLVD	None	OCEANSIDE	CA	92057	5435	37	06073	33.24784562	-117.2923586	San Diego County
3997	Fee-for-Service	1649216706	1649216706	1	1	GARFIELD BEACH CVS LLC	11/23/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16773 BERNARDO CENTER DR	None	RANCHO BERNARDO	CA	92128	2509	37	06073	33.01874412	-117.0752752	San Diego County
4015	Fee-for-Service	1467597138	1467597138	1	1	GROTZ-RHONE, MICHELLE MD	2/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94380	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
4028	Fee-for-Service	1720487572	1720487572	1	1	GARCIA, TABETHA D LMFT	1/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
4034	Fee-for-Service	1407059561	1407059561	1	1	GEETHA MALINI DEVDAS, M.D.	3/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
4035	Fee-for-Service	1710313887	1710313887	1	1	GAURINO, MARVIN M CRNA	11/5/2013	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
4071	Fee-for-Service	1588132138	1588132138	1	1	GARNSEY, SHANNON T LMFT	2/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9829 BLUE LARKSPUR LN	SUITE 2	MONTEREY	CA	93940	6535	27	06053	36.57109892	-121.8021077	Monterey County
4079	Fee-for-Service	1336398627	1336398627	1	1	GERMAN, MICHAEL A MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107047	04	Otology, Laryngology, Rhinology	0	In state provider	None	1095 LOS PALOS DRIVE	None	SALINAS	CA	93901	3916	27	06053	36.65804253	-121.6451894	Monterey County
4091	Fee-for-Service	1841448917	1841448917	1	1	GABRIEL, EPHRAIM M MD	12/24/2019	261QX0100X	NA	Other	026	PHYSICIANS	114323	39	Preventive (M.D. only)	0	In state provider	None	16300 ROSCOE BLVD	STE 1-A	VAN NUYS	CA	91406	1258	19	06037	34.22128033	-118.4884471	Los Angeles County
4113	Fee-for-Service	1710904289	1710904289	1	1	GORAKSHAKAR, POONAM S MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75162	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
4126	Fee-for-Service	1013488279	1013488279	1	1	GARDEN OF ANGELS HOSPICE INC	3/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5530 CORBIN AVE	218	TARZANA	CA	91356	6020	19	06037	34.171812	-118.5621935	Los Angeles County
4151	Fee-for-Service	1538292115	1538292115	1	1	GERNANDT, DEBRA J LMFT	1/8/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30240 HWY 78	None	SANTA YSABEL	CA	92070	0035	37	06073	33.10894332	-116.6750407	San Diego County
4165	Fee-for-Service	1093537789	1093537789	1	1	GRIGORYAN, HRACHYA G NP	3/11/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1701 CESAR E CHAVEZ AVE	SUITE 535	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
4168	Fee-for-Service	1992869440	1992869440	1	1	GUIDOTTI, SYLVANA L MD	8/17/2015	207P00000X	NA	Other	026	PHYSICIANS	55426	66	Emergency Medicine (Urgent Care)	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
4171	Fee-for-Service	1043738339	1043738339	1	1	GONZALES, MARIA SUSANA E	5/27/2019	293D00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	9759 TELFAIR AVE	None	PACOIMA	CA	91331	3438	19	06037	34.2469321	-118.4079934	Los Angeles County
4189	Fee-for-Service	1255042768	1255042768	1	1	GORDON, DANIEL J NP	12/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
4239	Fee-for-Service	1508951328	1508951328	1	1	GADON, SHAND 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	377 N FAIRGROUNDS RD	None	PRICE	UT	84501	4241	00	None	39.606165	-110.8351935	Carbon County
4321	Fee-for-Service	1528047180	1528047180	1	1	GILL, HARJOT K MD	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100495	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
4323	Fee-for-Service	1992925796	1992925796	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PLANADA	9235 E BROADWAY	None	PLANADA	CA	95365	9573	24	06047	37.29049953	-120.3207705	Merced County
4347	Fee-for-Service	1386199644	1386199644	1	1	GUZMAN, MONIQUE E LMFT	8/13/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118742	-	NOT APPLICABLE	0	In state provider	None	710 & 714 N ANAHEIM BLVD	None	ANAHEIM	CA	92805	2652	30	06059	33.84260597	-117.916209	Orange County
4424	Fee-for-Service	1992274807	1992274807	1	1	GU, TIFFANY OT	6/26/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	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
4446	Fee-for-Service	1093790206	1093790206	1	1	GUERREIN, MARSHA A MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	39687	30	Radiology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
4458	Fee-for-Service	1720102155	1720102155	1	1	GORDON, TRACY M LCSW	7/21/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER 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
4460	Fee-for-Service	1508360728	1508360728	1	1	GRAJOWER, DANIEL N MD	10/1/2021	152WP0200X	NA	Other	026	PHYSICIANS	166318	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
4485	Fee-for-Service	1851357867	1851357867	1	1	GOODMAN, GILBERT MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	38358	41	Internal Medicine	0	In state provider	None	1301 MISSION STREET	None	SANTA CRUZ	CA	95060	3530	44	06087	36.96817615	-122.0381947	Santa Cruz County
4505	Fee-for-Service	1083618441	1083618441	1	1	GHC OF LOS GATOS, LLC	9/10/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PLUM TREE CARE CENTER	2580 SAMARITAN DR	None	SAN JOSE	CA	95124	4101	43	06085	37.25295115	-121.9506706	Santa Clara County
4540	Fee-for-Service	1992794424	1992794424	1	1	GARCIA, MICHAEL MD	8/1/1998	174400000X	NA	Other	026	PHYSICIANS	65854	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
4558	Fee-for-Service	1306259668	1306259668	1	1	GUPTA, ANIRUDH MD	3/16/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	171524	13	Neurology (M.D. only)	0	In state provider	None	147 BRENT	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
4567	Fee-for-Service	1407904410	1407904410	1	1	GONZALEZ, YOLANDA G MD	4/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90495	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
4607	Fee-for-Service	1669734604	1669734604	1	2	GUNN PSYCHOLOGICAL SERVICES,	9/24/2023	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC.	2555 E. COLORADO BLVD	101	PASADENA	CA	91107	6617	19	06037	34.14612746	-118.0979505	Los Angeles County
4612	Fee-for-Service	1992925796	1992925796	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PLANADA	9235 E BROADWAY	None	PLANADA	CA	95365	9573	24	06047	37.29049953	-120.3207705	Merced County
4640	Fee-for-Service	1437273687	1437273687	1	1	GARCIA, PETER L MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112173	36	Psychiatry	0	In state provider	None	116 S PALISADE RD	STE 200	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
4645	Fee-for-Service	1740636141	1740636141	1	1	GEFEN, ASHLEY MD	1/26/2023	246ZN0300X	NA	Other	026	PHYSICIANS	176441	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
4646	Fee-for-Service	1053940221	1053940221	1	1	GYORFI, KALEY MD	9/3/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
4657	Fee-for-Service	1932522851	1932522851	1	1	GARCIA, JULIE A MFT	5/3/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	60 EAGLE ROCK WAY	SUITE B	BRENTWOOD	CA	94513	4943	07	06013	37.92416641	-121.7368704	Contra Costa County
4708	Fee-for-Service	1063561488	1063561488	1	1	GORDON, EDWARD S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38423	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
4717	Fee-for-Service	1255119236	1255119236	1	1	GUERRERO, ELIZABETH M	10/20/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	561 N MOUNTAIN AVE	None	UPLAND	CA	91786	5016	36	06071	34.100505	-117.6703307	San Bernardino County
4777	Fee-for-Service	1437724093	1437724093	1	1	GARFIELD BEACH CVS LLC	12/7/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17401 VENTURA BLVD	STE 1	ENCINO	CA	91316	3861	19	06037	34.16126511	-118.5124423	Los Angeles County
4789	Fee-for-Service	1023194537	1023194537	1	1	GO, MATEO MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36988	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
4812	Fee-for-Service	1215260864	1215260864	1	1	GRAFF, LEANNE M LCSW	5/6/2019	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
4828	Fee-for-Service	1881957900	1881957900	1	1	GARFIELD BEACH CVS, LLC	2/21/2013	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91401	4603	19	06037	34.172622	-118.448769	Los Angeles County
4883	Fee-for-Service	1538240866	1538240866	1	1	GOLDEN GATE ENDOSCOPY CENTER	3/7/2017	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	3370 GEARY BLVD	FLOOR 1	SAN FRANCISCO	CA	94118	3324	38	06075	37.7815583	-122.4551943	San Francisco County
4895	Fee-for-Service	1669734604	1669734604	1	2	GUNN PSYCHOLOGICAL SERVICES,	4/11/2019	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC.	2555 E. COLORADO BLVD	101	PASADENA	CA	91107	6617	19	06037	34.14612746	-118.0979505	Los Angeles County
4927	Fee-for-Service	1265596191	1265596191	1	1	GUYN, THOMAS C MD	11/6/2012	207R00000X	NA	Other	026	PHYSICIANS	42640	41	Internal Medicine	0	In state provider	None	1165 MONTOGMERY DRIVE	None	SANTA ROSA	CA	95495	4801	49	06097	38.443806	-122.701374	Sonoma County
4928	Fee-for-Service	1598292450	1598292450	1	1	GUARDIAN MOBILITY, INC.	2/9/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2347 CRESTVIEW DR	None	ATWATER	CA	95301	2617	24	06047	37.35955134	-120.6195723	Merced County
4934	Fee-for-Service	1053940221	1053940221	1	1	GYORFI, KALEY MD	9/3/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
4968	Fee-for-Service	1720006976	1720006976	1	1	GRITSCH, HANS A MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	59082	34	Urology and Urological Surgery	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
4996	Fee-for-Service	1063561488	1063561488	1	1	GORDON, EDWARD S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38423	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
5003	Fee-for-Service	1750416632	1750416632	1	1	GOOD SAMARITAN SHELTER	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	412 B E TUNNELL ST	None	SANTA MARIA	CA	93454	4146	42	06083	34.95749049	-120.4307595	Santa Barbara County
5020	Fee-for-Service	1588206072	1588206072	1	1	GRAYSON, TIARA LCSW	10/28/2024	101YA0400X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
5113	Fee-for-Service	1710145610	1710145610	1	1	GUILLAUME, CLAUDIA LMFT	10/15/2018	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
5124	Fee-for-Service	1023124096	1023124096	1	1	GU, JANE S MD	3/27/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	37925	40	Pediatrics	0	In state provider	None	1850 S AZUSA AVE	STE 205	HACIENDA HEIGHTS	CA	91745	6853	19	06037	33.98895597	-117.9322797	Los Angeles County
5146	Fee-for-Service	1740677715	1740677715	1	1	GAYNON, LISA MD	3/30/2022	208M00000X	NA	Other	026	PHYSICIANS	146949	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
5151	Fee-for-Service	1972525582	1972525582	2	1	GARFIELD BEACH CVS LLC	9/28/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1790 AIRLINE HWY	None	HOLLISTER	CA	95023	5621	35	06069	36.83549636	-121.388504	San Benito County
5177	Fee-for-Service	1922549286	1922549286	1	1	GUO, TIFFANY W MD	3/19/2021	207R00000X	NA	Other	026	PHYSICIANS	157135	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
5183	Fee-for-Service	1669734604	1669734604	1	2	GUNN PSYCHOLOGICAL SERVICES,	4/11/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC.	2555 E. COLORADO BLVD	101	PASADENA	CA	91107	6617	19	06037	34.14612746	-118.0979505	Los Angeles County
5229	Fee-for-Service	1982600946	1982600946	1	1	GERGES, CHAWKI A MD	7/17/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66288	41	Internal Medicine	0	In state provider	None	128 N AKERS ST	STE C	VISALIA	CA	93291	5121	54	06107	36.330552	-119.3477265	Tulare County
5241	Fee-for-Service	1427093327	1427093327	1	1	GARFIELD BEACH CVS, LLC	7/30/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	318 W EL NORTE PKWY	None	ESCONDIDO	CA	92026	1925	37	06073	33.14269478	-117.0953874	San Diego County
5247	Fee-for-Service	1184920944	1184920944	1	1	GUTIERREZ, RODOLFO MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130258	41	Internal Medicine	0	In state provider	None	2001 SANTA MONICA BLVD	SUITE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
5254	Fee-for-Service	1710749916	1710749916	1	1	GREEN PASTURES DOULA LLC	1/24/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
5269	Fee-for-Service	1043348436	1043348436	1	1	GREENBERG, LAWRENCE MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58769	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
5274	Fee-for-Service	1467066621	1467066621	1	1	GLENN, RYAN PT	4/6/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1252 BROADWAY	SUITE B	PLACERVILLE	CA	95667	5806	09	06017	38.73128098	-120.7852781	El Dorado County
5330	Fee-for-Service	1760468839	1760468839	1	1	GREER, JONATHAN R MD	12/1/2003	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	64615	08	Family Practice	0	In state provider	None	799 E RIALTO AVE	None	SAN BERNARDINO	CA	92415	1014	36	06071	34.10142952	-117.2685735	San Bernardino County
5360	Fee-for-Service	1821253170	1821253170	1	1	GARAY, MARIA A LMFT	3/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
5405	Fee-for-Service	1326158767	1326158767	1	1	GILBERTSON, ERIK O MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78193	01	General Practice	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
5411	Fee-for-Service	1730348970	1730348970	1	1	GRUSD, BRANDON L MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91380	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
5438	Fee-for-Service	1871028670	1871028670	1	1	GASKIN, GREGORY MD	6/3/2020	207P00000X	NA	Other	026	PHYSICIANS	166845	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
5468	Fee-for-Service	1639123607	1639123607	1	1	GOOD SAMARITAN HOSP LP	2/1/1999	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3985	43	06085	37.25111017	-121.9465891	Santa Clara County
5471	Fee-for-Service	1669734604	1669734604	1	2	GUNN PSYCHOLOGICAL SERVICES,	8/3/2022	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC.	2555 E. COLORADO BLVD	101	PASADENA	CA	91107	6617	19	06037	34.14612746	-118.0979505	Los Angeles County
5476	Fee-for-Service	1619996048	1619996048	1	1	GREEN, STEVEN M MD	7/28/1992	207P00000X	NA	Other	026	PHYSICIANS	58768	66	Emergency Medicine (Urgent Care)	0	In state provider	EMERGENCY DEPT	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
5482	Fee-for-Service	1972584472	1972584472	1	1	GUZOUJIAN, ROBERT MD	7/3/1997	207R00000X	NA	Other	026	PHYSICIANS	49508	41	Internal Medicine	0	In state provider	None	724 MEDICAL CENTER DR E	STE 106	CLOVIS	CA	93611	6811	10	06019	36.84107334	-119.6587409	Fresno County
5533	Fee-for-Service	1184920944	1184920944	1	1	GUTIERREZ, RODOLFO MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130258	68	Hematology	0	In state provider	None	2001 SANTA MONICA BLVD	SUITE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
5547	Fee-for-Service	1700180742	1700180742	1	2	GONZALEZ ORTIZ, GABRIELA G L	10/17/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	MFT	6203 SAN IGNACIO AVE	SUITE 150	SAN JOSE	CA	95119	1371	43	06085	37.23598537	-121.7783065	Santa Clara County
5552	Fee-for-Service	1053393538	1053393538	1	1	GROVE, ANDERSEN, GHIRINGHELL	11/21/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS THERAPY	127 HOSPITAL DR	STE 101	VALLEJO	CA	94589	2500	48	06095	38.13103371	-122.2387342	Solano County
5581	Fee-for-Service	1053708917	1053708917	1	1	GILDEA, THOMAS MD	8/1/2018	207P00000X	NA	Other	026	PHYSICIANS	145085	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
5583	Fee-for-Service	1497491203	1497491203	1	1	GRACE BRIDGE FAMILY COUNSELI	3/12/2025	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	NG SERVICES, PC	39755 MURRIETA HOT SPRIN	SUITE D160	MURRIETA	CA	92563	9113	33	06065	33.55575954	-117.1627899	Riverside County
5621	Fee-for-Service	1760468839	1760468839	1	1	GREER, JONATHAN R MD	12/1/2003	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	64615	66	Emergency Medicine (Urgent Care)	0	In state provider	None	799 E RIALTO AVE	None	SAN BERNARDINO	CA	92415	1014	36	06071	34.10142952	-117.2685735	San Bernardino County
5627	Fee-for-Service	1144475211	1144475211	1	1	GLUCK, LOUISA LMFT	5/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	621 CHERRY ST	None	SANTA ROSA	CA	95404	4202	49	06097	38.444877	-122.7163005	Sonoma County
5660	Fee-for-Service	1033441639	1033441639	1	1	GREINER, MICHELLE R OT	11/9/2022	174400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4675 VIA LOS SANTOS	None	SANTA BARBARA	CA	93111	1346	42	06083	34.4561269	-119.7851783	Santa Barbara County
5662	Fee-for-Service	1740436237	1740436237	1	2	GOUNDER, SIVARAMAN K MD	9/19/2016	No Taxonomy Provided	NA	None	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
5692	Fee-for-Service	1326158767	1326158767	1	1	GILBERTSON, ERIK O MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78193	07	Dermatology	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
5703	Fee-for-Service	1114942059	1114942059	1	1	GOKLI, ASIT R MD	1/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54214	41	Internal Medicine	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
5715	Fee-for-Service	1649483850	1649483850	1	1	GOELITZ, BRIAN W MD	8/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97686	None	None	0	In state provider	None	355 E GRAND AVE	STE 3	ESCONDIDO	CA	92025	3313	37	06073	33.12354429	-117.0775982	San Diego County
5729	Fee-for-Service	1457396277	1457396277	1	1	GALLACHER, GERGANA B MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76447	07	Dermatology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
5740	Fee-for-Service	1558419341	1558419341	1	1	GROESBECK, GARY D MD	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	52329	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
5747	Fee-for-Service	1407491483	1407491483	1	1	GARCIA, ALEXANDRA LMFT	3/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6276 N 1ST ST	103	FRESNO	CA	93710	5400	10	06019	36.82794977	-119.7721574	Fresno County
5757	Fee-for-Service	1669734604	1669734604	1	2	GUNN PSYCHOLOGICAL SERVICES,	1/26/2024	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC.	2555 E. COLORADO BLVD	101	PASADENA	CA	91107	6617	19	06037	34.14612746	-118.0979505	Los Angeles County
5823	Fee-for-Service	1184920944	1184920944	1	1	GUTIERREZ, RODOLFO MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130258	78	Neoplastic Diseases/Oncology	0	In state provider	None	2001 SANTA MONICA BLVD	SUITE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
5824	Fee-for-Service	1518996669	1518996669	1	1	GRUBER, VALERIE A PHD	10/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	13194	-	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
5847	Fee-for-Service	1598127128	1598127128	1	1	GRZYBOWSKI, BRITTANY L MD	5/21/2020	207P00000X	NA	Other	026	PHYSICIANS	150328	66	Emergency Medicine (Urgent Care)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
5850	Fee-for-Service	1669854923	1669854923	1	1	GIPSMAN, AARON M MD	6/14/2021	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	145730	None	None	0	In state provider	None	959 E WALNUT ST	SUITE 220	PASADENA	CA	91106	5363	19	06037	34.14962102	-118.1305187	Los Angeles County
5852	Fee-for-Service	1023484292	1023484292	1	1	GORDILLO, JENNIFER A LMFT	12/3/2019	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
5869	Fee-for-Service	1497491203	1497491203	1	1	GRACE BRIDGE FAMILY COUNSELI	10/13/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NG SERVICES, PC	39755 MURRIETA HOT SPRIN	SUITE D160	MURRIETA	CA	92563	9113	33	06065	33.55575954	-117.1627899	Riverside County
5882	Fee-for-Service	1790197721	1790197721	1	1	GOMEZ, MIGUEL C MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143066	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
5893	Fee-for-Service	1649767229	1649767229	1	1	GIRGIS, SAMUEL	3/1/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10092 CHAPMAN AVE	SUITE 2 - ROOM C	GARDEN GROVE	CA	92840	2833	30	06059	33.7885755	-117.9566235	Orange County
5926	Fee-for-Service	1528283249	1528283249	1	1	GIDNEY, BRETT A MD	11/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81336	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	575 E HARDY ST	STE 201	INGLEWOOD	CA	90301	4043	19	06037	33.94909392	-118.3477665	Los Angeles County
5959	Fee-for-Service	1639191331	1639191331	2	1	GARFIELD BEACH CVS LLC	5/31/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2499 WHIPPLE RD	None	HAYWARD	CA	94544	7807	01	06001	37.60680446	-122.062645	Alameda County
5974	Fee-for-Service	1649260803	1649260803	1	1	GALICH, RICHARD MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	18435	04	Otology, Laryngology, Rhinology	0	In state provider	None	210 S GRAND AVE	STE 202	GLENDORA	CA	91741	4269	19	06037	34.133859	-117.872523	Los Angeles County
5976	Fee-for-Service	1588632830	1588632830	1	1	GARBER, GABRIEL MD	8/4/2009	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
5987	Fee-for-Service	1043256100	1043256100	1	1	GARFIELD BEACH CVS, LLC	2/4/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1250 E. PACIFIC COAST HW	None	LONG BEACH	CA	90806	5733	19	06037	33.78982954	-118.175184	Los Angeles County
5990	Fee-for-Service	1114942059	1114942059	1	1	GOKLI, ASIT R MD	1/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54214	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
5992	Fee-for-Service	1043224686	1043224686	1	1	GREENFIELD, BRUCE MD	4/30/1987	207RN0300X	NA	Nephrology	026	PHYSICIANS	46615	45	Nephrology (Renal-Kidney)	0	In state provider	None	407 N MAPLE DR	# 236	BEVERLY HILLS	CA	90210	3818	19	06037	34.07561863	-118.3935803	Los Angeles County
6004	Fee-for-Service	1396767786	1396767786	1	1	GONZALEZ, ELIZABETH M MD	9/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94840	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8170 LAGUNA BLVD	STE 303	ELK GROVE	CA	95758	7903	34	06067	38.421054	-121.405365	Sacramento County
6014	Fee-for-Service	1508832387	1508832387	1	2	GOTTLIEB, KLAUS T MD	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146628	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93645	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
6021	Fee-for-Service	1427401652	1427401652	1	1	GABRIEL, OMAR J NP	10/9/2018	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
6028	Fee-for-Service	1558419341	1558419341	1	1	GROESBECK, GARY D MD	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	52329	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
6033	Fee-for-Service	1063027118	1063027118	1	1	GRANADOS DUNCAN, MAURA A NP	8/12/2022	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
6046	Fee-for-Service	1497924930	1497924930	1	1	GENG, ELVIN H MD	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95961	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	BLDG 80, W84	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
6086	Fee-for-Service	1780689877	1780689877	1	1	GONZALES, KARRIE S PT	10/24/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	125 N LINCOLN ST	SUITE J	DIXON	CA	95620	3258	48	06095	38.44614779	-121.8364229	Solano County
6089	Fee-for-Service	1609886316	1609886316	1	1	GABRIELSON, MARY 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	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
6169	Fee-for-Service	1396893343	1396893343	1	1	GHAZI, HAMID MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55429	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
6214	Fee-for-Service	1770080954	1770080954	1	1	GARCHA, MANVEER S MD	5/8/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	166089	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
6239	Fee-for-Service	1265424865	1265424865	1	1	GRAF, JOY MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76244	85	Surgery-Pediatric	0	In state provider	None	5275 F ST	# 3	SACRAMENTO	CA	95819	3225	34	06067	38.57042952	-121.4377223	Sacramento County
6326	Fee-for-Service	1285723379	1285723379	1	1	GEILING, MICHAEL D MD	5/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	6847	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	254 N KESSING ST	None	PORTERVILLE	CA	93257	3424	54	06107	36.07048847	-119.025139	Tulare County
6333	Fee-for-Service	1497924930	1497924930	1	1	GENG, ELVIN H MD	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95961	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	BLDG 80, W84	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
6334	Fee-for-Service	1730387887	1730387887	1	1	GONZALEZ, NESTOR R MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84357	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
6336	Fee-for-Service	1750494696	1750494696	1	1	GRAVATT, ANDREA 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	317 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
6360	Fee-for-Service	1699735910	1699735910	1	1	GINA STORRS NP	5/20/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9145 SPRINGBROOK DR NW	STE 200	COON RAPIDS	MN	55433	5897	00	None	45.13651483	-93.27460473	Anoka County
6382	Fee-for-Service	1689232977	1689232977	1	1	GARTH, MELISSA NP	5/14/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
6413	Fee-for-Service	1679337810	1679337810	1	1	GUMPORT, NICOLE PHD	7/26/2024	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
6423	Fee-for-Service	1275587172	1275587172	1	1	GTMS FITNESS CORPORATION	5/2/2016	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39815 ALTA MURRIETA DR	SUITE C-1	MURRIETA	CA	92563	5405	33	06065	33.5604437	-117.1776992	Riverside County
6428	Fee-for-Service	1396926937	1396926937	1	2	GONG, YIN-JIA MEDICAL	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	CORPORATION	1520 BROOKHOLLOW DR	STE 36	SANTA ANA	CA	92705	5427	30	06059	33.7145683	-117.8475378	Orange County
6431	Fee-for-Service	1669744272	1669744272	1	1	GARCIA, JANICE R	5/1/2024	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
6484	Fee-for-Service	1972554558	1972554558	1	1	GOSHIMA, KAORU 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 CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
6494	Fee-for-Service	1417142779	1417142779	1	1	GIDANIAN, BEHFAR MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94488	41	Internal Medicine	0	In state provider	None	6330 VAN NUYS BLVD	None	VAN NUYS	CA	91401	2610	19	06037	34.18546095	-118.4487065	Los Angeles County
6497	Fee-for-Service	1801094495	1801094495	1	1	GARCIA, CHARLES DO	6/17/2010	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
6576	Fee-for-Service	1770926602	1770926602	1	1	GRANZELLA, NICHOLAS P MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147200	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
6586	Fee-for-Service	1831538123	1831538123	1	1	GILL, KIRAT K MD	7/25/2019	207RC0200X	NA	Other	026	PHYSICIANS	143402	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
6592	Fee-for-Service	1790727873	1790727873	1	1	GROETSEMA, GREGORY A MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71705	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
6595	Fee-for-Service	1114498789	1114498789	1	1	GITTHENS MOSES, LISA M RCP	9/7/2020	207RP1001X	NA	Pulmonology	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
6620	Fee-for-Service	1740968221	1740968221	1	1	GOODWIN, RYAN CRNA	7/27/2023	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
6621	Fee-for-Service	1730387887	1730387887	1	1	GONZALEZ, NESTOR R MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84357	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
6642	Fee-for-Service	1457539231	1457539231	1	1	GOLD, CHRIS K MD	9/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89758	24	Plastic Surgery	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
6661	Fee-for-Service	1639559461	1639559461	1	1	GUEVARA, CLAIRE A MD	6/16/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	168831	None	None	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
6667	Fee-for-Service	1548208283	1548208283	1	1	GENERAL & VASCULAR ASSOC	5/1/2000	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	28	Proctology (colon and rectal)	1	Border provider	None	1500 E 2ND ST	STE 206	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
6673	Fee-for-Service	1902811375	1902811375	1	1	GUO, GRACE L MD	5/1/1999	207R00000X	NA	Other	026	PHYSICIANS	64096	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
6681	Fee-for-Service	1821103631	1821103631	1	1	GORDON, CHARLES A MD	12/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66858	25	Physical Medicine and Rehabilitation	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
6700	Fee-for-Service	1811168917	1811168917	1	1	GOBOVIC, MARA S MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107842	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
6705	Fee-for-Service	1659850394	1659850394	1	1	GURPREET DHALIWAL, M.D., INC	2/28/2020	207L00000X	NA	Other	026	PHYSICIANS	None	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
6706	Fee-for-Service	1093212557	1093212557	1	1	GOMEZ, JENNIFER LMFT	10/16/2023	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
6742	Fee-for-Service	1295876290	1295876290	1	2	GREATER HOME HEALTH	1/20/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INCORPORATED	2400 W CARSON STREET	SUITE 235	TORRANCE	CA	90501	3166	19	06037	33.83131647	-118.3262625	Los Angeles County
6757	Fee-for-Service	1669038634	1669038634	1	1	GALEA, VICTORIA MD	3/29/2022	207P00000X	NA	Other	026	PHYSICIANS	176823	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
6769	Fee-for-Service	1609920008	1609920008	1	1	GOLDBERG, ROBERT Y MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91754	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	26800 CROWN VALLEY PKWY	#205	MISSION VIEJO	CA	92691	6384	30	06059	33.56286021	-117.6673449	Orange County
6770	Fee-for-Service	1831130756	1831130756	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	734 S RANCHO SANTA FE RD	None	SAN MARCOS	CA	92078	3935	37	06073	33.13225162	-117.2078296	San Diego County
6808	Fee-for-Service	1962585828	1962585828	1	1	GEE, BRIAN MING MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64351	41	Internal Medicine	0	In state provider	None	2809 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2727	19	06037	33.89654236	-118.3961215	Los Angeles County
6819	Fee-for-Service	1194803452	1194803452	1	1	GORDON, MICHAEL J MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	46	Hand Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
6824	Fee-for-Service	1942833660	1942833660	1	3	GRACE SPEECH THERAPY CORP	3/9/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	222 MOUNTAIN AVE	109-A	UPLAND	CA	91786	5714	36	06071	34.096401	-117.6700615	San Bernardino County
6841	Fee-for-Service	1053455261	1053455261	1	1	GUTIERREZ, KATHLEEN M	12/31/1991	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	69973	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
6859	Fee-for-Service	1730611435	1730611435	1	1	GLASSMAN, LAURA MD	6/4/2020	207R00000X	NA	Other	026	PHYSICIANS	160325	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
6865	Fee-for-Service	1063754067	1063754067	1	1	GOODSITE, TIFFANY LMFT	1/15/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	110119	-	NOT APPLICABLE	0	In state provider	None	350 VINTON AVE	STE 102	POMONA	CA	91767	3000	19	06037	34.07937061	-117.746663	Los Angeles County
6874	Fee-for-Service	1336786144	1336786144	1	1	GENNETTE, SHANNON M NP	9/9/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
6915	Fee-for-Service	1417290198	1417290198	1	1	GOGIA, NAVDEEP MD	8/7/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	156531	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
6948	Fee-for-Service	1356434427	1356434427	1	1	GHAFFARI, ORCHID E MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69245	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
6950	Fee-for-Service	1831567031	1831567031	2	1	GARCIA, DANIEL CRNA	2/14/2023	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
6953	Fee-for-Service	1548208283	1548208283	1	1	GENERAL & VASCULAR ASSOC	5/1/2000	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	1	Border provider	None	1500 E 2ND ST	STE 206	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
7004	Fee-for-Service	1417951435	1417951435	1	1	GROESCHEL, ANA 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	2828 CHICAGO AVE	STE 320	MINNEAPOLIS	MN	55407	1544	00	None	44.951121	-93.26266952	Hennepin County
7025	Fee-for-Service	1356500268	1356500268	1	1	GALION, ANJALEE W MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101608	79	Neurology-Child	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
7080	Fee-for-Service	1801979117	1801979117	2	1	GARFIELD BEACH CVS LLC	12/22/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2305 THEATRE DR	None	PASO ROBLES	CA	93446	9604	40	06079	35.583885	-120.699018	San Luis Obispo County
7091	Fee-for-Service	1225479736	1225479736	1	1	GOMEZ, MARLENE G LMFT	3/8/2019	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
7105	Fee-for-Service	1194803452	1194803452	1	1	GORDON, MICHAEL J MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	24	Plastic Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
7130	Fee-for-Service	1902828791	1902828791	2	1	GARFIELD BEACH CVS LLC	4/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4200 E MAIN ST	None	VENTURA	CA	93003	5230	56	06111	34.26286088	-119.2364332	Ventura County
7131	Fee-for-Service	1912248477	1912248477	1	1	GRAY, KELLY MD	1/10/2024	207P00000X	NA	Other	026	PHYSICIANS	143306	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
7164	Fee-for-Service	1811077969	1811077969	1	1	GUPTA, SUDHIR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39046	47	Miscellaneous	0	In state provider	BLDG. 53	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
7227	Fee-for-Service	1215163183	1215163183	1	1	GUPTA, SACHIN MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111461	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
7237	Fee-for-Service	1457318602	1457318602	1	1	GIASI, PAUL C MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55913	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 BUTTE STREET	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
7242	Fee-for-Service	1548208283	1548208283	1	1	GENERAL & VASCULAR ASSOC	5/1/2000	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	1	Border provider	None	1500 E 2ND ST	STE 206	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
7277	Fee-for-Service	1285961789	1285961789	1	1	GANDHI, DAYAN K MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114933	41	Internal Medicine	0	In state provider	None	18433 ROSCOE BLVD	SUITE 202	NORTHRIDGE	CA	91325	4134	19	06037	34.22076747	-118.534725	Los Angeles County
7315	Fee-for-Service	1710101555	1710101555	1	1	GARDNER, MICHAEL J MD	1/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139207	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
7328	Fee-for-Service	1811407604	1811407604	1	1	GO FOR HELP HOSPICE INC	7/1/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5352 LAUREL CANYON BLVD	SUITE 201	VALLEY VILLAGE	CA	91607	4937	19	06037	34.168176	-118.3964725	Los Angeles County
7351	Fee-for-Service	1275606758	1275606758	1	1	GOKEL, SUZANNE S DO	9/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7072	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
7366	Fee-for-Service	1124284716	1124284716	1	1	GARG, PARVEEN K MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125031	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
7388	Fee-for-Service	1396195475	1396195475	1	1	GUAN, SHENGSHENG DPM	3/29/2021	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
7486	Fee-for-Service	1750500237	1750500237	1	1	GRANITE WELLNESS CENTERS	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	180 SIERRA COLLEGE DRIVE	None	GRASS VALLEY	CA	95945	5768	29	06057	39.23235449	-121.0475561	Nevada County
7548	Fee-for-Service	1750608485	1750608485	1	1	GIN, JANE L MD	4/1/2019	208600000X	NA	General Surgery	026	PHYSICIANS	143322	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
7553	Fee-for-Service	1841788106	1841788106	1	1	GALLEGOS, DANIEL A	7/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174231	None	None	0	In state provider	None	1328 NATIVIDAD ROAD	None	SALINAS	CA	93906	3101	27	06053	36.69930093	-121.6350349	Monterey County
7566	Fee-for-Service	1285961789	1285961789	1	1	GANDHI, DAYAN K MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114933	45	Nephrology (Renal-Kidney)	0	In state provider	None	18433 ROSCOE BLVD	SUITE 202	NORTHRIDGE	CA	91325	4134	19	06037	34.22076747	-118.534725	Los Angeles County
7583	Fee-for-Service	1093473795	1093473795	1	1	GUERRERO, YANELLI PT	12/28/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	921 G ST	None	REEDLEY	CA	93654	2626	10	06019	36.59818369	-119.4528264	Fresno County
7616	Fee-for-Service	1811407604	1811407604	1	1	GO FOR HELP HOSPICE INC	7/1/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5352 LAUREL CANYON BLVD	SUITE 201	VALLEY VILLAGE	CA	91607	4937	19	06037	34.168176	-118.3964725	Los Angeles County
7636	Fee-for-Service	1184603110	1184603110	1	1	GLUCK, GARY S MD	5/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	74124	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST FOURTH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
7654	Fee-for-Service	1124284716	1124284716	1	1	GARG, PARVEEN K MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125031	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
7718	Fee-for-Service	1376770594	1376770594	1	1	GALLAGER, SARAH N MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114165	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
7754	Fee-for-Service	1932896719	1932896719	1	1	GONZALEZ, STEVIE	1/20/2024	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	19	06037	0	0	None
7770	Fee-for-Service	1801906995	1801906995	1	1	GUETZKOW, JAMES S	12/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	35753	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4799	12	06023	40.78355148	-124.1420294	Humboldt County
7805	Fee-for-Service	1962136002	1962136002	1	1	GUO, CRYSTAL OD	12/8/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
7807	Fee-for-Service	1669080107	1669080107	1	1	GANCHIS DIALYSIS, LLC	5/20/2022	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4270 ROSEWOOD DR	SUITE E	PLEASANTON	CA	94588	3065	01	06001	37.69880121	-121.8758716	Alameda County
7815	Fee-for-Service	1417146002	1417146002	1	1	GONELLA, MARIE C MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100806	13	Neurology (M.D. only)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
7821	Fee-for-Service	1841823317	1841823317	1	1	GOD'S WAY HOSPICE, INC	1/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR STREET	STE 176	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
7885	Fee-for-Service	1932534039	1932534039	1	1	GIBSON, KELLY M CRNA	11/25/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
7892	Fee-for-Service	1366862807	1366862807	1	1	GOODSON, WILLIAM H MD	10/25/2019	390200000X	NA	Other	026	PHYSICIANS	143417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
7931	Fee-for-Service	1891056388	1891056388	1	1	GRAHAM, ROSHEL K E MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126823	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
8020	Fee-for-Service	1841731544	1841731544	1	1	GARRIDO, DAWN LMFT	11/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
8034	Fee-for-Service	1891704177	1891704177	1	1	GOODMAN, ERIC T MD	12/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77239	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
8043	Fee-for-Service	1063684561	1063684561	1	1	GAMBOA, EDGAR A MD MEDICAL	12/23/2014	193400000X	NA	Other	026	PHYSICIANS	41857	02	General Surgery	0	In state provider	CORP	65 NEILSON ST	SUITE 101	WATSONVILLE	CA	95076	2491	44	06087	36.92823955	-121.792905	Santa Cruz County
8060	Fee-for-Service	1336291566	1336291566	1	1	GULLAPALLI, MARK P MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97462	41	Internal Medicine	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
8084	Fee-for-Service	1134899859	1134899859	1	1	GABONE HOME HEALTH	1/31/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15206 VENTURA BLVD	STE 206	SHERMAN OAKS	CA	91403	3360	19	06037	34.15345738	-118.4641805	Los Angeles County
8107	Fee-for-Service	1841823317	1841823317	1	1	GOD'S WAY HOSPICE, INC	1/28/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR STREET	STE 176	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
8139	Fee-for-Service	1346621687	1346621687	1	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10861 WEYBURN AVE	None	LOS ANGELES	CA	90024	2957	19	06037	34.06257705	-118.4440955	Los Angeles County
8154	Fee-for-Service	1003851007	1003851007	1	1	GARFIELD BEACH CVS, LLC	2/26/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2655 SANTA ANA ST.	None	SOUTH GATE	CA	90280	2025	19	06037	33.96458675	-118.2232466	Los Angeles County
8168	Fee-for-Service	1104895580	1104895580	1	1	GANESAN, ANAND K MD	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85533	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
8171	Fee-for-Service	1386006021	1386006021	1	1	GRUNSEICH, KARL MD	9/15/2022	2085B0100X	NA	MRI Provider	026	PHYSICIANS	152500	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
8197	Fee-for-Service	1447574470	1447574470	1	1	GARY, CELESTE C MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136618	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
8259	Fee-for-Service	1811563281	1811563281	1	1	GONZALEZ, SAMANTHA A PHD	2/23/2024	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
8284	Fee-for-Service	1972987519	1972987519	1	1	GARCIA-BALL, MARIA R NP	2/4/2019	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
8304	Fee-for-Service	1124050307	1124050307	1	1	GRABOW, RYAN JOSEPH MD	12/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2650 N TENAYA WAY	STE 301	LAS VEGAS	NV	89128	1112	00	None	36.20804839	-115.2501292	Clark County
8320	Fee-for-Service	1891761607	1891761607	1	1	GUTIERREZ, GRISELDA C MD	2/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75163	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
8325	Fee-for-Service	1215949714	1215949714	1	1	GRAY, VIOLETTE G MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80249	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
8330	Fee-for-Service	1508802661	1508802661	1	1	GARFIELD BEACH CVS, LLC	11/30/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4400 E LOS COYOTES DIAGO	None	LONG BEACH	CA	90815	2819	19	06037	33.79043919	-118.1414737	Los Angeles County
8342	Fee-for-Service	1336233709	1336233709	1	1	GLEN, BARRIE PHD	5/10/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1303 JEFFERSON STREET	SUITE 600A	NAPA	CA	94559	2473	28	06055	38.30015229	-122.2932731	Napa County
8350	Fee-for-Service	1770660300	1770660300	1	1	GEDDAM, MAMATHA MD	5/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	114050	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
8367	Fee-for-Service	1639338452	1639338452	1	1	GARFIELD BEACH CVS, LLC	9/19/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	109 SO. WEST ST.	None	TULARE	CA	93274	3409	54	06107	36.20560514	-119.3668717	Tulare County
8379	Fee-for-Service	1932873726	1932873726	1	1	GUZON, WILFREDO RYAN M	8/6/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
8399	Fee-for-Service	1043362544	1043362544	1	1	GUTIN, MARC S MD INC	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48699	41	Internal Medicine	0	In state provider	None	210 S GRAND AVE	STE 224	GLENDORA	CA	91741	4205	19	06037	34.133859	-117.872523	Los Angeles County
8433	Fee-for-Service	1972131456	1972131456	1	1	GARCIA ECHEVERRIA, LAURA LM	4/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	71687 HIGHWAY 111	SUITE 205	RANCHO MIRAGE	CA	92270	4515	33	06065	33.74279697	-116.4137932	Riverside County
8438	Fee-for-Service	1326044181	1326044181	1	1	GINSBERG, LAWRENCE W MD	4/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36272	41	Internal Medicine	0	In state provider	None	835 SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21351337	-119.0961199	Tulare County
8460	Fee-for-Service	1851311849	1851311849	1	1	GORLICK, NEAL L MD	12/1/1997	2086S0105X	NA	General Surgery	026	PHYSICIANS	84029	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
8472	Fee-for-Service	1487117214	1487117214	1	1	GANNON, NICHOLAS P MD	7/29/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
8514	Fee-for-Service	1902238363	1902238363	1	1	GIRGIS, JENNIFER M CRNA	12/24/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
8542	Fee-for-Service	1952328494	1952328494	1	1	GRIGSBY, ERIC J MD	12/27/1988	174400000X	NA	Other	026	PHYSICIANS	64848	01	General Practice	0	In state provider	None	3443 VILLA LN	STE 5	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
8564	Fee-for-Service	1104186964	1104186964	1	1	GHARIBJANYAN, HRIPSIME MD	10/16/2014	207R00000X	NA	Other	026	PHYSICIANS	118597	41	Internal Medicine	0	In state provider	None	1045 ATLANTIC AVE	SUITE 708	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
8607	Fee-for-Service	1225346141	1225346141	1	2	GREENE, DARCY R LMFT	1/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	31352 WHISPERING MEADOW	234	SHINGLETOWN	CA	96088	9313	45	06089	40.49431828	-121.8853348	Shasta County
8628	Fee-for-Service	1821225012	1821225012	1	1	GLEGHORN, JANIE K MD	3/2/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89082	None	None	0	In state provider	None	65 NIELSON STREET	SUITE 125	WATSONVILLE	CA	95076	2491	44	06087	36.9282117	-121.7933197	Santa Cruz County
8641	Fee-for-Service	1437346822	1437346822	1	1	GREWAL, PREETPAL DO	9/8/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	2	Out of state provider	None	7930 FLOYD CURL DR	None	SAN ANTONIO	TX	78229	3925	00	None	29.51157346	-98.57548112	Bexar County
8676	Fee-for-Service	1295771301	1295771301	1	1	GANZ, PETER MD	7/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88194	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 5G1	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
8689	Fee-for-Service	1043362544	1043362544	1	1	GUTIN, MARC S MD INC	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48699	67	Endocrinology	0	In state provider	None	210 S GRAND AVE	STE 224	GLENDORA	CA	91741	4205	19	06037	34.133859	-117.872523	Los Angeles County
8703	Fee-for-Service	1205099777	1205099777	1	1	GUYER, AUTUMN C MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	102271	03	Allergy	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
8738	Fee-for-Service	1942224811	1942224811	1	2	GOLDEN, DONALD E MD	12/1/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	72192	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST STREET	None	OAKLAND	CA	94602	1010	01	06001	37.79926205	-122.2314248	Alameda County
8744	Fee-for-Service	1114153822	1114153822	1	1	GHANIMATI, SHAHED MD	1/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111873	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
8746	Fee-for-Service	1851311849	1851311849	1	1	GORLICK, NEAL L MD	12/1/1997	2086S0105X	NA	General Surgery	026	PHYSICIANS	84029	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
8806	Fee-for-Service	1881279925	1881279925	1	1	GORHAM, TIFFANY LMFT	4/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2108 N ST	9513	SACRAMENTO	CA	95816	5712	34	06067	38.571579	-121.480182	Sacramento County
8814	Fee-for-Service	1467163386	1467163386	1	1	GUARDIAN FLIGHT LLC	6/19/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	175 E RENO AVE	STE C5	LAS VEGAS	NV	89119	1102	00	None	36.09719326	-115.1658092	Clark County
8833	Fee-for-Service	1952328494	1952328494	1	1	GRIGSBY, ERIC J MD	12/27/1988	174400000X	NA	Other	026	PHYSICIANS	64848	05	Anesthesiology	0	In state provider	None	3443 VILLA LN	STE 5	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
8856	Fee-for-Service	1245798859	1245798859	1	1	GIOLZETTI, CHARLES L	4/21/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
8858	Fee-for-Service	1356345706	1356345706	1	1	GHC OF LA MESA LLC	10/1/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7800 PARKWAY DR	None	LA MESA	CA	91942	2001	37	06073	32.77438522	-117.0281637	San Diego County
8871	Fee-for-Service	1720166531	1720166531	1	1	GARZARO, PIERO MD	12/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	67808	77	Infectious Disease	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
8881	Fee-for-Service	1194829184	1194829184	1	1	GUNN, GORDON C MD	2/8/2015	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	27175	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	150 LAGUNA RD	None	FULLERTON	CA	92835	3614	30	06059	33.89367364	-117.9302191	Orange County
8905	Fee-for-Service	1619279239	1619279239	1	1	GRAZIER, MICHAEL R MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115788	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
8915	Fee-for-Service	1114975208	1114975208	1	1	GIOIA, FRANK R MD	6/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER DR	5TH FLOOR	LAS VEGAS	NV	89144	0518	00	None	36.180999	-115.3174815	Clark County
8919	Fee-for-Service	1801952957	1801952957	1	1	GEE, MICHAEL OD	9/11/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
8936	Fee-for-Service	1447257100	1447257100	1	1	GILLI, WILLIAM E MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	53033	01	General Practice	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
9008	Fee-for-Service	1982329892	1982329892	1	1	GATEWAY MEDICAL TRANSPORTATI	3/17/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON LLC	1276 DENNERY RD	306	SAN DIEGO	CA	92154	6447	37	06073	32.57341556	-117.0360454	San Diego County
9022	Fee-for-Service	1114583259	1114583259	1	1	GUPTA, KASHIKA MD	5/30/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182577	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
9024	Fee-for-Service	1861932972	1861932972	1	1	GOODNOW, LINDSEY D LAC	6/13/2017	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2365 HARRISON AVE	None	EUREKA	CA	95501	3216	12	06023	40.78593084	-124.139602	Humboldt County
9043	Fee-for-Service	1770996902	1770996902	1	1	GUTHRIE, JOHN M MD	7/1/2017	207P00000X	NA	Other	026	PHYSICIANS	134473	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
9054	Fee-for-Service	1114960010	1114960010	1	1	GARCIA, CHARLOTTE A CRNA	8/1/2002	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
9055	Fee-for-Service	1881710010	1881710010	1	1	GRAUERHOLZ, KATHRYN R NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	44105 15TH ST W	UNITS 401 3/5/7	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
9113	Fee-for-Service	1780835066	1780835066	1	1	GONZALEZ, KARLA M LMFT	3/1/2019	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
9161	Fee-for-Service	1528077518	1528077518	1	1	GLADDEN, JENNIFER L MD	12/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60792	66	Emergency Medicine (Urgent Care)	0	In state provider	None	560 HOSPITAL LN	None	SUSANVILLE	CA	96130	4809	18	06035	40.40754008	-120.6666326	Lassen County
9167	Fee-for-Service	1053766766	1053766766	1	1	GALASSO, MADISON M MD	10/10/2019	207P00000X	NA	Other	026	PHYSICIANS	160982	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
9225	Fee-for-Service	1447257100	1447257100	1	1	GILLI, WILLIAM E MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	53033	41	Internal Medicine	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
9254	Fee-for-Service	1982159968	1982159968	1	1	GENDE, DEANNA AU	8/28/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2577 SAMARITAN DR	STE 845	SAN JOSE	CA	95124	4110	43	06085	37.25246494	-121.9501879	Santa Clara County
9274	Fee-for-Service	1053699462	1053699462	1	1	GLOBAL HOSPICE CARE INC	3/2/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3510 TORRANCE BLVD	STE 215	TORRANCE	CA	90503	4824	19	06037	33.83756756	-118.3469036	Los Angeles County
9276	Fee-for-Service	1558489955	1558489955	1	1	GAUSE, DONNA H OT	10/18/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
9309	Fee-for-Service	1629401294	1629401294	1	1	GULKAR, INNA MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130435	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
9314	Fee-for-Service	1376511303	1376511303	1	1	GRUEN, ARTHUR L MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	63375	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
9360	Fee-for-Service	1073785408	1073785408	1	1	GEORGIA RUSELL	2/21/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	450 WILLIAMS WAY	None	MOAB	UT	84532	2185	00	None	38.57434043	-109.5593762	Grand County
9369	Fee-for-Service	1609984137	1609984137	1	1	GREANEY, GREGORY C MD	8/24/2004	208C00000X	NA	General Surgery	026	PHYSICIANS	47697	02	General Surgery	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
9387	Fee-for-Service	1043741879	1043741879	1	1	GUSTAFSON, LAUREN E MD	8/1/2020	207P00000X	NA	Other	026	PHYSICIANS	169368	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
9404	Fee-for-Service	1073872214	1073872214	1	1	GREEN, GILLIAN PHD	6/4/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9437	Fee-for-Service	1558581041	1558581041	1	1	GOOD HEALTH ADULT DAY	12/11/2002	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE CENTER	988 N HILL ST	STE 111	LOS ANGELES	CA	90012	1751	19	06037	34.06662691	-118.2375926	Los Angeles County
9448	Fee-for-Service	1528077518	1528077518	1	1	GLADDEN, JENNIFER L MD	12/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60792	08	Family Practice	0	In state provider	None	560 HOSPITAL LN	None	SUSANVILLE	CA	96130	4809	18	06035	40.40754008	-120.6666326	Lassen County
9452	Fee-for-Service	1427232982	1427232982	1	1	GREIDER, PHILIP A MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	44489	05	Anesthesiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
9505	Fee-for-Service	1790816189	1790816189	1	1	GAILIS, GLENN G MD	5/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	1905 MAIN STREET	None	KLAMATH FALLS	OR	97601	2638	00	None	42.22838442	-121.7691707	Klamath County
9515	Fee-for-Service	1235621087	1235621087	1	1	GEORGIA LABORATORY MANAGEMEN	11/15/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	3885 CRESTWOOD PKWY NW	SUITE 550	DULUTH	GA	30096	7169	00	None	33.9433756	-84.13179952	Gwinnett County
9517	Fee-for-Service	1366605875	1366605875	1	1	GORDON, NOAH E MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90247	05	Anesthesiology	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.79071145	-122.4308506	San Francisco County
9519	Fee-for-Service	1417020967	1417020967	1	1	GOLDING, COREY E MD	6/14/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	133661	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
9546	Fee-for-Service	1942600119	1942600119	1	1	GILLERAN, ELI M MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150626	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
9561	Fee-for-Service	1013951375	1013951375	1	1	GARFIELD BEACH CVS, LLC	2/19/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 PALM AVE	None	IMPERIAL BEACH	CA	91932	1529	37	06073	32.58411975	-117.1157018	San Diego County
9562	Fee-for-Service	1053699462	1053699462	1	1	GLOBAL 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	3510 TORRANCE BLVD	STE 215	TORRANCE	CA	90503	4824	19	06037	33.83756756	-118.3469036	Los Angeles County
9563	Fee-for-Service	1568403483	1568403483	1	1	GARFIELD BEACH CVS LLC	10/26/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4625 TORRANCE BLVD	None	TORRANCE	CA	90503	4305	19	06037	33.83760153	-118.363221	Los Angeles County
9577	Fee-for-Service	1003047408	1003047408	1	1	GORDON, DAVID M MD	6/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108335	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
9584	Fee-for-Service	1609892611	1609892611	1	1	GUIDO, DONALD J OD INC	12/26/2007	261Q00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2248 D ST	None	LA VERNE	CA	91750	5403	19	06037	34.10030594	-117.7702602	Los Angeles County
9598	Fee-for-Service	1306229430	1306229430	1	1	GRIFFITTS, JAMES H AU	7/17/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
9609	Fee-for-Service	1346773934	1346773934	1	1	GHIASSI, MARYAM MD	5/12/2023	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	184813	None	None	0	In state provider	None	3 PARKCENTER DR	STE 100	SACRAMENTO	CA	95825	8340	34	06067	38.572632	-121.4154135	Sacramento County
9610	Fee-for-Service	1053417691	1053417691	1	1	GHAFARI, DAUOD DO	10/6/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	98486	None	None	0	In state provider	None	5575 RUFFIN RD	STE 100	SAN DIEGO	CA	92123	1380	37	06073	32.83605627	-117.1266464	San Diego County
9634	Fee-for-Service	1184875999	1184875999	1	1	GOMEZ, JOSE M MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120877	02	General Surgery	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
9646	Fee-for-Service	1043615180	1043615180	1	2	GALLIVAN, WILLIAM R JR MD	8/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73901	20	Orthopedic Surgery	0	In state provider	None	2040 VIBORG ROAD	SUITE 230	SOLVANG	CA	93463	2272	42	06083	34.6024706	-120.1275138	Santa Barbara County
9678	Fee-for-Service	1821381153	1821381153	1	1	GAO, LIN LIN MD	2/3/2020	2086S0122X	NA	General Surgery	026	PHYSICIANS	150084	24	Plastic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
9699	Fee-for-Service	1205868577	1205868577	1	1	GUEVARA, CALEB M	2/21/2018	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
9718	Fee-for-Service	1083854582	1083854582	1	1	GUPTA, ANKUR MD	7/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104116	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
9728	Fee-for-Service	1700036316	1700036316	1	1	GRAHAM, JOSHUA D LCSW	7/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
9744	Fee-for-Service	1518254002	1518254002	1	1	GRIFFITH, ANNA M OD	1/18/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2565 CEANOTHUS AVE	STE 155	CHICO	CA	95973	7615	04	06007	39.76285262	-121.8199996	Butte County
9844	Fee-for-Service	1194705558	1194705558	1	1	GRAHAM, JAMES W MD	5/4/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54111	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
9904	Fee-for-Service	1043423205	1043423205	1	1	GOLDEN VALLEY HEALTH CTR	3/1/1997	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	GUSTINE-NEWMAN	637 MERCED ST	None	NEWMAN	CA	95360	9603	50	06099	37.31481158	-121.0162228	Stanislaus County
9909	Fee-for-Service	1184105603	1184105603	1	1	GUARDIAN FLIGHT LLC	10/30/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	655 S ROCK BLVD	None	RENO	NV	89502	4118	00	None	39.50240767	-119.7628465	Washoe County
9955	Fee-for-Service	1679013726	1679013726	1	2	GOLDEN VALLEY HEALTH CENTERS	5/23/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	302 NORTHGATE DRIVE	None	MANTECA	CA	95336	3139	39	06077	37.81902087	-121.2206405	San Joaquin County
9967	Fee-for-Service	1851397079	1851397079	1	1	GILBERT K JONES M. D.	10/24/2016	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
9970	Fee-for-Service	1114913282	1114913282	1	1	GALLARDO, DAVID MD	4/3/2006	2085R0001X	NA	Other	026	PHYSICIANS	77558	78	Neoplastic Diseases/Oncology	0	In state provider	None	1150 LELAND AVE	None	TULARE	CA	93274	7811	54	06107	36.22951388	-119.3294352	Tulare County
9972	Fee-for-Service	1467802082	1467802082	1	1	GROSSMAN, DYLLEN DO	1/14/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
9977	Fee-for-Service	1548930415	1548930415	1	1	GOLDEN CARE PHARMACY INC	1/18/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4128 1/2 S BROADWAY	None	LOS ANGELES	CA	90037	2221	19	06037	34.0085673	-118.2782999	Los Angeles County
9999	Fee-for-Service	1295037588	1295037588	1	1	GARCIA, ABEL G CRNA	3/22/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
10022	Fee-for-Service	1134390370	1134390370	1	1	GONZALES, MELINDA K CRNA	4/11/2008	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
10050	Fee-for-Service	1568810984	1568810984	1	1	GOUGOL, AMIR HOSSEIN MD	8/15/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	177795	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
10058	Fee-for-Service	1609176015	1609176015	1	1	GARCIA, SYLVIA L MD INC	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70849	08	Family Practice	0	In state provider	None	14442 WHITTIER BLVD	STE 105	WHITTIER	CA	90605	2162	19	06037	33.95385901	-118.0164461	Los Angeles County
10073	Fee-for-Service	1881677342	1881677342	1	1	GARDINER, BARBARA L LMFT	11/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12842 VALLEY VIEW STREET	SUITE 106	GARDEN GROVE	CA	92845	2540	30	06059	33.77717962	-118.0346285	Orange County
10100	Fee-for-Service	1780942235	1780942235	1	1	GHC HOSPICE INC	3/29/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	906 W 9TH ST	None	UPLAND	CA	91786	0000	36	06071	34.09600955	-117.663282	San Bernardino County
10109	Fee-for-Service	1831341486	1831341486	1	1	GULLE, APOLLO LESTER A MD	9/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110637	41	Internal Medicine	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
10117	Fee-for-Service	1821583550	1821583550	1	1	GUZMAN, JOSEPH R MD	8/16/2022	207L00000X	NA	Other	026	PHYSICIANS	165131	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
10133	Fee-for-Service	1477562718	1477562718	1	1	GORBATY, ISAAC MD	3/1/2011	174400000X	NA	Other	026	PHYSICIANS	33719	45	Nephrology (Renal-Kidney)	0	In state provider	None	18411 CLARK ST	#206	TARZANA	CA	91356	3537	19	06037	34.16981538	-118.5337442	Los Angeles County
10192	Fee-for-Service	1164440848	1164440848	1	1	GASH-KIM, TAMI L MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63751	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
10233	Fee-for-Service	1679013726	1679013726	1	2	GOLDEN VALLEY HEALTH CENTERS	5/23/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	302 NORTHGATE DRIVE	None	MANTECA	CA	95336	3139	39	06077	37.81902087	-121.2206405	San Joaquin County
10238	Fee-for-Service	1306927744	1306927744	1	1	GOHARI, ALI R MD	8/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112644	18	Ophthalmology	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
10252	Fee-for-Service	1497722755	1497722755	1	1	GROSSMAN, TANYA PT	5/23/2022	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
10255	Fee-for-Service	1114913282	1114913282	1	1	GALLARDO, DAVID MD	4/3/2006	2085R0001X	NA	Other	026	PHYSICIANS	77558	30	Radiology	0	In state provider	None	1150 LELAND AVE	None	TULARE	CA	93274	7811	54	06107	36.22951388	-119.3294352	Tulare County
10278	Fee-for-Service	1922267111	1922267111	1	1	GOMEZ, JORGE A LMFT	9/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15455 SAN FERNANDO MISSO	#300	MISSION HILLS	CA	91345	1353	19	06037	34.27194157	-118.469079	Los Angeles County
10296	Fee-for-Service	1285649962	1285649962	1	1	GALLEGO, CLAUDIO	7/25/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	60873	41	Internal Medicine	0	In state provider	None	1135 S SUNSET AVE	STE 406	WEST COVINA	CA	91790	3965	19	06037	34.06215064	-117.9453997	Los Angeles County
10329	Fee-for-Service	1154366052	1154366052	1	1	GARFIELD BEACH CVS LLC	9/22/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2011 E LA PALMA	None	ANAHEIM	CA	92806	2744	30	06059	33.84729834	-117.8880764	Orange County
10353	Fee-for-Service	1639429178	1639429178	1	1	GHASRI, PEDRAM MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123796	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
10365	Fee-for-Service	1932287752	1932287752	1	1	GOLDENBERG, RUTH P MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61749	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
10387	Fee-for-Service	1780942235	1780942235	1	1	GHC HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	906 W 9TH ST	None	UPLAND	CA	91786	0000	36	06071	34.09600955	-117.663282	San Bernardino County
10396	Fee-for-Service	1598874612	1598874612	1	1	GANESAN, SRIPRIYA MD	3/30/2022	208M00000X	NA	Other	026	PHYSICIANS	98126	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
10398	Fee-for-Service	1295093250	1295093250	1	1	GURNEY, ONAONA U MD	3/25/2021	2086S0102X	NA	General Surgery	026	PHYSICIANS	169189	None	None	0	In state provider	None	1798 GAREY	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
10477	Fee-for-Service	1518988062	1518988062	1	1	GUERRA, ROBERT M MD	10/25/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	65335	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
10499	Fee-for-Service	1396290193	1396290193	1	1	GUTIERREZ, LAURIE P	6/26/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
10501	Fee-for-Service	1346635125	1346635125	1	1	GUERRERO, EVAN M MD	10/1/2021	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	173015	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
10524	Fee-for-Service	1679013726	1679013726	1	2	GOLDEN VALLEY HEALTH CENTERS	5/23/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	302 NORTHGATE DRIVE	None	MANTECA	CA	95336	3139	39	06077	37.81902087	-121.2206405	San Joaquin County
10582	Fee-for-Service	1174082432	1174082432	1	1	GORAYA, ANAM A	10/25/2022	207R00000X	NA	Other	026	PHYSICIANS	177521	None	None	0	In state provider	None	800 SOUTH MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
10593	Fee-for-Service	1508263815	1508263815	1	1	GAMBALA, VANESSA T	4/23/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
10626	Fee-for-Service	1376641860	1376641860	1	1	GARFIELD BEACH CVS LLC	10/29/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1001 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	2902	19	06037	34.0623504	-118.4454725	Los Angeles County
10647	Fee-for-Service	1386715332	1386715332	1	1	GOW, WILLIAM W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37747	02	General Surgery	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
10654	Fee-for-Service	1922172089	1922172089	1	1	GRIMES, GARY A MD	9/22/2006	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45278	08	Family Practice	0	In state provider	None	2231 S WESTERN AVE	None	LOS ANGELES	CA	90018	1302	19	06037	34.03512469	-118.3090138	Los Angeles County
10694	Fee-for-Service	1447707922	1447707922	1	1	GUPTILL, MARIE M LAC	1/17/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2255 YGNACIO VALLEY RD	SUITE G	WALNUT CREEK	CA	94598	3335	07	06013	37.92242643	-122.0301696	Contra Costa County
10713	Fee-for-Service	1043302391	1043302391	1	1	GEFFNER, MITCHELL E MD	10/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	32337	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
10715	Fee-for-Service	1396341368	1396341368	1	1	GPS HOSPICE CARE INC	12/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1807 W KATELLA AVE	STE 208	ANAHEIM	CA	92804	1200	30	06059	33.80322548	-117.946044	Orange County
10740	Fee-for-Service	1639639503	1639639503	1	1	GO, DEREK	11/5/2024	2085R0001X	NA	Other	026	PHYSICIANS	182500	30	Radiology	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
10756	Fee-for-Service	1326638099	1326638099	1	1	GARCIA, ILIANA NP	11/15/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
10789	Fee-for-Service	1689780793	1689780793	1	1	GREENBERG, JODY M DPM	4/1/1984	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	24022 CALLE DE LA PLATA	STE 410	LAGUNA HILLS	CA	92653	3629	30	06059	33.6104493	-117.7110924	Orange County
10810	Fee-for-Service	1821054594	1821054594	1	1	GAGAN, SOHAIL A MD	1/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84615	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
10820	Fee-for-Service	1649378134	1649378134	2	1	GARFIELD BEACH CVS, LLC	5/27/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4775 W ROSECRANS AVE	None	HAWTHORNE	CA	90250	6842	19	06037	33.90190149	-118.3601565	Los Angeles County
10824	Fee-for-Service	1811918790	1811918790	1	1	GUAJARDO, LEONEL F MD	9/1/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	46185	01	General Practice	0	In state provider	None	2143 W ORANGEWOOD AVE	None	ORANGE	CA	92868	1941	30	06059	33.79581651	-117.875781	Orange County
10831	Fee-for-Service	1285701144	1285701144	1	1	GAINES, JEFF S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42194	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
10850	Fee-for-Service	1235979683	1235979683	1	1	GIL, ANDREW	10/9/2024	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
10883	Fee-for-Service	1497779888	1497779888	1	1	GRANHOLM, ERIC L PHD	3/14/2019	103T00000X	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
10888	Fee-for-Service	1447554308	1447554308	2	1	GARFIELD BEACH CVS LLC	11/17/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1555 40TH ST	None	EMERYVILLE	CA	94608	3515	01	06001	37.82884116	-122.2901404	Alameda County
10898	Fee-for-Service	1285618520	1285618520	1	1	GOLDMAN, MATTHEW A MD	7/1/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	185248	None	None	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
10908	Fee-for-Service	1003377391	1003377391	1	1	GURAM, KRIPA A	8/19/2024	2085R0001X	NA	Other	026	PHYSICIANS	181646	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
10921	Fee-for-Service	1316162324	1316162324	1	1	GORHAM, LAURA M MD	10/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169627	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
10926	Fee-for-Service	1851317341	1851317341	1	1	GAUDIANI, VINCENT A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39320	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
10944	Fee-for-Service	1073627014	1073627014	1	1	GOPALAN, NIRMALA MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86051	38	Geriatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
10961	Fee-for-Service	1770960866	1770960866	1	1	GARG, ELISHA MD	12/28/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	146334	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
10990	Fee-for-Service	1043302391	1043302391	1	1	GEFFNER, MITCHELL E MD	10/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	32337	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
10996	Fee-for-Service	1992201982	1992201982	1	1	GALBREATH, ETIENNE DO	8/12/2024	207P00000X	NA	Other	026	PHYSICIANS	None	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
11005	Fee-for-Service	1396341368	1396341368	1	1	GPS HOSPICE CARE INC	12/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1807 W KATELLA AVE	STE 208	ANAHEIM	CA	92804	1200	30	06059	33.80322548	-117.946044	Orange County
11055	Fee-for-Service	1487805784	1487805784	1	1	GAUCHAN, DRON MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152673	68	Hematology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
11078	Fee-for-Service	1407338478	1407338478	1	1	GILBERTLAMBERT, JANET RCP	10/4/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
11080	Fee-for-Service	1013953835	1013953835	1	1	GOMES, ANTOINETTE S MD	8/31/1990	2085R0204X	NA	Other	026	PHYSICIANS	19745	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
11098	Fee-for-Service	1831645282	1831645282	2	1	GLENDALE HOUSE CLHS INC	2/15/2023	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	620 MYRTLE STREET	None	GLENDALE	CA	91203	1612	19	06037	34.15075631	-118.2677375	Los Angeles County
11113	Fee-for-Service	1780611731	1780611731	1	1	GOMEZ, MIQUEL 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	9201 W. THOMAS RD	None	PHOENIX	AZ	85037	3332	00	None	33.47892	-112.2579	Maricopa County
11133	Fee-for-Service	1326613902	1326613902	1	1	GALINAT, MEGAN R PT	9/13/2021	225100000X	NA	Physical Therapist	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
11215	Fee-for-Service	1407972821	1407972821	1	1	GOODWIN, DANIEL F MD	4/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85849	41	Internal Medicine	0	In state provider	None	1510 S CENTRAL AVE	STE 150	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
11232	Fee-for-Service	1073627014	1073627014	1	1	GOPALAN, NIRMALA MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86051	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
11247	Fee-for-Service	1396832465	1396832465	1	1	GARFIELD NURSING HOME	7/13/1992	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	1451 28TH AVE	None	OAKLAND	CA	94601	1632	01	06001	37.78066946	-122.2292246	Alameda County
11306	Fee-for-Service	1730244591	1730244591	1	1	GARGUILE, SHAWNA M J CNM	8/14/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
11340	Fee-for-Service	1033470364	1033470364	1	1	GREENE, KYLE R MD	1/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126756	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
11343	Fee-for-Service	1366608093	1366608093	1	1	GEBERT-PARIKH, CHRISTINE	12/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102038	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
11353	Fee-for-Service	1225174758	1225174758	1	1	GHIONI, LINDA W LCSW	7/3/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
11368	Fee-for-Service	1942833660	1942833660	1	1	GRACE SPEECH THERAPY CORP	12/22/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22722 LAMBERT ST	SUITE 1711	LAKE FOREST	CA	92630	1633	30	06059	33.63264633	-117.7130631	Orange County
11396	Fee-for-Service	1184937468	1184937468	1	1	GRASS VALLEY OUTPATIENT SURG	7/1/2010	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	408 SIERRA COLLEGE DR	None	GRASS VALLEY	CA	95945	5089	29	06057	39.23652577	-121.0572556	Nevada County
11411	Fee-for-Service	1144977638	1144977638	1	1	GUTIERREZ, JULIA R	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	49	06097	0	0	None
11442	Fee-for-Service	1881942506	1881942506	1	1	GLUCKMAN, CRAIG MD	5/3/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	160033	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
11460	Fee-for-Service	1174840102	1174840102	1	1	GORDIN, JONATHAN S MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126076	None	None	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3103	19	06037	34.06550726	-118.3775199	Los Angeles County
11516	Fee-for-Service	1255311288	1255311288	1	1	GIBB, TYLER D MD	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 LINCOLN ST	STE 100	KELSO	WA	98626	1062	00	None	46.14511866	-122.9230612	Cowlitz County
11533	Fee-for-Service	1649657487	1649657487	1	1	GIGUERE, SARAH M DO	6/17/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	15328	None	None	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91913	1800	37	06073	32.62382113	-116.9960539	San Diego County
11579	Fee-for-Service	1487695425	1487695425	2	1	GARFIELD BEACH CVS, LLC	4/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2040 CALIFORNIA AVE	None	SAND CITY	CA	93955	3150	27	06053	36.6207484	-121.8424181	Monterey County
11592	Fee-for-Service	1205342565	1205342565	1	1	GLOVER, NICHOLAS DO	4/11/2022	390200000X	NA	Other	026	PHYSICIANS	19317	None	None	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
11611	Fee-for-Service	1174510655	1174510655	1	1	GEORGE P PAPPAS MD	4/15/2013	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
11616	Fee-for-Service	1902169287	1902169287	1	1	GHADERI NIRI, SANAZ MD	6/6/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153247	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
11640	Fee-for-Service	1043651599	1043651599	1	1	GOLDMAN, MELANIE L LCSW	11/9/2023	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
11683	Fee-for-Service	1063856185	1063856185	1	1	GAN, JOANNA MD	5/1/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	124998	13	Neurology (M.D. only)	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
11684	Fee-for-Service	1326683871	1326683871	1	1	GUNBY, ALISON C PT	1/27/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12402 INDUSTRIAL BLVD	SUITE B2-B5	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
11715	Fee-for-Service	1194769570	1194769570	1	1	GRUEN, JOHN P MD	8/31/1991	207T00000X	NA	General Surgery	026	PHYSICIANS	63324	14	Neurological Surgery	0	In state provider	UNIV OF SO CALIF	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
11718	Fee-for-Service	1881942506	1881942506	1	1	GLUCKMAN, CRAIG MD	5/3/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	160033	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
11755	Fee-for-Service	1982714143	1982714143	1	2	GHAHERI, F S MD	12/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	67184	-	NOT APPLICABLE	0	In state provider	None	5980 WEBB STREET	None	LOOMIS	CA	95650	7625	31	06061	38.8221281	-121.1921002	Placer County
11762	Fee-for-Service	1831592500	1831592500	1	1	GOMEZ, KEITY LCSW	12/18/2023	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
11773	Fee-for-Service	1942655527	1942655527	1	1	GILMORE, AARON M DO	8/1/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16352	None	None	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
11829	Fee-for-Service	1568534048	1568534048	1	1	GOLDBERG, ANDREA S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35490	13	Neurology (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
11843	Fee-for-Service	1831432137	1831432137	1	1	GUTIERREZ, IRENE A MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141636	01	General Practice	0	In state provider	None	202 W WILLOW AVENUE	SUITE 502	VISALIA	CA	93291	6268	54	06107	36.328536	-119.293569	Tulare County
11851	Fee-for-Service	1760841597	1760841597	1	1	GLENVIEW HOME HEALTH INC	5/14/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	412 W BROADWAY	STE 210	GLENDALE	CA	91204	4117	19	06037	34.14682413	-118.261622	Los Angeles County
11857	Fee-for-Service	1891889903	1891889903	1	1	GREGORY, PETER B MD	1/1/1982	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	12521	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
11880	Fee-for-Service	1326165796	1326165796	1	1	GURLEY, RITA J MD	7/31/1989	207P00000X	NA	Other	026	PHYSICIANS	68267	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
11886	Fee-for-Service	1700014875	1700014875	1	1	GODDARD, JULIE A MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126233	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
11928	Fee-for-Service	1376510966	1376510966	1	1	GINEX, STEVEN L DPM	5/11/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	74050 ALESSANDRO DR	None	PALM DESERT	CA	92260	3705	33	06065	33.72202952	-116.372853	Riverside County
11942	Fee-for-Service	1639164361	1639164361	1	1	GATE THREE HEALTHCARE	11/1/2004	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	24962 CALLE ARAGON	None	LAGUNA HILLS	CA	92637	3883	30	06059	33.59966168	-117.7155087	Orange County
12000	Fee-for-Service	1871130500	1871130500	1	1	GROTEN DIALYSIS LLC	4/3/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1840 E MAIN ST	None	WOODLAND	CA	95776	6228	57	06113	38.67714163	-121.7364008	Yolo County
12008	Fee-for-Service	1174152888	1174152888	1	1	GILL, KARAM P MD	7/26/2023	208M00000X	NA	Other	026	PHYSICIANS	185792	None	None	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
12029	Fee-for-Service	1578504510	1578504510	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1150 EL CAMINO REAL	None	SAN BRUNO	CA	94066	2420	41	06081	37.636488	-122.4177075	San Mateo County
12033	Fee-for-Service	1013440866	1013440866	1	1	GARDNER, JULIANNA MD	5/27/2020	207R00000X	NA	Other	026	PHYSICIANS	159859	41	Internal Medicine	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
12038	Fee-for-Service	1376884072	1376884072	1	1	GUSTAVO ALVA MD, A PROFESSIO	3/1/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	SIONAL CORPORATION	3151 AIRWAY AVE	SUITE T3	COSTA MESA	CA	92626	4627	30	06059	33.67783408	-117.8720921	Orange County
12040	Fee-for-Service	1952628083	1952628083	1	1	GRIFFITH, JEAN W MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118354	36	Psychiatry	0	In state provider	None	555 TACHEVAH DR	SUITE 2E107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
12073	Fee-for-Service	1205378999	1205378999	1	1	GMH HOME HEALTH, INC	5/3/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8001 LAUREL CANYON BLVD	SUITE 206	NORTH HOLLYWOOD	CA	91605	1463	19	06037	34.216164	-118.396559	Los Angeles County
12081	Fee-for-Service	1962728550	1962728550	1	1	GARRISON-JAKEL, JARED N MD	4/9/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117594	08	Family Practice	0	In state provider	None	3883 AIRWAY DR	165	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
12122	Fee-for-Service	1164517132	1164517132	1	1	GENESIS OB GYN MEDICAL GROUP	6/3/2004	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84253	22	Pathology (M.D. only)	0	In state provider	INC	16000 APPLE VALLEY RD	STE C-3	APPLE VALLEY	CA	92307	7815	36	06071	34.5421391	-117.2732764	San Bernardino County
12158	Fee-for-Service	1437260742	1437260742	1	1	GARFORTH, EMMA M MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73103	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
12160	Fee-for-Service	1396106787	1396106787	1	1	GARFIELD BEACH CVS LLC	6/10/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6601 STINE RD	None	BAKERSFIELD	CA	93313	9504	15	06029	35.295147	-119.056718	Kern County
12170	Fee-for-Service	1235165226	1235165226	1	1	GOLDSTEIN, NEIL K MD	7/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	84575	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
12207	Fee-for-Service	1225019300	1225019300	1	1	GOLDBERG, NORMAN J MD	11/27/1985	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	34064	10	Gastroenterology (M.D. only)	0	In state provider	None	399 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3808	36	06071	34.1358627	-117.2757898	San Bernardino County
12248	Fee-for-Service	1760542138	1760542138	1	1	GRIFFITH, 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	7301 ROGERS AVE	None	FORT SMITH	AR	72903	4100	00	None	35.35551	-94.35276	Sebastian County
12265	Fee-for-Service	1588712020	1588712020	1	1	GENETIC DISEASE SCREENING PR	4/2/1986	251K00000X	NA	Other	033	GENETIC DISEASE TESTING	-	-	NOT APPLICABLE	0	In state provider	RANCH	850 MARINA BAY PKWY	SUITE G-265, MAIL STOP 8	RICHMOND	CA	94804	6403	07	06013	37.91927309	-122.3459757	Contra Costa County
12282	Fee-for-Service	1619036365	1619036365	1	1	GRUEN, JOHN L MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44209	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
12291	Fee-for-Service	1710575998	1710575998	1	1	GOLDEN STATE HOSPICE CARE	9/2/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4405 W RIVERSIDE DR	STE 203	BURBANK	CA	91505	4050	19	06037	34.15222929	-118.3480509	Los Angeles County
12298	Fee-for-Service	1992857361	1992857361	1	1	GOODMAN, NANCY J MD	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43194	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
12344	Fee-for-Service	1811075997	1811075997	1	1	GUNANAYAGAM, PIRIYATHAR-	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82707	41	Internal Medicine	0	In state provider	ISANI MD	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
12361	Fee-for-Service	1487032546	1487032546	1	1	GRANDE HOME HEALTH CARE INC	8/12/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1419 N SAN FERNANDO BLVD	STE 220	BURBANK	CA	91504	4100	19	06037	34.19071688	-118.322281	Los Angeles County
12390	Fee-for-Service	1578838199	1578838199	1	1	GANDHI, NITIN MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127846	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
12396	Fee-for-Service	1770524654	1770524654	2	1	GARFIELD BEACH CVS LLC	5/22/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26851 TRABUCO RD	None	MISSION VIEJO	CA	92691	3537	30	06059	33.62188117	-117.6601735	Orange County
12406	Fee-for-Service	1740523661	1740523661	1	1	GREENWALD, SALLY R MD	3/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132357	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
12411	Fee-for-Service	1164517132	1164517132	1	1	GENESIS OB GYN MEDICAL GROUP	6/3/2004	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84253	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	16000 APPLE VALLEY RD	STE C-3	APPLE VALLEY	CA	92307	7815	36	06071	34.5421391	-117.2732764	San Bernardino County
12438	Fee-for-Service	1326545146	1326545146	1	1	GALARZA, STELLA LPCC	8/9/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
12446	Fee-for-Service	1508014085	1508014085	1	1	GORDON BEHRER, KERIN PSY	12/2/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
12447	Fee-for-Service	1972869816	1972869816	1	1	GLASSY, CRYSTAL M DO	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13347	None	None	0	In state provider	None	500 UNIVERSITY AVE	STE 220	SACRAMENTO	CA	95825	6525	34	06067	38.568402	-121.418019	Sacramento County
12461	Fee-for-Service	1366414534	1366414534	1	1	GUTHRIE COUNTY HOSPITAL	3/23/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	710 N 12TH STREET	None	GUTHRIE CENTER	IA	50115	1549	00	None	41.68378082	-94.49435661	Guthrie County
12473	Fee-for-Service	1730245416	1730245416	1	1	GADWOOD, GARY J MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	23620	None	None	0	In state provider	None	2150 APPIAN WAY	STE 206	PINOLE	CA	94564	2520	07	06013	37.9958468	-122.3021554	Contra Costa County
12524	Fee-for-Service	1326190919	1326190919	1	1	GUPTA, AMIT DO	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11210	05	Anesthesiology	0	In state provider	None	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	40	06079	35.29325417	-120.667547	San Luis Obispo County
12544	Fee-for-Service	1760843098	1760843098	1	1	GOODELL, PARKER MD	7/22/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	158117	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
12548	Fee-for-Service	1356637185	1356637185	1	1	GUPTA, SAURABH PHD	8/28/2015	No Taxonomy Provided	NA	None	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
12577	Fee-for-Service	1871603787	1871603787	1	1	GLEASON, TIMOTHY W MD	3/1/2001	174400000X	NA	Other	026	PHYSICIANS	73082	05	Anesthesiology	0	In state provider	None	5794 CANYON VIEW DR	None	PARADISE	CA	95969	5503	04	06007	39.75768493	-121.5694125	Butte County
12578	Fee-for-Service	1710575998	1710575998	1	1	GOLDEN STATE HOSPICE CARE	9/2/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4405 W RIVERSIDE DR	STE 203	BURBANK	CA	91505	4050	19	06037	34.15222929	-118.3480509	Los Angeles County
12581	Fee-for-Service	1396759742	1396759742	1	1	GILLOGLEY, KATHERINE MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56083	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
12586	Fee-for-Service	1801425145	1801425145	1	1	GONZALEZ, ALPHA S NP	9/16/2022	363L00000X	NA	Nurse Practitioner	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
12630	Fee-for-Service	1003094384	1003094384	1	1	GHAJAR, JAMSHID MD	9/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131971	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
12631	Fee-for-Service	1891888731	1891888731	1	1	GILLES, FLOYD H MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49938	22	Pathology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
12716	Fee-for-Service	1134574346	1134574346	1	1	GLOBAL INTERNATIONAL LLC	2/15/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1305 LARC INDUSTRIAL BLV	None	BURNSVILLE	MN	55337	1411	00	None	44.787078	-93.256596	Dakota County
12725	Fee-for-Service	1144292384	1144292384	1	1	GLEN E SUTHERLAND,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
12727	Fee-for-Service	1619589991	1619589991	1	1	GRATIFIED HOSPICE CARE INC	3/1/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 202Z	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
12731	Fee-for-Service	1174788665	1174788665	1	1	GOYKHMAN, PAVEL A MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105559	41	Internal Medicine	0	In state provider	None	8536 WILSHIRE BOULEVARD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
12741	Fee-for-Service	1154437325	1154437325	1	1	GUTH, RICHARD H MD	5/30/1990	207P00000X	NA	Other	026	PHYSICIANS	28728	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
12747	Fee-for-Service	1366414534	1366414534	1	1	GUTHRIE COUNTY HOSPITAL	3/23/2011	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	710 N 12TH STREET	None	GUTHRIE CENTER	IA	50115	1549	00	None	41.68378082	-94.49435661	Guthrie County
12752	Fee-for-Service	1922392562	1922392562	2	1	GARFIELD BEACH CVS LLC	1/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2850 N OXNARD BLVD	None	OXNARD	CA	93036	5443	56	06111	34.24320639	-119.178392	Ventura County
12788	Fee-for-Service	1972509800	1972509800	1	1	GOLOD, MARK I MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	33893	20	Orthopedic Surgery	0	In state provider	None	15720 WINCHESTER BLVD	None	LOS GATOS	CA	95030	3337	43	06085	37.24027269	-121.9767692	Santa Clara County
12803	Fee-for-Service	1053649848	1053649848	1	1	GHETMIRI, REZA MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110832	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
12823	Fee-for-Service	1801067590	1801067590	1	1	GULIK, ANNA M NP	6/13/2024	363LA2200X	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
12824	Fee-for-Service	1801283635	1801283635	1	1	GUTIERREZ, MARIO MD	11/4/2019	207RA0401X	NA	Other	026	PHYSICIANS	155646	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
12846	Fee-for-Service	1598224982	1598224982	1	1	GUERRA, GERARDO MD	8/18/2022	2279E0002X	NA	Other	026	PHYSICIANS	176413	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
12858	Fee-for-Service	1063760072	1063760072	1	1	GREEN, KATHRYN R LMFT	5/18/2020	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
12865	Fee-for-Service	1205952694	1205952694	1	1	GTD MEDICAL, INC	1/7/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	830 S MASON RD	#B1	KATY	TX	77450	3863	00	None	29.77133355	-95.75182076	Harris County
12890	Fee-for-Service	1770589152	1770589152	1	1	GUPTA, ARTI MD	1/9/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	187247	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
12893	Fee-for-Service	1235158585	1235158585	1	1	GAUTAM M. REDDY M.D.	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	210 E SUNRISE HWY	STE 304	VALLEY STREAM	NY	11581	1328	00	None	40.657473	-73.6909605	Nassau County
12895	Fee-for-Service	1811062680	1811062680	1	1	GEER, DANIEL H LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3779 PIEDMONT AVE	G-41	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
12922	Fee-for-Service	1891888731	1891888731	1	1	GILLES, FLOYD H MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	49938	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
12923	Fee-for-Service	1205381316	1205381316	1	1	GOH, REGINE	7/2/2024	207L00000X	NA	Other	026	PHYSICIANS	184059	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
12929	Fee-for-Service	1811125677	1811125677	1	1	GUEVARA, NATALIA LCSW	9/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
12943	Fee-for-Service	1104204080	1104204080	1	1	GUPTA HEART AND VASCULAR	2/17/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	CENTER OF LAS VEGAS PC	500 S RANCHO DR	STE 12	LAS VEGAS	NV	89106	4852	00	None	36.16522717	-115.1727844	Clark County
13013	Fee-for-Service	1619589991	1619589991	1	1	GRATIFIED HOSPICE CARE INC	3/1/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 202Z	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
13014	Fee-for-Service	1386849958	1386849958	1	1	GOODARZI, HEIDI MD	10/18/2017	207N00000X	NA	Dermatology	026	PHYSICIANS	107754	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
13017	Fee-for-Service	1174788665	1174788665	1	1	GOYKHMAN, PAVEL A MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105559	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8536 WILSHIRE BOULEVARD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
13046	Fee-for-Service	1902172042	1902172042	1	1	GILANI, MORGAN L MD	8/30/2020	208M00000X	NA	Other	026	PHYSICIANS	128217	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
13081	Fee-for-Service	1093154825	1093154825	1	1	GODELMAN, STEVEN MD	3/20/2020	208600000X	NA	General Surgery	026	PHYSICIANS	163683	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
13084	Fee-for-Service	1629505383	1629505383	1	1	GARFIELD BEACH CVS, LLC	5/10/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 EAGLE ROCK BLVD	None	LOS ANGELES	CA	90065	4404	19	06037	34.1222581	-118.2246536	Los Angeles County
13095	Fee-for-Service	1063528321	1063528321	1	1	GOLDSOBEL, ALAN B MD	7/31/1984	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39891	03	Allergy	0	In state provider	None	4155 MOORPARK AVE	STE 3	SAN JOSE	CA	95117	1714	43	06085	37.31587947	-121.974255	Santa Clara County
13113	Fee-for-Service	1265577589	1265577589	1	1	GARFIELD BEACH CVS, LLC	11/30/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15286 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.15052961	-117.4711826	San Bernardino County
13222	Fee-for-Service	1790081347	1790081347	1	1	GOMEZ, ROSA M MD PC	8/26/2011	261QP2300X	NA	Other	026	PHYSICIANS	94489	08	Family Practice	0	In state provider	None	38925 TRADE CENTER DRIVE	SUITE #H	PALMDALE	CA	93551	3655	19	06037	34.59028112	-118.1433053	Los Angeles County
13230	Fee-for-Service	1104204080	1104204080	1	1	GUPTA HEART AND VASCULAR	2/17/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	CENTER OF LAS VEGAS PC	500 S RANCHO DR	STE 12	LAS VEGAS	NV	89106	4852	00	None	36.16522717	-115.1727844	Clark County
13233	Fee-for-Service	1114426541	1114426541	1	1	GJE INC.	12/17/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5159 VIA EL MOLINO	None	NEWBURY PARK	CA	91320	6995	56	06111	34.17964631	-118.9853286	Ventura County
13251	Fee-for-Service	1528045317	1528045317	1	1	GODBOLD SANCHEZ, MONIQUE T M	12/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74248	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
13331	Fee-for-Service	1437101342	1437101342	1	1	GRAZIER, ROBERT K MD	3/1/1999	207P00000X	NA	Other	026	PHYSICIANS	23231	66	Emergency Medicine (Urgent Care)	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
13333	Fee-for-Service	1376552893	1376552893	1	1	GLENDIVE MEDICAL CENTER INC	6/13/2010	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	202 PROSPECT DR	None	GLENDIVE	MT	59330	1943	00	None	47.116899	-104.7042405	Dawson County
13348	Fee-for-Service	1366805392	1366805392	1	1	GISSY, JACOB J MD	11/1/2022	207L00000X	NA	Other	026	PHYSICIANS	180076	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
13364	Fee-for-Service	1124290853	1124290853	1	1	GREENLAND, JOHN R MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111543	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
13365	Fee-for-Service	1659309805	1659309805	1	1	GUPTA, SUBHAS C MD	9/28/2000	2086S0122X	NA	General Surgery	026	PHYSICIANS	73167	24	Plastic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
13383	Fee-for-Service	1104416395	1104416395	1	1	GADINSKY, NATASHA PSYD	6/18/2021	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
13387	Fee-for-Service	1588155287	1588155287	1	1	GRYGUC-SAXANOFF, AGNIESZKA	10/1/2021	208M00000X	NA	Other	026	PHYSICIANS	174731	None	None	0	In state provider	MD	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
13391	Fee-for-Service	1396177564	1396177564	1	1	GANDHI, ANSHUL M MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140220	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
13433	Fee-for-Service	1437253671	1437253671	1	1	GUNDOGDU, MELEK B MD	9/25/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	156629	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
13443	Fee-for-Service	1932701638	1932701638	1	1	GOLDEN HEALTH MEDICAL INC	7/19/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1303 MABLE AVE	None	MODESTO	CA	95355	1119	50	06099	37.69613281	-120.9756292	Stanislaus County
13444	Fee-for-Service	1326481300	1326481300	1	1	GEISSLER, THEODORE M MD	8/15/2019	207L00000X	NA	Other	026	PHYSICIANS	147713	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
13446	Fee-for-Service	1609834167	1609834167	1	1	GRIM, JOSEPH R MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71215	05	Anesthesiology	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
13448	Fee-for-Service	1356833891	1356833891	1	1	GOYAL, NEHA G PHD	7/24/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
13540	Fee-for-Service	1821136433	1821136433	1	1	GERTSON, LINDA L PHD	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	9260	-	NOT APPLICABLE	0	In state provider	None	1911 WILLIAMS DRIVE	None	OXNARD	CA	93036	2612	56	06111	34.219566	-119.1539365	Ventura County
13541	Fee-for-Service	1184096810	1184096810	1	1	GIBBS, GARY N M D INC	11/2/2015	207L00000X	NA	Other	026	PHYSICIANS	42132	05	Anesthesiology	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
13554	Fee-for-Service	1205845815	1205845815	1	1	GRUA, MICHELLE S MD	10/28/2021	207L00000X	NA	Other	026	PHYSICIANS	167496	None	None	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
13574	Fee-for-Service	1841636917	1841636917	1	1	GITHENS, THOMAS C DO	7/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16204	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
13585	Fee-for-Service	1356076756	1356076756	1	1	GARETSON, FLOR NP	3/28/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
13621	Fee-for-Service	1376552893	1376552893	1	1	GLENDIVE MEDICAL CENTER INC	6/13/2010	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	202 PROSPECT DR	None	GLENDIVE	MT	59330	1943	00	None	47.116899	-104.7042405	Dawson County
13634	Fee-for-Service	1386121945	1386121945	1	1	GUZMAN, LUZ	11/27/2023	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
13640	Fee-for-Service	1083835995	1083835995	1	1	GOVINDARAJAN, SUDHA MD A	10/3/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36370	01	General Practice	0	In state provider	PROFESSIONAL CORP	101 E BEVERLY BLVD	STE 302	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
13645	Fee-for-Service	1285679183	1285679183	1	1	GARFIELD BEACH CVS, LLC	5/13/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9730 MISSION GORGE	None	SANTEE	CA	92071	3808	37	06073	32.83879131	-116.9848056	San Diego County
13654	Fee-for-Service	1124290853	1124290853	1	1	GREENLAND, JOHN R MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111543	29	Pulmonary Diseases (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
13701	Fee-for-Service	1619437746	1619437746	1	1	GHANI, ASMAR A MD	6/26/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	192417	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
13712	Fee-for-Service	1144757626	1144757626	1	1	GELL, JACLYN DO	2/7/2023	207P00000X	NA	Other	026	PHYSICIANS	20568	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
13758	Fee-for-Service	1679591788	1679591788	1	1	GOLDBERG, MICHAEL H MD	3/21/2008	207L00000X	NA	Other	026	PHYSICIANS	64383	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
13762	Fee-for-Service	1386672632	1386672632	1	1	GATLING, JASON W MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87478	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
13796	Fee-for-Service	1437546025	1437546025	1	1	GOEL, KHUSHBOO MD	8/1/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	176840	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
13807	Fee-for-Service	1568460624	1568460624	1	1	GRATIANNE, ROBERTO MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	43717	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
13821	Fee-for-Service	1669543625	1669543625	1	1	GREEN, ARON MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	35316	26	Psychiatry (child)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
13882	Fee-for-Service	1912084146	1912084146	1	1	GARCIA, GEORGE H MD INC	6/20/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1031 W CHAPMAN AVE	#204	ORANGE	CA	92868	2872	30	06059	33.78791049	-117.8632755	Orange County
13937	Fee-for-Service	1285161521	1285161521	1	1	GUPTA, SURBHI MD	8/8/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	163050	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
13950	Fee-for-Service	1033399860	1033399860	1	1	GUPTA, NIDHI A MD	4/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101611	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
13972	Fee-for-Service	1477567345	1477567345	1	1	GRADY, SHAUN P MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	70152	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	207 S SANTA ANITA AVE	STE 335	SAN GABRIEL	CA	91776	1160	19	06037	34.10120583	-118.1065375	Los Angeles County
14005	Fee-for-Service	1124478664	1124478664	1	1	GREEN, MORGAN A MD	7/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150503	None	None	0	In state provider	None	25828 REDLANDS BLVD	101	REDLANDS	CA	92373	8450	36	06071	34.06306846	-117.240957	San Bernardino County
14043	Fee-for-Service	1053351510	1053351510	1	1	GRIFFITH, JOHN L MD	12/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
14051	Fee-for-Service	1154350528	1154350528	1	1	GELLER, DAVID H MD	7/31/1990	174400000X	NA	Other	026	PHYSICIANS	70850	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
14072	Fee-for-Service	1851781645	1851781645	1	1	GOYAL, PREEYA MD	1/29/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	150556	None	None	0	In state provider	None	12291 WASHINGTON BLVD	SUITE 500	WHITTIER	CA	90606	2500	19	06037	33.96734104	-118.0508773	Los Angeles County
14083	Fee-for-Service	1891998159	1891998159	1	1	GRAGEDA, MARIE C MD	1/29/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	98158	08	Family Practice	0	In state provider	None	901 SUNSET DR	STE 4	HOLLISTER	CA	95023	5613	35	06069	36.83511073	-121.3873227	San Benito County
14089	Fee-for-Service	1881288314	1881288314	1	1	GREYSON, LAUREL OT	4/3/2024	225X00000X	NA	Other	019	OCCUPATIONAL 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
14093	Fee-for-Service	1275719544	1275719544	1	1	GANDHI, NIKHIL R MD	2/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	81799	41	Internal Medicine	0	In state provider	L CORPORAITON	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
14099	Fee-for-Service	1568460624	1568460624	1	1	GRATIANNE, ROBERTO MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	43717	13	Neurology (M.D. only)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
14120	Fee-for-Service	1396713434	1396713434	1	2	GOODWIN, MARK C MD	4/30/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	70773	-	NOT APPLICABLE	0	In state provider	None	144 STONY POINT ROAD	None	SANTA ROSA	CA	95401	4122	49	06097	38.440494	-122.74353	Sonoma County
14123	Fee-for-Service	1205935780	1205935780	1	1	GAEBLER, SHARON R OT	3/7/2022	225XH1200X	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
14137	Fee-for-Service	1700445236	1700445236	1	1	GOVALAN, RAJALAKSHMI MD	6/9/2022	207R00000X	NA	Other	026	PHYSICIANS	177553	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
14154	Fee-for-Service	1235590985	1235590985	1	1	GENEVA HEALTHCARE	9/14/2017	293D00000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	87 NORTH RAYMOND AVE	SUITE 521	PASADENA	CA	91103	3932	19	06037	34.14740618	-118.1489352	Los Angeles County
14189	Fee-for-Service	1962758615	1962758615	1	1	GOLDSMITH, SERENA J LCSW	10/1/2023	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
14204	Fee-for-Service	1982714143	1982714143	1	1	GHAHERI, F S MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	67184	26	Psychiatry (child)	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
14210	Fee-for-Service	1487619201	1487619201	1	1	GOLD, WARREN M MD	1/31/1988	207R00000X	NA	Other	026	PHYSICIANS	7800	41	Internal Medicine	0	In state provider	None	500 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2203	38	06075	37.76351054	-122.4579681	San Francisco County
14242	Fee-for-Service	1992777585	1992777585	1	2	GOYA, DEBBIE M OD &	3/11/1999	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2202 ARTESIA BLVD	STE A	TORRANCE	CA	90504	2963	19	06037	33.87277548	-118.3181895	Los Angeles County
14274	Fee-for-Service	1114245248	1114245248	1	1	GREWAL, SUNDEEP K DO	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13377	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
14280	Fee-for-Service	1689868721	1689868721	1	1	GONZALEZ, SERGIO A MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108179	01	General Practice	0	In state provider	None	280 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
14291	Fee-for-Service	1760638712	1760638712	1	1	GARCIA, JAMIE E MD	11/2/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	105001	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
14323	Fee-for-Service	1518481415	1518481415	1	1	GHAJAR, NAHID S LMFT	10/25/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DRIVE	STE 550	IRVINE	CA	92612	2619	30	06059	33.650775	-117.838296	Orange County
14407	Fee-for-Service	1982748232	1982748232	1	1	GROSSERODE, ROBERT S MD	6/27/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	51975	18	Ophthalmology	0	In state provider	None	3720 SUNSET LN	STE A	ANTIOCH	CA	94509	6124	07	06013	37.98416157	-121.804246	Contra Costa County
14446	Fee-for-Service	1285673558	1285673558	1	1	GOLDBERG, JOEL MD	12/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76929	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
14447	Fee-for-Service	1801536867	1801536867	1	1	GALEN INPATIENT PHYSICIANS,	6/1/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	700 RIVER DRIVE	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
14481	Fee-for-Service	1306078647	1306078647	1	1	GENUINE PATIENT CARE	9/9/2009	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	GENUINE PATIENT CARE	500 E. "E" STREET	SUITE 216	ONTARIO	CA	91764	4276	36	06071	34.068114	-117.6458355	San Bernardino County
14482	Fee-for-Service	1255779641	1255779641	1	1	GORDON, ASHLYNN N DO	1/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13758	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS ROAD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
14500	Fee-for-Service	1487619201	1487619201	1	1	GOLD, WARREN M MD	1/31/1988	207R00000X	NA	Other	026	PHYSICIANS	7800	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2203	38	06075	37.76351054	-122.4579681	San Francisco County
14511	Fee-for-Service	1265499065	1265499065	1	1	GRAY, RUSSELL MD	3/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	55505	05	Anesthesiology	0	In state provider	None	2140 COTNER AVE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
14538	Fee-for-Service	1588127344	1588127344	1	1	GUTHRIE, WILLIAM MD	9/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176986	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
14540	Fee-for-Service	1619294220	1619294220	1	1	GESKE, MICHAEL J MD	6/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119200	18	Ophthalmology	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
14559	Fee-for-Service	1255461711	1255461711	1	1	GALLEGOS, BELINDA A LMFT	9/11/2018	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
14691	Fee-for-Service	1578003166	1578003166	1	1	GARFIELD BEACH CVS LLC	3/21/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	125 N CENTRAL AVE	None	GLENDALE	CA	91203	2502	19	06037	34.14758903	-118.2579551	Los Angeles County
14698	Fee-for-Service	1790893485	1790893485	1	1	GOGI, ANDREI MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68570	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
14738	Fee-for-Service	1457396350	1457396350	1	1	GARFIELD BEACH CVS LLC	3/21/2008	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8260 MIRA MESA BLVD	None	SAN DIEGO	CA	92126	2662	37	06073	32.91277002	-117.1459433	San Diego County
14743	Fee-for-Service	1447576236	1447576236	1	1	GHOFRANI, HOSSEIN MD	9/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124747	45	Nephrology (Renal-Kidney)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
14747	Fee-for-Service	1851475925	1851475925	1	1	GOLDSTEIN, ANDREW MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	54373	20	Orthopedic Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
14784	Fee-for-Service	1073689386	1073689386	1	1	GEVORKYAN, HAKOP MD	5/15/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63848	41	Internal Medicine	0	In state provider	None	401 S GLENOAKS BLVD	STE 101	BURBANK	CA	91502	2707	19	06037	34.18077992	-118.3029503	Los Angeles County
14796	Fee-for-Service	1508933490	1508933490	1	1	GERRAS, GREGORY G MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	74743	14	Neurological Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
14830	Fee-for-Service	1154434447	1154434447	1	1	GREEN, CLARE A DO	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11841	01	General Practice	0	In state provider	None	27800 MEDICAL CENTER RD	SUITE 461	MISSION VIEJO	CA	92691	6424	30	06059	33.55952733	-117.6645199	Orange County
14831	Fee-for-Service	1831320027	1831320027	1	1	GETTY, JORGE L MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112025	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
14875	Fee-for-Service	1477974202	1477974202	1	1	GARRISON, JARED D DO INC	12/30/2013	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8298	08	Family Practice	0	In state provider	None	320 N CRAWFORD AVE	None	WILLOWS	CA	95988	2326	11	06021	39.52340241	-122.20599	Glenn County
14895	Fee-for-Service	1053987305	1053987305	1	1	GENEROSO, PRICILLA LOUISE P	12/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	MD	1045 W REDONDO BEACH BLV	SUITE 100	GARDENA	CA	90247	4128	19	06037	33.89247044	-118.2931941	Los Angeles County
14896	Fee-for-Service	1538488705	1538488705	1	1	GALLARDO, ANDREA F MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119025	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
14903	Fee-for-Service	1285184929	1285184929	1	1	GOOKIN, GLENN R MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145429	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
14917	Fee-for-Service	1255166757	1255166757	1	1	GIARA PHARMACY INC	10/5/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5400 BALBOA BLVD	100	ENCINO	CA	91316	1598	19	06037	34.169283	-118.501072	Los Angeles County
14972	Fee-for-Service	1891830881	1891830881	1	1	GURTNER, GEOFFREY MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	93283	02	General Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
14984	Fee-for-Service	1700203858	1700203858	1	1	GOULD, AIDEN S MD	7/31/2017	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
14988	Fee-for-Service	1790893485	1790893485	1	1	GOGI, ANDREI MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68570	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
14994	Fee-for-Service	1114690872	1114690872	1	1	GARAI PEREZ, EIDER CNP	2/25/2022	363LP2300X	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
15013	Fee-for-Service	1073807434	1073807434	2	1	GARFIELD BEACH CVS LLC	3/8/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1010 N EL CAMINO REAL	None	ENCINITAS	CA	92024	1320	37	06073	33.062589	-117.2651445	San Diego County
15020	Fee-for-Service	1699192542	1699192542	1	1	GUARNOTTA, SUSAN S LCSW	6/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
15036	Fee-for-Service	1851475925	1851475925	1	1	GOLDSTEIN, ANDREW MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	54373	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
15040	Fee-for-Service	1033596267	1033596267	1	1	GARVEY, SHEQUELLA MD	1/7/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154891	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
15090	Fee-for-Service	1720592371	1720592371	1	1	GREGORY, BRUCE K LMFT	4/10/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	3590 EL PORTAL DR.	7, 8, 9, 10, 15, 16, & 1	REDDING	CA	96002	3154	45	06089	40.55435123	-122.3565549	Shasta County
15101	Fee-for-Service	1144331604	1144331604	1	1	GARCIA KHORASHADI, ANGELICA	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	G LCSW	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
15117	Fee-for-Service	1811024060	1811024060	1	1	GOUBEAUX, JOCELYN	6/1/1995	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2100 W 3RD ST	None	LOS ANGELES	CA	90057	1922	19	06037	34.06308947	-118.2733326	Los Angeles County
15121	Fee-for-Service	1770978850	1770978850	1	1	GONZALES, MATTHEW J MD	9/4/2018	208M00000X	NA	Other	026	PHYSICIANS	149424	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
15135	Fee-for-Service	1598144503	1598144503	1	1	GNANADEV, YAMUNA E MD	1/8/2019	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
15144	Fee-for-Service	1225068885	1225068885	1	1	GREENHOW, TARA LYNN MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73570	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
15175	Fee-for-Service	1114342805	1114342805	1	1	GAMAD, FIEL	8/10/2023	363LF0000X	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
15187	Fee-for-Service	1629432000	1629432000	1	1	GORRELL, DAVID MD	10/4/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176978	30	Radiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
15208	Fee-for-Service	1881975761	1881975761	1	1	GHAZAL, JOSEPH S MD APC	1/6/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	53712	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1300 N VERMONT AVE	STE 808	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
15221	Fee-for-Service	1073676854	1073676854	1	1	GREWAL, SANGEETA K MD	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91516	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
15265	Fee-for-Service	1982617890	1982617890	1	1	GALE CULVER, AMY L MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70712	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
15284	Fee-for-Service	1578521548	1578521548	1	1	GIATTINA, MARA R MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108506	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
15292	Fee-for-Service	1699848655	1699848655	1	1	GOODBOY, KATHLEEN A LMFT	6/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2601 E CHAPMAN AVE	STE 105	FULLERTON	CA	92831	3737	30	06059	33.87433432	-117.8837211	Orange County
15342	Fee-for-Service	1467496984	1467496984	1	1	GOLDSTEIN, SANDRA E MD	3/31/1993	207R00000X	NA	Other	026	PHYSICIANS	69972	41	Internal Medicine	0	In state provider	None	2999 REGENT ST	STE 525	BERKELEY	CA	94705	2120	01	06001	37.85592021	-122.2566436	Alameda County
15343	Fee-for-Service	1679976492	1679976492	1	1	GALAVIZ, NIKKIE LCSW	10/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
15364	Fee-for-Service	1023019346	1023019346	1	1	GOODMAN, GREG 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	8TH AVE + C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.779063	-111.8805548	Salt Lake County
15378	Fee-for-Service	1750804027	1750804027	1	1	GRAMMATICO, JONATHAN LCSW	8/20/2022	101YP2500X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	706 13TH ST	None	MODESTO	CA	95354	2414	50	06099	37.63996267	-120.9942148	Stanislaus County
15393	Fee-for-Service	1386086577	1386086577	1	1	GONZALEZ, NANCY LMFT	9/30/2020	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
15408	Fee-for-Service	1881223444	1881223444	1	1	GUO, HAIYAN DO	9/27/2024	207L00000X	NA	Other	026	PHYSICIANS	21435	05	Anesthesiology	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
15414	Fee-for-Service	1346336088	1346336088	1	1	GRAMES, BARRY S MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	72511	20	Orthopedic Surgery	0	In state provider	None	225 W HOSPITALITY LN	STE 108	SAN BERNARDINO	CA	92408	3244	36	06071	34.06586109	-117.2884682	San Bernardino County
15441	Fee-for-Service	1063454585	1063454585	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	150 W CARSON ST	None	CARSON	CA	90745	2601	19	06037	33.83152953	-118.279503	Los Angeles County
15446	Fee-for-Service	1124060322	1124060322	1	1	GARFIELD BEACH CVS, LLC	10/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2521 E AVENUE S	None	PALMDALE	CA	93550	6402	19	06037	34.55995915	-118.0843798	Los Angeles County
15450	Fee-for-Service	1982182770	1982182770	1	1	GARAY, BLANCA E RCP	10/4/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
15471	Fee-for-Service	1811593700	1811593700	1	1	GRACE, JESSICA E LMFT	3/2/2021	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
15494	Fee-for-Service	1538412994	1538412994	1	1	GHAFOURIAN, MITRA MD	10/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125908	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
15496	Fee-for-Service	1487181376	1487181376	1	1	GUINN, ASHLEY D MD	9/2/2022	207P00000X	NA	Other	026	PHYSICIANS	178044	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
15524	Fee-for-Service	1205910296	1205910296	1	1	GORENBERG, PETER H MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79676	18	Ophthalmology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
15531	Fee-for-Service	1912200510	1912200510	1	1	GILL, AJAIPAL S MD INC	3/1/2011	207RP1001X	NA	Pulmonology	026	PHYSICIANS	55220	None	None	0	In state provider	None	1215 PLUMAS STREET	SUITE 1800	YUBA CITY	CA	95991	4085	51	06101	39.14709336	-121.6175316	Sutter County
15553	Fee-for-Service	1538138078	1538138078	1	1	GERSCHULTZ, STEVEN J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	70324	None	None	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
15591	Fee-for-Service	1043745193	1043745193	1	1	GARIMELLA, BHASKARA MD	9/27/2024	208M00000X	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
15596	Fee-for-Service	1366511743	1366511743	1	1	GARCIA, CARLOS T	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2103 N BROADWAY	None	SANTA ANA	CA	92706	2660	30	06059	33.76425049	-117.8695346	Orange County
15627	Fee-for-Service	1114359452	1114359452	1	1	GOVLICH, REGINA PSYD	6/7/2024	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
15639	Fee-for-Service	1205927415	1205927415	2	1	GONZALEZ-DIAZ, JOSE MD	12/21/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	41311	01	General Practice	0	In state provider	None	7220 WOODMAN AVE	STE 105	VAN NUYS	CA	91405	2665	19	06037	34.20189	-118.431221	Los Angeles County
15660	Fee-for-Service	1962632299	1962632299	1	1	GULLY, CHERYL LCSW	12/2/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
15672	Fee-for-Service	1083690440	1083690440	1	1	GILBERT, WILLIAM M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60619	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
15683	Fee-for-Service	1144343005	1144343005	1	1	GUPTA, SACHIN MD	4/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111493	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
15687	Fee-for-Service	1639410020	1639410020	1	1	GARCIA, VIVIANA	5/20/2024	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
15721	Fee-for-Service	1659833960	1659833960	1	1	GLAEWKETGARN, ISSAREEKORN M	1/24/2023	390200000X	NA	Other	026	PHYSICIANS	179676	None	None	0	In state provider	D	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
15726	Fee-for-Service	1891346433	1891346433	1	1	GANDARA, MELIZA M LCSW	10/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5000 BIRCH ST	WEST TOWER STE 3000	NEWPORT BEACH	CA	92660	2127	30	06059	33.66605605	-117.8586733	Orange County
15751	Fee-for-Service	1518525187	1518525187	1	1	GERBUTAVICIUS, AARON M CNP	7/8/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
15764	Fee-for-Service	1699838839	1699838839	1	1	GOPAKUMAR PANIKKAR	4/19/2022	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
15809	Fee-for-Service	1891007183	1891007183	2	1	GREEN MED TRANS INC	10/1/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14359 AMARGOSA RD	SUITE B	VICTORVILLE	CA	92392	2334	36	06071	34.51176581	-117.3301466	San Bernardino County
15825	Fee-for-Service	1598184715	1598184715	1	1	GEORGE, ELIZABETH L MD	7/13/2022	2086S0129X	NA	General Surgery	026	PHYSICIANS	139459	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
15834	Fee-for-Service	1932353281	1932353281	1	1	GUSTAFSON, DAWN M	7/3/2013	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
15878	Fee-for-Service	1225079106	1225079106	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	650 E EL SEGUNDO BLVD	None	LOS ANGELES	CA	90059	3308	19	06037	33.91632805	-118.26378	Los Angeles County
15879	Fee-for-Service	1679906580	1679906580	1	1	GANGADHAR, KIRAN MD	11/14/2022	2085R0205X	NA	Other	026	PHYSICIANS	179353	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
15883	Fee-for-Service	1649256124	1649256124	1	1	GOLDSTEIN, ROBERT A MD	1/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	34558	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27852 PUERTA REAL	STE 10	MISSION VIEJO	CA	92675	0000	30	06059	33.56849493	-117.6696298	Orange County
15893	Fee-for-Service	1750933768	1750933768	1	1	GAW, JULIA	2/5/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
15898	Fee-for-Service	1164635173	1164635173	1	1	GREEN, DOUGLAS A MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	100113	None	None	0	In state provider	None	43731 N 15TH ST WEST	None	LANCASTER	CA	93534	4785	19	06037	34.67731742	-118.1564784	Los Angeles County
15907	Fee-for-Service	1508823675	1508823675	1	1	GOLDFINE, IRA D MD	8/31/1989	207RE0101X	NA	Endocrinology	026	PHYSICIANS	24592	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
15931	Fee-for-Service	1265071005	1265071005	1	1	GANTA, SRUJAN MD	2/19/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	166273	33	Thoracic Surgery	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
15943	Fee-for-Service	1770966988	1770966988	1	1	GALLOWAY, SAMUEL J MD	8/6/2018	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	144055	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
15972	Fee-for-Service	1972254449	1972254449	1	1	GOODLOW, JENNIFER C LMFT	1/18/2022	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
15992	Fee-for-Service	1447270608	1447270608	1	1	GLENN, WILLIAM V MD	2/14/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36983	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
16043	Fee-for-Service	1750491585	1750491585	1	1	GARCIA, JACOB R MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97544	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
16054	Fee-for-Service	1750378188	1750378188	2	1	GHIYAM, DANIEL M MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	75370	08	Family Practice	0	In state provider	None	2840 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	3937	56	06111	34.27167882	-118.7404467	Ventura County
16062	Fee-for-Service	1003865783	1003865783	1	1	GRABB, ALBERT MD	6/30/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55767	30	Radiology	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
16076	Fee-for-Service	1194071951	1194071951	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	735 S FIGUEROA ST	None	LOS ANGELES	CA	90017	2571	19	06037	34.04861139	-118.2606594	Los Angeles County
16087	Fee-for-Service	1114297330	1114297330	1	1	GUZMAN, LUIS A MD	9/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118752	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
16094	Fee-for-Service	1982927174	1982927174	1	1	GRODAN, PAUL J MD A	12/14/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30279	06	Cardiovascular Disease (M.D. only)	0	In state provider	PROFESSIONAL	150 N ROBERTSON BLVD	STE 211	BEVERLY HILLS	CA	90211	2142	19	06037	34.06812722	-118.3837146	Los Angeles County
16104	Fee-for-Service	1033278981	1033278981	1	1	GASMANN, INGVILD B PT	4/15/2020	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
16111	Fee-for-Service	1548795024	1548795024	1	1	GASSER, ERIN K NP	11/14/2017	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
16116	Fee-for-Service	1730575754	1730575754	1	1	GORE, ASHWANI MD	6/22/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	166736	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
16117	Fee-for-Service	1497797690	1497797690	1	1	GARFIELD BEACH CVS LLC	1/17/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1380 43RD ST	None	SAN DIEGO	CA	92113	3408	37	06073	32.69206379	-117.1024759	San Diego County
16121	Fee-for-Service	1093219321	1093219321	1	1	GALHOTRA, ANITA T NP	1/5/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
16133	Fee-for-Service	1164705133	1164705133	1	1	GARCIA, LORENA LCSW	8/29/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1875 W REDONDO BEACH BLV	STE 303	GARDENA	CA	90247	3644	19	06037	33.8879044	-118.3111113	Los Angeles County
16162	Fee-for-Service	1770251225	1770251225	1	1	GENTLE AND PROFESSIONAL HOME	12/12/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	869 E FOOTHILL BLVD	SUITE L	UPLAND	CA	91401	4063	36	06071	34.10724031	-117.6393375	San Bernardino County
16170	Fee-for-Service	1720026271	1720026271	1	1	GUNDA, NARAYANA R MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70434	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
16198	Fee-for-Service	1508823675	1508823675	1	1	GOLDFINE, IRA D MD	8/31/1989	207RE0101X	NA	Endocrinology	026	PHYSICIANS	24592	67	Endocrinology	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
16217	Fee-for-Service	1194707612	1194707612	1	1	GALKOWSKI, JOE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12303 DEPAUL DR	None	BRIDGETON	MO	63044	2512	00	None	38.750967	-90.4336785	St. Louis County
16252	Fee-for-Service	1316499239	1316499239	1	1	GALINATO, DENA L PHD	12/13/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
16266	Fee-for-Service	1447277371	1447277371	1	1	GABBAY, MOJAN MD	9/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	86936	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
16282	Fee-for-Service	1790863348	1790863348	1	1	GASPARINI, MARK E MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	62898	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
16288	Fee-for-Service	1548551641	1548551641	1	1	GHIMIRE, LAXMI MD	2/28/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	127727	None	None	0	In state provider	None	726 MEDICAL CENTER	STE 209	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
16308	Fee-for-Service	1306898937	1306898937	1	1	GRABER, KEVIN MD	7/31/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	79141	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
16323	Fee-for-Service	1114318821	1114318821	1	1	GARFIELD BEACH CVS LLC	12/13/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	474 WINTON PKWY	None	LIVINGSTON	CA	95334	9809	24	06047	37.38639368	-120.7371066	Merced County
16357	Fee-for-Service	1992727689	1992727689	2	1	GARFIELD BEACH CVS LLC	1/30/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3173 E SHIELDS AVE	None	FRESNO	CA	93726	6902	10	06019	36.77966576	-119.7709687	Fresno County
16379	Fee-for-Service	1336430156	1336430156	1	1	GEORGE, CHRISTOPHER E MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142622	01	General Practice	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
16381	Fee-for-Service	1982927174	1982927174	1	1	GRODAN, PAUL J MD A	12/14/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30279	41	Internal Medicine	0	In state provider	PROFESSIONAL	150 N ROBERTSON BLVD	STE 211	BEVERLY HILLS	CA	90211	2142	19	06037	34.06812722	-118.3837146	Los Angeles County
16392	Fee-for-Service	1770693087	1770693087	1	1	GRAMES, GEORGE M MD	3/19/1974	207RN0300X	NA	Nephrology	026	PHYSICIANS	9288	45	Nephrology (Renal-Kidney)	0	In state provider	None	LOMA LINDA UNIVERSITY	None	LOMA LINDA	CA	92354	2741	36	06071	34.052004	-117.2698814	San Bernardino County
16409	Fee-for-Service	1720210289	1720210289	1	1	GRAVELY, LANCE E MD INC	12/1/2009	193400000X	NA	Other	026	PHYSICIANS	87871	None	None	0	In state provider	None	50 ALESSANDRO PLACE	STE 340	PASADENA	CA	91105	3148	19	06037	34.13101049	-118.151532	Los Angeles County
16439	Fee-for-Service	1730664244	1730664244	1	1	GARRETT, ALISON B RCP	11/12/2018	2279C0205X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	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
16448	Fee-for-Service	1205129020	1205129020	1	1	GRANT, CHANEL R LMFT	5/6/2019	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
16463	Fee-for-Service	1699832725	1699832725	1	1	GRANBERRY, LAURIE K NP	7/10/2020	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
16464	Fee-for-Service	1003286022	1003286022	1	1	GARNETT, KEVIN P	9/3/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4045 LONE TREE WAY	SUITE D	ANTIOCH	CA	94531	6206	07	06013	37.976122	-121.8012402	Contra Costa County
16471	Fee-for-Service	1679726236	1679726236	1	1	GARFIELD BEACH CVS LLC	12/8/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1102 N DEMAREE ST	None	VISALIA	CA	93291	9415	54	06107	36.339552	-119.331369	Tulare County
16480	Fee-for-Service	1669417556	1669417556	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7915 FLORENCE AVE	None	DOWNEY	CA	90240	3801	19	06037	33.95424264	-118.1313464	Los Angeles County
16491	Fee-for-Service	1538232905	1538232905	1	1	GOLDMAN, GERALD D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38042	10	Gastroenterology (M.D. only)	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 104	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
16499	Fee-for-Service	1124087846	1124087846	1	1	GENTILE, MICHAEL A DPM	8/2/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
16511	Fee-for-Service	1407175334	1407175334	1	1	GOLSHAN MOMENI, MARYAM MD	3/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108334	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
16519	Fee-for-Service	1306233937	1306233937	1	1	GOMEZ, LISSETTE P MD	9/15/2022	2086S0127X	NA	General Surgery	026	PHYSICIANS	147665	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
16535	Fee-for-Service	1649306481	1649306481	1	1	GILL, KULWANT K NP	5/23/2017	No Taxonomy Provided	NA	None	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
16550	Fee-for-Service	1467981480	1467981480	1	1	GATES, KARAMJIT R LMFT	2/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
16594	Fee-for-Service	1235705989	1235705989	1	1	GLISSON, TIFFANY L LCSW	4/9/2024	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
16616	Fee-for-Service	1063794923	1063794923	1	1	GARCIA, DENISE D LCSW	7/13/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	286 EUCLID AVE	STE 302	SAN DIEGO	CA	92114	3613	37	06073	32.70706919	-117.0850896	San Diego County
16638	Fee-for-Service	1720088123	1720088123	1	1	GUADALUPE REGIONAL	6/22/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	1215 E COURT ST	None	SEGUIN	TX	78155	5129	00	None	29.569055	-97.94688981	Guadalupe County
16650	Fee-for-Service	1205852209	1205852209	1	1	GOOD SAMARITAN HOSP	8/15/1989	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	901 OLIVE DR	None	BAKERSFIELD	CA	93308	4144	15	06029	35.41225153	-119.0396655	Kern County
16662	Fee-for-Service	1043250566	1043250566	2	1	GENESEN, MARK C MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61853	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON STREET	SUITE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
16663	Fee-for-Service	1598865388	1598865388	1	1	GOLKARIEH, NARSIS MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88808	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
16677	Fee-for-Service	1770693087	1770693087	1	1	GRAMES, GEORGE M MD	3/19/1974	207RN0300X	NA	Nephrology	026	PHYSICIANS	9288	30	Radiology	0	In state provider	None	LOMA LINDA UNIVERSITY	None	LOMA LINDA	CA	92354	2741	36	06071	34.052004	-117.2698814	San Bernardino County
16708	Fee-for-Service	1851490445	1851490445	1	1	GOLDEN STATE EYE CENTER	6/12/2017	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1001 TOWER WAY	STE 150	BAKERSFEILD	CA	93309	1586	15	06029	35.36363292	-119.0611362	Kern County
16720	Fee-for-Service	1396713434	1396713434	1	1	GOODWIN, MARK C MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70773	08	Family Practice	0	In state provider	None	741 N MAIN ST	None	CEDARVILLE	CA	96104	0000	25	06049	41.53220678	-120.1718287	Modoc County
16748	Fee-for-Service	1063583037	1063583037	1	1	GLAZER, SIDNEY M MD	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30174	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
16749	Fee-for-Service	1790322618	1790322618	1	1	GARCIA, JENNIFER A NP	6/21/2023	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
16759	Fee-for-Service	1578676573	1578676573	1	1	GARAY, ALON A	8/31/1990	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	65061	20	Orthopedic Surgery	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
16762	Fee-for-Service	1689792277	1689792277	1	1	GARCIA, GLORIA L LCSW	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22963	-	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
16792	Fee-for-Service	1063438471	1063438471	1	1	GEMMEL, PETER S MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93278	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
16798	Fee-for-Service	1700343415	1700343415	1	1	GRIZOFFI, SHAWNA C LMFT	3/24/2025	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
16800	Fee-for-Service	1174615629	1174615629	1	1	GHADIMI, KAMRAN MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	50028	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1412 W 7TH ST	None	SAN PEDRO	CA	90732	3507	19	06037	33.73794546	-118.3081455	Los Angeles County
16856	Fee-for-Service	1144455957	1144455957	2	1	GARFIELD BEACH CVS LLC	4/20/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3150 BUSINESS PARK DR	None	VISTA	CA	92081	8520	37	06073	33.13620809	-117.2299612	San Diego County
16869	Fee-for-Service	1841532603	1841532603	1	1	GUSMAN, MARIYA MD	3/3/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170590	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
16912	Fee-for-Service	1326677485	1326677485	1	1	GADIA, JENNY PT	11/30/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3756 W AVE 40	SUITE 2B	LOS ANGELES	CA	90065	3667	19	06037	34.11925081	-118.2278334	Los Angeles County
16924	Fee-for-Service	1720088123	1720088123	1	1	GUADALUPE REGIONAL	3/11/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	1215 E COURT ST	None	SEGUIN	TX	78155	5129	00	None	29.569055	-97.94688981	Guadalupe County
16937	Fee-for-Service	1205852209	1205852209	1	1	GOOD SAMARITAN HOSP	8/15/1989	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	901 OLIVE DR	None	BAKERSFIELD	CA	93308	4144	15	06029	35.41225153	-119.0396655	Kern County
16958	Fee-for-Service	1891900866	1891900866	1	1	GUPTA, NAVEEN K MD	7/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99310	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
16976	Fee-for-Service	1215096771	1215096771	1	1	GOLD, HOWARD J MD	3/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	66396	78	Neoplastic Diseases/Oncology	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
16979	Fee-for-Service	1588087357	1588087357	1	1	GV CONGREGATE LIVING INC	7/31/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3027 W AVE L-8	None	LANCASTER	CA	93536	3405	19	06037	34.6603263	-118.1839097	Los Angeles County
17042	Fee-for-Service	1669480083	1669480083	1	1	GORDON, BRENT M MD	6/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85016	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
17055	Fee-for-Service	1174957088	1174957088	1	1	GRAPEVINE HOME HEALTH	7/22/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	462 CORONA MALL	SUITE 101	CORONA	CA	92879	1455	33	06065	33.87671529	-117.5663099	Riverside County
17062	Fee-for-Service	1386624807	1386624807	1	1	GANSAEUER, MICHAEL A MD	8/17/2001	2084N0400X	NA	Neurology	026	PHYSICIANS	66954	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
17067	Fee-for-Service	1629253927	1629253927	1	1	GRECO, REBECCA J MD	9/10/2008	207R00000X	NA	Other	026	PHYSICIANS	94961	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
17084	Fee-for-Service	1548400567	1548400567	1	1	GUNTKOWSKI, ASHLEY CNMW	8/26/2011	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	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
17090	Fee-for-Service	1629145164	1629145164	1	1	GRAHAM, KENNETH S DC	10/15/2018	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2191 EL CAMINO REAL	STE 105	OCEANSIDE	CA	92054	6625	37	06073	33.18725135	-117.3284665	San Diego County
17124	Fee-for-Service	1376565119	1376565119	1	1	GREEN, JEFFREY P MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54103	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
17137	Fee-for-Service	1295848059	1295848059	1	1	GO, ADAMSON G MD INC	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69542	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
17148	Fee-for-Service	1275597452	1275597452	1	1	GUNASEKERA, CHRISTOPHER	4/1/2003	207R00000X	NA	Other	026	PHYSICIANS	41868	41	Internal Medicine	0	In state provider	PHYSICARE	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
17168	Fee-for-Service	1275708448	1275708448	1	1	GALLINGER, DIANE E	2/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6117 BROCKTON AVE	STE 102	RIVERSIDE	CA	92506	2282	33	06065	33.959448	-117.396799	Riverside County
17190	Fee-for-Service	1720543671	1720543671	1	1	GENOA HEALTHCARE, LLC	7/1/2019	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17782 COWAN STREET	SUITE G	IRVINE	CA	92614	6049	30	06059	33.69590054	-117.862371	Orange County
17221	Fee-for-Service	1841903739	1841903739	1	1	GARCIA, TEODORA CNP	4/17/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	301 N PRAIRIE AVENUE	SUITE 611	INGLEWOOD	CA	90301	4513	19	06037	33.965712	-118.3439965	Los Angeles County
17224	Fee-for-Service	1477567683	1477567683	1	1	GOODSTEIN, JORDAN H MD	1/31/1979	174400000X	NA	Other	026	PHYSICIANS	21688	02	General Surgery	0	In state provider	None	3831 HUGHES AVE	STE 603	CULVER CITY	CA	90232	6846	19	06037	34.02243278	-118.3981492	Los Angeles County
17228	Fee-for-Service	1528326196	1528326196	1	1	GRAY, CARMEN LCSW	6/20/2020	171M00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 N SUTTER ST	None	STOCKTON	CA	95202	1506	39	06077	37.96541565	-121.2891842	San Joaquin County
17246	Fee-for-Service	1326070046	1326070046	1	1	GALANG, CARMELINO L MD	10/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	38507	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
17265	Fee-for-Service	1215096771	1215096771	1	1	GOLD, HOWARD J MD	3/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	66396	68	Hematology	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
17272	Fee-for-Service	1437377280	1437377280	1	1	GARCIA TOCA, MANUEL MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133988	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2205	43	06085	37.43304542	-122.1759654	Santa Clara County
17278	Fee-for-Service	1013180488	1013180488	1	1	GREGG, JENNIFER PHD	2/24/2020	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
17283	Fee-for-Service	1588773295	1588773295	1	1	GRUBBS, KENNETH E DO	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	6349	01	General Practice	0	In state provider	None	867 S TUSTIN STREET	None	ORANGE	CA	92866	3426	30	06059	33.774102	-117.835733	Orange County
17295	Fee-for-Service	1972681617	1972681617	1	1	GRENNAN, TIM W MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49590	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
17310	Fee-for-Service	1760563068	1760563068	1	1	GRIFFITHS, KENNETH J MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52451	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
17333	Fee-for-Service	1154381267	1154381267	1	1	GUARDIAN ANGEL HOME	4/28/2005	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH AGENCY, INC	980 ENCHANTED WAY	SUITE 206	SIMI VALLEY	CA	93065	0913	56	06111	34.28347675	-118.7826819	Ventura County
17356	Fee-for-Service	1629253927	1629253927	1	1	GRECO, REBECCA J MD	9/10/2008	207R00000X	NA	Other	026	PHYSICIANS	94961	40	Pediatrics	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
17366	Fee-for-Service	1205394608	1205394608	1	1	GONG, NATHANAEL DO	3/1/2024	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
17399	Fee-for-Service	1790947950	1790947950	1	1	GARFIELD BEACH CVS, LLC	10/31/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27310 BASELINE	None	HIGHLAND	CA	92346	3252	36	06071	34.12126552	-117.208026	San Bernardino County
17440	Fee-for-Service	1275597452	1275597452	1	1	GUNASEKERA, CHRISTOPHER	4/1/2003	207R00000X	NA	Other	026	PHYSICIANS	41868	06	Cardiovascular Disease (M.D. only)	0	In state provider	PHYSICARE	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
17497	Fee-for-Service	1720591589	1720591589	1	1	GERAGHTY, NORA NP	12/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
17517	Fee-for-Service	1962813543	1962813543	2	1	GARFIELD BEACH CVS LLC	10/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30740 RUSSELL RANCH RD	None	WESTLAKE VILLAGE	CA	91362	6399	19	06037	34.14858811	-118.7952614	Los Angeles County
17539	Fee-for-Service	1508941923	1508941923	1	1	GENUS HOME CARE, INC	8/9/2001	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1476 W 9TH STREET	STE B-1	UPLAND	CA	91786	5699	36	06071	34.09595647	-117.6773265	San Bernardino County
17544	Fee-for-Service	1730528266	1730528266	1	1	GOLDSMITH, SCOTT R MD	7/8/2021	207RH0000X	NA	Hematology	026	PHYSICIANS	172328	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
17546	Fee-for-Service	1477961084	1477961084	1	1	GAVIN, MICHELLE A DO	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13804	08	Family Practice	0	In state provider	None	5900 STATE FARM DRIVE	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
17549	Fee-for-Service	1558916379	1558916379	1	1	GARFIELD BEACH CVS LLC	11/12/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1010 N. PEPPER AVE	None	COLTON	CA	92324	1806	36	06071	34.0781471	-117.3528957	San Bernardino County
17653	Fee-for-Service	1689894487	1689894487	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1405 CALIFORNIA AVE	None	DOS PALOS	CA	93620	2300	24	06047	36.98665246	-120.6290163	Merced County
17659	Fee-for-Service	1982629036	1982629036	1	1	GRANET, DAVID B MD	6/30/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	77597	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
17740	Fee-for-Service	1962504423	1962504423	1	1	GOVENDER, SHAMINI M MD	1/2/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52845	40	Pediatrics	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
17803	Fee-for-Service	1538181144	1538181144	2	1	GARFIELD BEACH CVS LLC	4/19/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4300 LAS POSITAS RD	None	LIVERMORE	CA	94551	9641	01	06001	37.70050406	-121.7471549	Alameda County
17862	Fee-for-Service	1811302664	1811302664	1	1	GRIGMAR HOSPICE AND	5/23/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	14640 VICTORY BLVD	STE 208	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
17888	Fee-for-Service	1043252232	1043252232	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	233 E WILLOW ST	None	LONG BEACH	CA	90806	2623	19	06037	33.80447104	-118.1909935	Los Angeles County
17897	Fee-for-Service	1427310366	1427310366	1	1	GUTIERREZ SHERMAN, VIOLETA	4/22/2020	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	155235	20	Orthopedic Surgery	0	In state provider	MD	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
17930	Fee-for-Service	1164608063	1164608063	1	1	GOEL, MANISHA MD	5/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100939	None	None	0	In state provider	None	1801 W ROMNEYA DR	STE 409	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
17938	Fee-for-Service	1982629036	1982629036	1	1	GRANET, DAVID B MD	6/30/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	77597	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
17991	Fee-for-Service	1457384604	1457384604	1	1	GARABEDIAN, MELINDA J PHD	2/26/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	28348 ROADSIDE DR.	SUITE 201	AGOURA HILLS	CA	91301	2596	19	06037	34.1428141	-118.7445098	Los Angeles County
17998	Fee-for-Service	1821141359	1821141359	1	1	GUILLEMINAULT, C MD	8/12/1982	2084P0800X	NA	Psychiatry	026	PHYSICIANS	32807	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
18002	Fee-for-Service	1205280872	1205280872	1	1	GOFF, ALAN D DO	1/10/2020	207P00000X	NA	Other	026	PHYSICIANS	16686	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
18028	Fee-for-Service	1285963793	1285963793	1	1	GIANNAKIDIS, DIMITRIOS MD	10/5/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	171628	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
18029	Fee-for-Service	1770832230	1770832230	1	1	GRIFFIN, MATTHEW J MD	9/1/2019	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	122583	20	Orthopedic Surgery	0	In state provider	None	611 ABBOTT ST	100	SALINAS	CA	93901	4389	27	06053	36.66192801	-121.6413283	Monterey County
18035	Fee-for-Service	1275843765	1275843765	1	1	GREWAL, DAMANPREET K MD	5/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133855	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
18036	Fee-for-Service	1053690743	1053690743	1	1	GARCIA-MONDRAGON, ESBEIDE L	10/2/2019	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	256 CAJON ST	SUITE E	REDLANDS	CA	92373	5278	36	06071	34.05204454	-117.1802319	San Bernardino County
18047	Fee-for-Service	1952388647	1952388647	1	1	GALLAGHER, TIMOTHY A MD	2/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	700 SOUTH J STREET	None	LAKEVIEW	OR	97630	1623	00	None	42.181335	-120.351489	Lake County
18091	Fee-for-Service	1306477864	1306477864	1	1	GARFIELD BEACH CVS LLC	3/9/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1982 OLD MISSION DR	None	SOLVANG	CA	93463	2304	42	06083	34.59921877	-120.1299096	Santa Barbara County
18092	Fee-for-Service	1255694196	1255694196	1	1	GUO, THERESA MD	11/13/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	170293	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
18105	Fee-for-Service	1538686597	1538686597	1	2	GENENTOX LABORATORIES LLC	10/10/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	2001 E 1ST ST	STE 109	SANTA ANA	CA	92705	4020	30	06059	33.74572853	-117.8385885	Orange County
18115	Fee-for-Service	1457329732	1457329732	1	1	GUPTA, NEERAJ MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75095	None	None	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
18148	Fee-for-Service	1841778255	1841778255	1	1	GELUZ, FRANCIA B RCP	8/27/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18152	Fee-for-Service	1811302664	1811302664	1	1	GRIGMAR HOSPICE AND	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	14640 VICTORY BLVD	STE 208	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
18167	Fee-for-Service	1386822377	1386822377	1	1	GILLIS, DOMINIQUE A LMFT	10/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
18176	Fee-for-Service	1023101557	1023101557	1	1	GRUSHKIN, CARL M MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	13885	45	Nephrology (Renal-Kidney)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
18222	Fee-for-Service	1972548774	1972548774	2	1	GARFIELD BEACH CVS LLC	1/5/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20 E ORANGE GROVE BLVD	None	PASADENA	CA	91103	3416	19	06037	34.15777532	-118.1502709	Los Angeles County
18332	Fee-for-Service	1700079316	1700079316	1	1	GONZALES, COREY S PHD	1/16/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2920 H STREET	SUITE 108	BAKERSFIELD	CA	93301	1943	15	06029	35.38622993	-119.0210971	Kern County
18340	Fee-for-Service	1336339555	1336339555	1	1	GADDIPATI, HIMABINDU C MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120992	78	Neoplastic Diseases/Oncology	0	In state provider	None	7930 FROST ST	STE 405	SAN DIEGO	CA	92123	2759	37	06073	32.80027001	-117.1532893	San Diego County
18388	Fee-for-Service	1215644992	1215644992	1	1	GARCIA, STEPHANIE A NP	2/14/2023	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
18411	Fee-for-Service	1013952902	1013952902	1	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6360 WEST THIRD ST	None	LOS ANGELES	CA	90036	3155	19	06037	34.07132518	-118.3601082	Los Angeles County
18428	Fee-for-Service	1730178278	1730178278	1	1	GARRETT, WAYNE C MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64587	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
18434	Fee-for-Service	1558343038	1558343038	1	1	GROVE, ANDERSEN, GHIRINGHELL	2/3/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	D SPORTS THERAPY	860 SOUTHAMPTON RD	None	BENICIA	CA	94510	1907	48	06095	38.06686461	-122.1665031	Solano County
18438	Fee-for-Service	1063938470	1063938470	1	1	GHC OF WALNUT CREEK LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1224 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87855195	-122.0701068	Contra Costa County
18449	Fee-for-Service	1013785518	1013785518	1	1	GOMEZ, JESSICA	10/25/2024	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
18462	Fee-for-Service	1639602303	1639602303	1	1	GOODMAN, LEAH MD	1/17/2022	207R00000X	NA	Other	026	PHYSICIANS	159936	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
18463	Fee-for-Service	1023101557	1023101557	1	1	GRUSHKIN, CARL M MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	13885	01	General Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
18509	Fee-for-Service	1902413735	1902413735	1	1	GOLDEN AGE HOSPICE &	12/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	15300 VENTURA BLVD	STE 200A	SHERMAN OAKS	CA	91403	3136	19	06037	34.15387425	-118.4666626	Los Angeles County
18522	Fee-for-Service	1740484773	1740484773	1	1	GUSHIKEN, LYNNE M	5/4/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
18554	Fee-for-Service	1225118177	1225118177	1	1	GROOTENDORST, DAVID H DC	2/14/2001	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	900 W YOSEMITE AVE	None	MADERA	CA	93637	4555	20	06039	36.95534722	-120.0691832	Madera County
18558	Fee-for-Service	1467488015	1467488015	1	1	GITLITZ, BARBARA J MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	70326	68	Hematology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
18570	Fee-for-Service	1124136734	1124136734	1	1	GAITAN, JOHN G MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74787	40	Pediatrics	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
18584	Fee-for-Service	1386217883	1386217883	1	1	GALLAGHER, CONNER M NP	11/22/2021	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
18608	Fee-for-Service	1447566591	1447566591	1	1	GUERRIER, CLAUDE E MD	10/8/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172447	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
18615	Fee-for-Service	1770506925	1770506925	1	1	GREELY, RONALD M MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	28928	05	Anesthesiology	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
18621	Fee-for-Service	1790982213	1790982213	1	1	GARCIA, ERIKA LMFT	3/6/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
18627	Fee-for-Service	1336339555	1336339555	1	1	GADDIPATI, HIMABINDU C MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120992	68	Hematology	0	In state provider	None	7930 FROST ST	STE 405	SAN DIEGO	CA	92123	2759	37	06073	32.80027001	-117.1532893	San Diego County
18709	Fee-for-Service	1932567062	1932567062	1	1	GUTIERREZ, JESSICA	12/4/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
18727	Fee-for-Service	1689837031	1689837031	1	1	GUTIERREZ, MALINTZE DO	3/27/2020	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	11099	39	Preventive (M.D. only)	0	In state provider	None	5575 RUFFIN RD	STE 100	SAN DIEGO	CA	92123	1380	37	06073	32.83605627	-117.1266464	San Diego County
18740	Fee-for-Service	1104933985	1104933985	1	1	GNANADEV, APPANNAGARI MD	1/1/1982	208600000X	NA	General Surgery	026	PHYSICIANS	35743	02	General Surgery	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
18798	Fee-for-Service	1902413735	1902413735	1	1	GOLDEN AGE HOSPICE &	12/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	15300 VENTURA BLVD	STE 200A	SHERMAN OAKS	CA	91403	3136	19	06037	34.15387425	-118.4666626	Los Angeles County
18833	Fee-for-Service	1154512663	1154512663	1	1	GREWAL, SONIA R MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95350	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
18834	Fee-for-Service	1629016894	1629016894	1	1	GUREVITCH, MICHAEL J MD	4/15/2005	207RP1001X	NA	Pulmonology	026	PHYSICIANS	50403	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	39 CONGRESS ST	STE 201	PASADENA	CA	91105	3022	19	06037	34.13407645	-118.151226	Los Angeles County
18838	Fee-for-Service	1730163734	1730163734	1	1	GOLDEN VALLEY HEALTH CTR	11/10/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	24	06047	37.06376226	-120.860675	Merced County
18844	Fee-for-Service	1467488015	1467488015	1	1	GITLITZ, BARBARA J MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	70326	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
18922	Fee-for-Service	1619520491	1619520491	1	1	GREEN, CAMERON LCSW	2/3/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2525 W WASHINGTON BLVD	104	LOS ANGELES	CA	90018	1247	19	06037	34.03992146	-118.3185405	Los Angeles County
18925	Fee-for-Service	1902564057	1902564057	1	1	GALLO, CRISTINA PT	12/27/2022	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
18937	Fee-for-Service	1003178484	1003178484	1	1	GALLEGOS, MARIA P LPCC	6/18/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	PCC 7731	8300 UTICA AVE	155	RANCHO CUCAMONGA	CA	91730	3879	36	06071	34.10227306	-117.5715643	San Bernardino County
18987	Fee-for-Service	1336545706	1336545706	1	1	GLOBAL MEDICAL SERVICE	11/1/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11818 SOUTH STREET	SUITE 201	CERRITOS	CA	90703	6848	19	06037	33.85844679	-118.081166	Los Angeles County
19009	Fee-for-Service	1386151769	1386151769	1	1	GOLDEN STATE HEARING AID	3/28/2018	193400000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	200 W ROSEBURG AVE	SUITE B2	MODESTO	CA	95350	5200	50	06099	37.66005508	-120.995031	Stanislaus County
19022	Fee-for-Service	1134141914	1134141914	2	1	GARFIELD BEACH CVS LLC	12/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1925 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3834	31	06061	38.746188	-121.2545025	Placer County
19046	Fee-for-Service	1396926937	1396926937	1	3	GONG, YIN-JIA MEDICAL	3/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56519	None	None	0	In state provider	CORPORATION	112 N RIVERSIDE AVE	None	RIALTO	CA	92376	5922	36	06071	34.10124678	-117.3705407	San Bernardino County
19082	Fee-for-Service	1760196133	1760196133	1	1	GLOSMAN, JACQUELINE LMFT	4/24/2024	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
19095	Fee-for-Service	1851356018	1851356018	1	1	GELMAN, LEV MD	2/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53616	41	Internal Medicine	0	In state provider	None	777-A FLOWER ST	None	GLENDALE	CA	91201	3000	19	06037	34.15802552	-118.2812712	Los Angeles County
19122	Fee-for-Service	1629016894	1629016894	1	1	GUREVITCH, MICHAEL J MD	4/15/2005	207RP1001X	NA	Pulmonology	026	PHYSICIANS	50403	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39 CONGRESS ST	STE 201	PASADENA	CA	91105	3022	19	06037	34.13407645	-118.151226	Los Angeles County
19127	Fee-for-Service	1730163734	1730163734	1	1	GOLDEN VALLEY HEALTH CTR	10/18/2024	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	24	06047	37.06376226	-120.860675	Merced County
19169	Fee-for-Service	1124040753	1124040753	2	1	GARFIELD BEACH CVS LLC	7/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	5104	19	06037	33.8884322	-118.3959069	Los Angeles County
19199	Fee-for-Service	1790280592	1790280592	1	1	GASPARIAN, SUZIE	4/15/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	164468	18	Ophthalmology	0	In state provider	None	25395 HANCOCK AVE	STE 100	MURRIETA	CA	92562	9054	33	06065	33.5591482	-117.185187	Riverside County
19217	Fee-for-Service	1134536402	1134536402	1	1	GHIO, ANDREA M LMFT	9/19/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	624 W 9TH ST STE 202	None	SAN PEDRO	CA	90731	3158	19	06037	33.73607853	-118.290789	Los Angeles County
19275	Fee-for-Service	1609108083	1609108083	1	2	GENESIS AMBULATORY SURGERY	9/25/2017	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	26781 PORTOLA PARKWAY	SUITE 4-E	FOOTHILL RANCH	CA	92610	1758	30	06059	33.6785505	-117.6626791	Orange County
19282	Fee-for-Service	1598792764	1598792764	1	1	GABSTER, ALAN A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	500 WEST BROADWAYART INS	500 WEST BROADWAY	SUITE 320	MISSOULA	MT	59802	4031	00	None	46.874889	-114.000444	Missoula County
19286	Fee-for-Service	1619509650	1619509650	1	1	GREEN, KORI N CCC-SLP	4/7/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
19296	Fee-for-Service	1629252457	1629252457	1	1	GOROZA, EDMUND R MD	10/11/2013	No Taxonomy Provided	NA	None	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
19301	Fee-for-Service	1205522596	1205522596	1	1	GOOLIX LLC	6/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11916 FOOTHILL BLVD	None	LAKE VIEW TERRACE	CA	91342	7101	19	06037	34.27530279	-118.3960027	Los Angeles County
19310	Fee-for-Service	1982246575	1982246575	1	3	GOLDEN STATE HEART & VASCULA	11/19/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	ENTER, INC.	65 NIELSON STREET	SUITE 135	WATSONVILLE	CA	95076	2461	44	06087	36.9282117	-121.7933197	Santa Cruz County
19363	Fee-for-Service	1710909411	1710909411	2	1	GARFIELD BEACH CVS LLC	3/2/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 SPRECKELS AVE	None	MANTECA	CA	95336	6005	39	06077	37.79427501	-121.1977728	San Joaquin County
19410	Fee-for-Service	1629016894	1629016894	1	1	GUREVITCH, MICHAEL J MD	4/15/2005	207RP1001X	NA	Pulmonology	026	PHYSICIANS	50403	41	Internal Medicine	0	In state provider	None	39 CONGRESS ST	STE 201	PASADENA	CA	91105	3022	19	06037	34.13407645	-118.151226	Los Angeles County
19484	Fee-for-Service	1174304372	1174304372	1	1	GARFIELD BEACH CVS, L.L.C.	8/1/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4301 PARK BLVD	None	SAN DIEGO	CA	92103	0000	37	06073	32.75537276	-117.1462264	San Diego County
19487	Fee-for-Service	1710920947	1710920947	1	1	GOPALAKRISHNAN, RAJALAKSHMI	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56161	41	Internal Medicine	0	In state provider	T MD	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
19542	Fee-for-Service	1992247936	1992247936	1	1	GOSLINGA, TYLER J PT	4/21/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1222 W COLONY RD	STE 130	RIPON	CA	95366	9480	39	06077	37.75395862	-121.136171	San Joaquin County
19563	Fee-for-Service	1710542824	1710542824	2	1	GROSSMAN, LEAH E MD	6/9/2023	207R00000X	NA	Other	026	PHYSICIANS	178486	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
19566	Fee-for-Service	1427057959	1427057959	1	1	GARWOOD, JOHN L MD	2/8/2015	193400000X	NA	Other	026	PHYSICIANS	49986	18	Ophthalmology	0	In state provider	None	1301 20TH ST	STE 250	SANTA MONICA	CA	90404	2052	19	06037	34.02976782	-118.4812493	Los Angeles County
19582	Fee-for-Service	1427100650	1427100650	1	1	GABRIELE, LAURA A MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65260	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
19643	Fee-for-Service	1346262870	1346262870	1	1	GEORGE THOMAS SHIRES III MD	4/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8230 WALNUT HILL LN	STE 408	DALLAS	TX	75231	4425	00	None	32.880555	-96.761079	Dallas County
19703	Fee-for-Service	1508019704	1508019704	1	1	GUZMAN, LIZETTE LCSW	6/23/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1130 L ST	B	MODESTO	CA	95354	0893	50	06099	37.64366499	-121.0009345	Stanislaus County
19727	Fee-for-Service	1669734604	1669734604	1	1	GUNN PSYCHOLOGICAL SERVICES,	1/26/2024	103G00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC.	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
19730	Fee-for-Service	1306058151	1306058151	1	1	GHUMAN, MANDEEP S MD	3/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108800	08	Family Practice	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4100	19	06037	34.2206967	-118.5342638	Los Angeles County
19778	Fee-for-Service	1710920947	1710920947	1	1	GOPALAKRISHNAN, RAJALAKSHMI	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56161	13	Neurology (M.D. only)	0	In state provider	T MD	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
19786	Fee-for-Service	1033426028	1033426028	1	1	GRACE FAMILY HEALTH INC	11/8/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66038	08	Family Practice	0	In state provider	None	24910 LAS BRISAS ROAD	STE 106	MURRIETA	CA	92562	4010	33	06065	33.57522424	-117.1828078	Riverside County
19805	Fee-for-Service	1679145635	1679145635	1	1	GAMBLE, MICAH MD	3/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
19832	Fee-for-Service	1710390760	1710390760	1	1	GILBERT-AU, CARA E NP	3/2/2018	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
19847	Fee-for-Service	1609155084	1609155084	1	1	GANELIS, IRINA MD PC	11/1/2011	207W00000X	NA	Ophthalmology	026	PHYSICIANS	99531	18	Ophthalmology	0	In state provider	None	16055 VENTURA BLVD	SUITE 690	ENCINO	CA	91436	2631	19	06037	34.15632563	-118.4832351	Los Angeles County
19853	Fee-for-Service	1912625930	1912625930	1	1	GARFIELD BEACH CVS, L.L.C.	3/27/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5731 BICKETT ST	None	HUNTINGTON PARK	CA	90255	2624	19	06037	33.990336	-118.216126	Los Angeles County
19881	Fee-for-Service	1588712400	1588712400	1	1	GEIS, WILLIAM D MD	2/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81997	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
19910	Fee-for-Service	1013958925	1013958925	1	1	GARFIELD BEACH CVS, LLC	9/30/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8225 GARVEY AVE.	None	ROSEMEAD	CA	91770	2551	19	06037	34.06267846	-118.089801	Los Angeles County
19915	Fee-for-Service	1386806834	1386806834	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4500 MACDONALD AVE	None	RICHMOND	CA	94805	2307	07	06013	37.93282259	-122.327545	Contra Costa County
19928	Fee-for-Service	1205567211	1205567211	1	1	GANDHI, BUNTY H	11/27/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
19970	Fee-for-Service	1871915736	1871915736	2	1	GARFIELD BEACH CVS LLC	1/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6655 NORTH RIVERSIDE DR	None	FRESNO	CA	93722	9308	10	06019	36.83528878	-119.910112	Fresno County
19984	Fee-for-Service	1972997104	1972997104	1	1	GOVEA, ALAYN MD	8/9/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	145802	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
20006	Fee-for-Service	1801881503	1801881503	1	1	GARRISON, MARK S DO	1/14/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9268	09	Gynecology (D.O. only)	0	In state provider	None	1405 MAGNOLIA AVE	STE A	CHICO	CA	95926	3226	04	06007	39.74046859	-121.8497839	Butte County
20015	Fee-for-Service	1669734604	1669734604	1	1	GUNN PSYCHOLOGICAL SERVICES,	9/25/2018	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC.	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
20023	Fee-for-Service	1831421759	1831421759	1	1	GONZALES, MICHAEL A CRNA	7/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
20033	Fee-for-Service	1477873768	1477873768	1	1	GOLDBERG, JANA MD	1/6/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	175560	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
20068	Fee-for-Service	1033426028	1033426028	1	1	GRACE FAMILY HEALTH INC	11/8/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66038	41	Internal Medicine	0	In state provider	None	24910 LAS BRISAS ROAD	STE 106	MURRIETA	CA	92562	4010	33	06065	33.57522424	-117.1828078	Riverside County
20071	Fee-for-Service	1437103777	1437103777	1	1	GOOD SAMARITAN HOSP, LP	2/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3985	43	06085	37.25111017	-121.9465891	Santa Clara County
20085	Fee-for-Service	1154429355	1154429355	1	1	GIROD, SABINE C MD	5/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85991	02	General Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20094	Fee-for-Service	1942435904	1942435904	1	1	GARFIELD BEACH CVS, LLC	9/16/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5184 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2671	15	06029	35.35430649	-119.0592135	Kern County
20218	Fee-for-Service	1659450864	1659450864	1	1	GOODMAN, HERBERT B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37212	41	Internal Medicine	0	In state provider	None	2186 GEARY BLVD	STE 312	SAN FRANCISCO	CA	94115	3457	38	06075	37.78343395	-122.4392245	San Francisco County
20224	Fee-for-Service	1942289962	1942289962	1	1	GREGORY, RICHARD D MD	11/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75677	02	General Surgery	0	In state provider	None	30 RIVER PARK PL W	STE 260	FRESNO	CA	93720	1547	10	06019	36.85863998	-119.7892053	Fresno County
20256	Fee-for-Service	1821076068	1821076068	1	1	GOERTZEN, TIMOTHY 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	640 JACKSON ST	None	SAINT PAUL	MN	55101	2502	00	None	44.95496967	-93.09587426	Ramsey County
20293	Fee-for-Service	1801881503	1801881503	1	1	GARRISON, MARK S DO	1/14/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9268	02	General Surgery	0	In state provider	None	1405 MAGNOLIA AVE	STE A	CHICO	CA	95926	3226	04	06007	39.74046859	-121.8497839	Butte County
20301	Fee-for-Service	1669734604	1669734604	1	1	GUNN PSYCHOLOGICAL SERVICES,	9/24/2023	103G00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC.	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
20334	Fee-for-Service	1407192206	1407192206	1	1	GASKIN, ALEXIS D MD	9/10/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	162322	20	Orthopedic Surgery	0	In state provider	None	11795 EDUCATION ST	STE 100	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
20335	Fee-for-Service	1609987973	1609987973	1	1	GOKALDAS, RAY MD INC	3/31/1979	174400000X	NA	Other	026	PHYSICIANS	29886	10	Gastroenterology (M.D. only)	0	In state provider	None	12820 STUDEBAKER RD	STE 201	NORWALK	CA	90650	2581	19	06037	33.91419086	-118.0991425	Los Angeles County
20348	Fee-for-Service	1265676043	1265676043	1	1	GOWHARI, DANIEL B DO	10/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
20359	Fee-for-Service	1437103777	1437103777	1	1	GOOD SAMARITAN HOSP, LP	2/1/1999	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3985	43	06085	37.25111017	-121.9465891	Santa Clara County
20361	Fee-for-Service	1003955303	1003955303	1	1	GRAYSON, PAULA S MD	8/1/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72924	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
20371	Fee-for-Service	1295899847	1295899847	1	1	GRAVEN, NADINE E MD	10/6/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79068	None	None	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
20373	Fee-for-Service	1144858705	1144858705	1	1	GOODSON, DAVID A MD	6/30/2023	390200000X	NA	Other	026	PHYSICIANS	177837	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
20374	Fee-for-Service	1205014552	1205014552	1	1	GUZMAN, ETELBERTO LCSW	12/2/2018	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
20382	Fee-for-Service	1316042567	1316042567	1	1	GODBOLE, SHUBHANGI S MD	7/29/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41942	08	Family Practice	0	In state provider	None	12675 LA MIRADA BLVD	STE 200	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
20394	Fee-for-Service	1912526831	1912526831	1	1	GO, ARIEL MD	11/7/2023	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
20425	Fee-for-Service	1891136933	1891136933	1	1	GOLEPANG, JAYFERSON M A MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143216	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
20435	Fee-for-Service	1356752877	1356752877	1	1	GRAND PHARMACY INC	9/25/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	505 S VIRGIL AVE	SUITE 107	LOS ANGELES	CA	90020	1406	19	06037	34.064883	-118.287086	Los Angeles County
20456	Fee-for-Service	1336109891	1336109891	1	1	GREAGER, DICK 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	3460 PIONEER PKWY	None	W VALLEY CITY	UT	84120	2049	00	None	40.697982	-111.9903965	Salt Lake County
20472	Fee-for-Service	1457548190	1457548190	1	1	GUPTA, DEEPA MD	12/19/2007	208M00000X	NA	Other	026	PHYSICIANS	98568	01	General Practice	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
20485	Fee-for-Service	1972115855	1972115855	1	1	GARDNER, BRIAN L RCP	9/10/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	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
20508	Fee-for-Service	1467446195	1467446195	1	2	GRANDE RONDE HOSPITAL INC.	7/1/2019	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	900 SUNSET DR	None	LA GRANDE	OR	97850	1387	00	None	45.31960272	-118.104929	Union County
20536	Fee-for-Service	1154710507	1154710507	1	1	GARCIA, JANET NP	8/12/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
20579	Fee-for-Service	1154762201	1154762201	1	1	GUNDERSEN, ELISABETH T NP	4/5/2016	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
20584	Fee-for-Service	1801881503	1801881503	1	1	GARRISON, MARK S DO	1/14/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9268	34	Urology and Urological Surgery	0	In state provider	None	1405 MAGNOLIA AVE	STE A	CHICO	CA	95926	3226	04	06007	39.74046859	-121.8497839	Butte County
20591	Fee-for-Service	1669734604	1669734604	1	1	GUNN PSYCHOLOGICAL SERVICES,	10/18/2018	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC.	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
20643	Fee-for-Service	1962042879	1962042879	1	1	GIBSON, APRIL LMFT	6/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
20652	Fee-for-Service	1043453376	1043453376	1	1	GREENE, BRANDY N MD	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113668	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
20672	Fee-for-Service	1316042567	1316042567	1	1	GODBOLE, SHUBHANGI S MD	7/29/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41942	41	Internal Medicine	0	In state provider	None	12675 LA MIRADA BLVD	STE 200	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
20680	Fee-for-Service	1073053229	1073053229	1	1	GIOIENI, SHURIEE	3/14/2023	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
20701	Fee-for-Service	1477785152	1477785152	1	1	GEORGE-CABALLERO, JESSICA L	3/5/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
20723	Fee-for-Service	1922241736	1922241736	1	1	GHATTAS, MAURICE S MD APC	5/5/2005	193400000X	NA	Other	026	PHYSICIANS	35441	01	General Practice	0	In state provider	None	11180 WARNER AVE	STE 259	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
20749	Fee-for-Service	1609248202	1609248202	1	1	GOODMAN, JESSE NP	4/7/2020	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
20751	Fee-for-Service	1760688139	1760688139	1	1	GRABLE, BENJAMIN R 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
20764	Fee-for-Service	1811044498	1811044498	1	1	GOMEZ, PATRICIA C LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
20795	Fee-for-Service	1740798404	1740798404	1	1	GOMEZ CARRANZA, PEDRO LPCC	4/17/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
20797	Fee-for-Service	1467446195	1467446195	1	2	GRANDE RONDE HOSPITAL INC.	7/1/2019	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	900 SUNSET DR	None	LA GRANDE	OR	97850	1387	00	None	45.31960272	-118.104929	Union County
20801	Fee-for-Service	1902837719	1902837719	1	1	GUPTA, ANJALI MD	2/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84836	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
20838	Fee-for-Service	1417158114	1417158114	1	1	GOLDBERG, JEFFREY L MD	1/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124021	18	Ophthalmology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20841	Fee-for-Service	1528295235	1528295235	1	1	GARCIA RODRIGUEZ, MILDRED D	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136938	41	Internal Medicine	0	In state provider	MD	300 PASTEUR DR	MC5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20878	Fee-for-Service	1669734604	1669734604	1	1	GUNN PSYCHOLOGICAL SERVICES,	6/14/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC.	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
20884	Fee-for-Service	1619499050	1619499050	1	1	GHADIMI, TALA S DO	9/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17248	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
20891	Fee-for-Service	1982643060	1982643060	1	1	GO, JOHN LOUIE	7/19/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79525	None	None	0	In state provider	None	1200 N STATE ST	STE 3550	LOS ANGELES	CA	90089	0285	19	06037	34.05855992	-118.209755	Los Angeles County
20959	Fee-for-Service	1316042567	1316042567	1	1	GODBOLE, SHUBHANGI S MD	7/29/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41942	01	General Practice	0	In state provider	None	12675 LA MIRADA BLVD	STE 200	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
20966	Fee-for-Service	1174094932	1174094932	1	1	GOMEZ, ADRIANA A LMFT	4/25/2019	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
20971	Fee-for-Service	1588168108	1588168108	1	1	GRUSHCHAK, SOLOMIYA	4/4/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	177233	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20991	Fee-for-Service	1205217494	1205217494	1	1	GERARDINE, SUPRIYA MD	7/1/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	176112	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
21014	Fee-for-Service	1649231739	1649231739	1	1	GONZALES, MARY E MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90912	41	Internal Medicine	0	In state provider	None	3932 LONG BEACH BLVD	STE B	LONG BEACH	CA	90807	2615	19	06037	33.830325	-118.1893215	Los Angeles County
21017	Fee-for-Service	1457480998	1457480998	1	1	GEPHART, BARBARA I LMFT	7/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2030 HARTNELL AVE	STE D	REDDING	CA	96002	5090	45	06089	40.56375148	-122.333535	Shasta County
21018	Fee-for-Service	1154507374	1154507374	1	1	GARFIELD BEACH CVS, LLC	10/31/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1651 BELLEVUE RD	None	ATWATER	CA	95301	2608	24	06047	37.36046151	-120.611133	Merced County
21019	Fee-for-Service	1083670970	1083670970	1	1	GLENWOOD SURGICAL CENTER	11/1/1995	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LP	8945 MAGNOLIA AVE	STE 200	RIVERSIDE	CA	92503	4436	33	06065	33.92652134	-117.4358795	Riverside County
21047	Fee-for-Service	1821023201	1821023201	1	1	GREENBERG, BRIAN K MD	2/2/2023	2080P0201X	NA	Neurology	026	PHYSICIANS	61421	None	None	0	In state provider	None	18370 BURBANK BLVD	SUITE 307	TARZANA	CA	91356	2804	19	06037	34.17173059	-118.5331881	Los Angeles County
21055	Fee-for-Service	1346374378	1346374378	1	1	GOURLAY, STUART J MD	12/3/2020	208600000X	NA	General Surgery	026	PHYSICIANS	22868	None	None	0	In state provider	None	535 AUTO CENTER DR	None	WATSONVILLE	CA	95076	3745	44	06087	36.9192996	-121.7674357	Santa Cruz County
21064	Fee-for-Service	1699110635	1699110635	1	1	GHANBARI, YASSI MD	10/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175403	None	None	0	In state provider	None	2160 APPIAN WAY	SUITE 200	PINOLE	CA	94564	2565	07	06013	37.99585174	-122.3021549	Contra Costa County
21073	Fee-for-Service	1891722500	1891722500	1	1	GERARD, ANDRE B MD	7/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8016	08	Family Practice	0	In state provider	None	1312 PRENTICE DR	None	HEALDSBURG	CA	95448	3381	49	06097	38.62736288	-122.8667004	Sonoma County
21098	Fee-for-Service	1972805307	1972805307	1	1	GROGAN, KASSIDY A LMFT	9/28/2020	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
21110	Fee-for-Service	1083254205	1083254205	1	1	GONZALEZ, LISA A CRNA	4/7/2020	207L00000X	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
21121	Fee-for-Service	1396728481	1396728481	1	1	GEER,GEOFFREY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	AVISTA EMERG PHYS	3033 S PARKER RD STE 800	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
21129	Fee-for-Service	1528295235	1528295235	1	1	GARCIA RODRIGUEZ, MILDRED D	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136938	10	Gastroenterology (M.D. only)	0	In state provider	MD	300 PASTEUR DR	MC5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
21130	Fee-for-Service	1639531403	1639531403	1	1	GOWER, ARIAN MD	11/4/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	172943	None	None	0	In state provider	None	23928 LYONS AVE	STE 205	NEWHALL	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
21186	Fee-for-Service	1942431069	1942431069	1	1	GUPTA, VINEET MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129028	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
21221	Fee-for-Service	1659501633	1659501633	1	1	GRIFFITH, AMANDA M DO	1/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PKWY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
21262	Fee-for-Service	1992748446	1992748446	1	1	GOLDSTEIN, LAUREL A MD	11/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150267	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
21295	Fee-for-Service	1184882904	1184882904	1	1	GUPTA, ANSHU K MD	8/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87872	02	General Surgery	0	In state provider	None	4077 FIFTH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
21330	Fee-for-Service	1962441758	1962441758	1	1	GERSTEIN, JARED D MD	8/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	33588	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15891 LOS GATOS ALMADEN	None	LOS GATOS	CA	95032	3742	43	06085	37.24361275	-121.9477516	Santa Clara County
21345	Fee-for-Service	1588622955	1588622955	1	1	GAMBIN, JOHN P MD	1/1/1982	2084N0400X	NA	Neurology	026	PHYSICIANS	24766	13	Neurology (M.D. only)	0	In state provider	None	2773 HARRIS ST	STE A	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
21354	Fee-for-Service	1669086211	1669086211	1	1	GEORGE OPTOMETRIC CORP	10/20/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	931 ANZA AVE	B	VISTA	CA	92084	4531	37	06073	33.21215886	-117.2318869	San Diego County
21369	Fee-for-Service	1104320068	1104320068	1	1	GONZALEZ, FRANK MD	10/10/2022	207PP0204X	NA	Other	026	PHYSICIANS	174332	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
21394	Fee-for-Service	1841485919	1841485919	1	1	GILMER, BOBBY R LCSW	7/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
21439	Fee-for-Service	1386778058	1386778058	1	1	GREENLEE, JAMES M DC	1/1/1979	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3720 GRASS VALLEY HWY	None	AUBURN	CA	95602	2002	31	06061	38.95085268	-121.1001173	Placer County
21479	Fee-for-Service	1659312627	1659312627	1	1	GREENE, HENRY R MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	19771	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
21488	Fee-for-Service	1841313772	1841313772	1	1	GARABEDIAN, SHAHE MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103461	41	Internal Medicine	0	In state provider	None	23929 MCBEAN PKWY	STE 216	VALENCIA	CA	91355	4468	19	06037	34.39588575	-118.5538975	Los Angeles County
21507	Fee-for-Service	1821137746	1821137746	1	1	GRASS, JOHN C LMFT	10/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	20535	-	NOT APPLICABLE	0	In state provider	None	1295 W STATE ST	SUITE 101-106	EL CENTRO	CA	92243	2881	13	06025	32.79169087	-115.5674379	Imperial County
21535	Fee-for-Service	1467674176	1467674176	1	1	GUTIERREZ, VERONICA PHD	2/8/2024	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ICA GUTIERREZ, PH.D.	380 S. MELROSE DRIVE	SUITE 128	VISTA	CA	92081	6641	37	06073	33.19121306	-117.2537723	San Diego County
21537	Fee-for-Service	1932288081	1932288081	1	1	GAVINO, DANIEL E MD	7/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81843	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
21543	Fee-for-Service	1891941605	1891941605	1	1	GOHIL, HARSHKUMAR R MD	12/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116325	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
21551	Fee-for-Service	1376727693	1376727693	1	1	GRANITE WELLNESS CENTERS	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	10015 PALISADES DRIVE	SUITE 1	TRUCKEE	CA	96161	1941	29	06057	39.32564146	-120.177149	Nevada County
21576	Fee-for-Service	1174886881	1174886881	1	1	GREWAL, RABEEP K MD	8/25/2021	390200000X	NA	Other	026	PHYSICIANS	149999	None	None	0	In state provider	None	340 W EAST AVE	None	CHICO	CA	95926	7238	04	06007	39.75353271	-121.8668176	Butte County
21582	Fee-for-Service	1184882904	1184882904	1	1	GUPTA, ANSHU K MD	8/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87872	24	Plastic Surgery	0	In state provider	None	4077 FIFTH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
21595	Fee-for-Service	1740764976	1740764976	1	1	GUTIERREZ, GABRIEL J RCP	11/16/2018	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
21602	Fee-for-Service	1144433988	1144433988	1	1	GOLDEN VALLEY HEALTH CTR	4/8/1996	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1121 HAMMOND ST	None	MODESTO	CA	95351	3509	50	06099	37.614366	-121.0186465	Stanislaus County
21617	Fee-for-Service	1104206242	1104206242	1	1	GAN, SARAH MD	2/7/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162897	15	Obstetrics (D.O. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
21624	Fee-for-Service	1144369414	1144369414	1	1	GUERETTE, LISA M CCC-A	12/26/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
21629	Fee-for-Service	1780610527	1780610527	1	1	GATES, ELENA MD	12/11/2002	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	49564	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
21633	Fee-for-Service	1124630736	1124630736	1	1	GALINDO, CHRISTINA M	11/20/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1271 ROSS AVE	None	EL CENTRO	CA	92243	4304	13	06025	32.78145047	-115.5673098	Imperial County
21636	Fee-for-Service	1033221452	1033221452	1	1	GRACEFUL SENESCENCE	5/10/2006	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ADULT DAY HEALTH CARE	120 W EL SEGUNDO BLVD	None	LOS ANGELES	CA	90061	1628	19	06037	33.91638952	-118.2746565	Los Angeles County
21673	Fee-for-Service	1316193881	1316193881	1	1	GREEN, JONAS B MD	10/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98048	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
21674	Fee-for-Service	1427094788	1427094788	1	1	GERSTEN, KEVIN M MD	3/22/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74129	04	Otology, Laryngology, Rhinology	0	In state provider	None	2557 MOWRY AVE	STE 30	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
21722	Fee-for-Service	1154856326	1154856326	1	1	GINGRAS, ALEXA M DO	7/4/2021	207P00000X	NA	Other	026	PHYSICIANS	18713	None	None	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
21724	Fee-for-Service	1538446216	1538446216	1	1	GOMEZ, CAROL J LCSW	12/12/2023	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
21739	Fee-for-Service	1629061445	1629061445	1	1	GABRIEL,VICTOR 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
21756	Fee-for-Service	1588929756	1588929756	1	1	GREER, MATTHEW R MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134072	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
21760	Fee-for-Service	1659705325	1659705325	1	1	GEE, BRIAN K	7/3/2017	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
21809	Fee-for-Service	1588748131	1588748131	1	1	GERRARD, MICHELLE L MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111872	None	None	0	In state provider	None	1800 N CALIFORNIA	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
21836	Fee-for-Service	1295856409	1295856409	1	1	GUERENA, VINCENT R MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	65658	41	Internal Medicine	0	In state provider	None	240 S MAIN STREET	None	POMONA	CA	91766	1630	19	06037	34.05739181	-117.7522926	Los Angeles County
21852	Fee-for-Service	1871556746	1871556746	1	1	GODBOLD, DONALD MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51364	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2740 M ST	None	MERCED	CA	95340	2813	24	06047	37.31239905	-120.478839	Merced County
21878	Fee-for-Service	1538215512	1538215512	1	1	GEST, STEVEN A MD	2/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	58556	None	None	0	In state provider	None	2356 GOLD MEADOW WAY	STE 130	GOLD RIVER	CA	95670	6323	34	06067	38.622141	-121.2625395	Sacramento County
21913	Fee-for-Service	1740448703	1740448703	1	1	GRIMSBY, GWEN M MD	12/18/2018	2088P0231X	NA	Other	026	PHYSICIANS	-	34	Urology and Urological Surgery	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
21927	Fee-for-Service	1164646642	1164646642	1	1	GUPTA, KAPIL MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92432	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
21984	Fee-for-Service	1063462083	1063462083	1	1	GINIECZKI, BRANDON T MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71866	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
22074	Fee-for-Service	1316226327	1316226327	1	1	GAMBHIR, VANDANA MD	9/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148930	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
22108	Fee-for-Service	1306119680	1306119680	1	1	GWON, SEUNG S MD INC	4/11/2012	208600000X	NA	General Surgery	026	PHYSICIANS	81046	78	Neoplastic Diseases/Oncology	0	In state provider	None	1671 W MAIN ST	STE B	EL CENTRO	CA	92243	5420	13	06025	32.79277051	-115.5732165	Imperial County
22111	Fee-for-Service	1174187629	1174187629	1	1	GARCIA, VIVIAN L MD	5/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178525	None	None	0	In state provider	None	1332 NATIVIDAD RD	C	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
22122	Fee-for-Service	1073821922	1073821922	1	1	GREWAL, YUVRAJ S MD	8/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143512	13	Neurology (M.D. only)	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
22164	Fee-for-Service	1033117452	1033117452	1	1	GOLDSMITH, BRIAN J MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71213	None	None	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
22178	Fee-for-Service	1881702504	1881702504	1	1	GREEN, STUART A MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	22945	20	Orthopedic Surgery	0	In state provider	None	3801 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3338	30	06059	33.80318951	-118.066068	Orange County
22186	Fee-for-Service	1295029445	1295029445	1	1	GEORGE, MONIQUE M MD	3/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127193	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
22188	Fee-for-Service	1346272283	1346272283	1	1	GOLDBERG, DAVID J MD	6/1/2001	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	74593	30	Radiology	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 100	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
22215	Fee-for-Service	1164646642	1164646642	1	1	GUPTA, KAPIL MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92432	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
22231	Fee-for-Service	1851327449	1851327449	1	1	GOLDEN ROWLAND HEIGHTS	1/1/2002	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY	1015 S NOGALES ST	STE 109	ROWLAND HEIGHTS	CA	91748	1309	19	06037	33.99637543	-117.8884823	Los Angeles County
22337	Fee-for-Service	1669635413	1669635413	1	1	GARCIA, JENNIFER E OD	9/10/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	734 N MAIN ST	None	CORONA	CA	92880	1439	33	06065	33.89171973	-117.5640251	Riverside County
22393	Fee-for-Service	1306119680	1306119680	1	1	GWON, SEUNG S MD INC	4/11/2012	208600000X	NA	General Surgery	026	PHYSICIANS	81046	02	General Surgery	0	In state provider	None	1671 W MAIN ST	STE B	EL CENTRO	CA	92243	5420	13	06025	32.79277051	-115.5732165	Imperial County
22410	Fee-for-Service	1891065447	1891065447	1	1	GARFIELD BEACH CVS LLC	5/31/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1599 TIBURON BLVD	None	TIBURON	CA	94920	2525	21	06041	37.87560282	-122.459477	Marin County
22434	Fee-for-Service	1740225630	1740225630	1	1	GARFIELD BEACH CVS, LLC	10/26/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	950 NORTH WESTERN AVE	None	SAN PEDRO	CA	90732	2427	19	06037	33.75118691	-118.3090341	Los Angeles County
22448	Fee-for-Service	1447264536	1447264536	1	1	GROSSE, SABINA A PHD	11/8/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
22521	Fee-for-Service	1780791475	1780791475	1	1	GOMEZ, IVAN A MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67957	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
22537	Fee-for-Service	1346522141	1346522141	1	1	GUMA, MONICA MD	1/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126993	83	Rheumatology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
22567	Fee-for-Service	1689746976	1689746976	1	1	GRIFFIN, ANNE M LMFT	8/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	118 NEVADA ST	None	ARROYO GRANDE	CA	93420	2610	40	06079	35.1239014	-120.5794364	San Luis Obispo County
22640	Fee-for-Service	1851719371	1851719371	1	1	GU, DAVID L MD	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148622	01	General Practice	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
22643	Fee-for-Service	1093248882	1093248882	1	1	GAMAS, LIZETTE	11/18/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	13121 PHILADELPHIA ST	None	WHITTIER	CA	90601	4302	19	06037	33.97912551	-118.0353645	Los Angeles County
22650	Fee-for-Service	1811224298	1811224298	1	1	GROVE INTERNAL MEDICINE INC.	1/15/2025	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	8283 GROVE AVE	201	RANCHO CUCAMONGA	CA	91730	3140	36	06071	34.10380433	-117.6285116	San Bernardino County
22678	Fee-for-Service	1376085027	1376085027	1	1	GALACE, TONI R PSYD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
22691	Fee-for-Service	1417186107	1417186107	1	1	GERSTEIN, MICHAEL J MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120837	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
22706	Fee-for-Service	1649856345	1649856345	1	1	GO, DAVID DO	9/11/2024	207R00000X	NA	Other	026	PHYSICIANS	22459	41	Internal Medicine	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
22751	Fee-for-Service	1538325949	1538325949	1	1	GASTON, ELAINE D MFT	7/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2600 MISSION ST	STE 201	SAN MARINO	CA	91008	1676	19	06037	34.11610632	-118.1375175	Los Angeles County
22766	Fee-for-Service	1568573806	1568573806	1	1	GRAHAM, JEFFREY MD	3/27/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	64094	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1201 ALHAMBRA BLVD	STE 320	SACRAMENTO	CA	95816	5242	34	06067	38.570076	-121.4657145	Sacramento County
22780	Fee-for-Service	1235177791	1235177791	1	1	GOLSHANI, PEYMAN MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85166	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	0000	19	06037	34.06473399	-118.445865	Los Angeles County
22795	Fee-for-Service	1083744916	1083744916	2	1	G AND J GROSS INC	8/17/2012	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	433 N ROXBURY DR	None	BEVERLY HILLS	CA	90210	5001	19	06037	34.06778127	-118.4067057	Los Angeles County
22813	Fee-for-Service	1609034057	1609034057	1	1	GUPTA, NEERU R MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104788	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
22821	Fee-for-Service	1124213673	1124213673	1	1	GARDEZI, NAJMA M MD	12/1/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55297	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
22832	Fee-for-Service	1003007287	1003007287	1	1	GINN, MICHAELA E MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111803	41	Internal Medicine	0	In state provider	None	3807 UNION AVENUE	SUITE A	BAKERSFIELD	CA	93305	2400	15	06029	35.394102	-119.0030165	Kern County
22837	Fee-for-Service	1215320742	1215320742	1	1	GOMEZ, RONALD	11/20/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	780 W OLIVE AVE	100	MERCED	CA	95348	2437	24	06047	37.31916174	-120.4814268	Merced County
22841	Fee-for-Service	1992900120	1992900120	1	1	GRAVELINE, ANGIE	6/6/2011	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
22844	Fee-for-Service	1932696093	1932696093	1	1	GALUST, HENRIK MD	7/5/2022	207P00000X	NA	Other	026	PHYSICIANS	178809	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
22852	Fee-for-Service	1295453033	1295453033	1	1	GOVETT, RACHEL E OT	7/16/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
22853	Fee-for-Service	1457652885	1457652885	1	1	GATEWAY CENTER OF MONTEREY	9/28/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COUNTY INCORPORATED	854 CONGRESS AVENUE	None	PACIFIC GROVE	CA	93950	4811	27	06053	36.61425945	-121.9250975	Monterey County
22855	Fee-for-Service	1154338622	1154338622	1	1	GORE-FELTON, CHERYL PHD	10/17/2005	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
22878	Fee-for-Service	1649580655	1649580655	1	1	GRECO, VALERIE A MD	2/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114169	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
22917	Fee-for-Service	1851867550	1851867550	1	1	GONZALES, ADA E	11/30/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1145 E CLARK AVE	STE K	SANTA MARIA	CA	93455	5173	42	06083	34.8650893	-120.4170345	Santa Barbara County
22960	Fee-for-Service	1811264476	1811264476	1	1	GREWAL, SUNEET MD	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115464	83	Rheumatology	0	In state provider	None	13851 E 14TH ST	STE 301	SAN LEANDRO	CA	94578	2631	01	06001	37.71458918	-122.1418781	Alameda County
22962	Fee-for-Service	1376001883	1376001883	1	1	GUTIERREZ, LETICIA M LMFT	10/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
22973	Fee-for-Service	1407908205	1407908205	1	1	GOREK, JOSEF E MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	71664	20	Orthopedic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
23026	Fee-for-Service	1477057800	1477057800	1	1	GARMENDIA, FERMIN MD	8/25/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173476	None	None	0	In state provider	None	212 COFFEE ROAD	SUITE 101	BAKERSFIELD	CA	93309	1258	15	06029	35.356392	-119.092153	Kern County
23070	Fee-for-Service	1548603350	1548603350	1	1	GIN, STEVEN R MD	7/6/2017	390200000X	NA	Other	026	PHYSICIANS	131650	05	Anesthesiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
23079	Fee-for-Service	1457910499	1457910499	1	1	GONZALEZ, JUAN MD	2/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179019	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
23121	Fee-for-Service	1093226227	1093226227	1	1	GUARDIAN FLIGHT LLC	1/31/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	960 AVENUE C	APT A	ELY	NV	89301	6166	00	None	39.25704581	-114.8709876	White Pine County
23137	Fee-for-Service	1710971296	1710971296	1	1	GIORDANO, GARY 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	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
23167	Fee-for-Service	1427337179	1427337179	2	1	GRACE HEALTH INC	5/15/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18339 COLIMA RD	SUITE A	ROWLANDS HEIGHTS	CA	91748	2792	19	06037	33.98851675	-117.9050378	Los Angeles County
23205	Fee-for-Service	1104481423	1104481423	1	1	GHUKASYAN, HAYK MD	6/10/2022	208M00000X	NA	Other	026	PHYSICIANS	176450	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
23207	Fee-for-Service	1649242728	1649242728	1	1	GARG, NEETA MD	9/15/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	180368	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
23212	Fee-for-Service	1609434224	1609434224	1	1	GARCIA, LISA C LCSW	4/11/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
23215	Fee-for-Service	1083877633	1083877633	1	1	GUPTA, SURAJ MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136996	10	Gastroenterology (M.D. only)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
23217	Fee-for-Service	1376562181	1376562181	1	1	GREENBERG, JEROME MD	3/31/1986	207R00000X	NA	Other	026	PHYSICIANS	58828	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
23231	Fee-for-Service	1952328429	1952328429	1	1	GETZ, DANIEL DO	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
23269	Fee-for-Service	1841240504	1841240504	1	1	GORMAN, SUSAN P MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	79764	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	77 CADILLAC DRIVE	SUITE 230	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
23277	Fee-for-Service	1750018073	1750018073	1	1	GLENDALE WEST PHARMACY INC	10/12/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1109 S GLENDALE AVE	STE. A & B	GLENDALE	CA	91205	5657	19	06037	34.13309768	-118.2521252	Los Angeles County
23282	Fee-for-Service	1386805521	1386805521	2	1	GUIAHI, MARYAM MD	2/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169723	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
23311	Fee-for-Service	1114955788	1114955788	1	1	GOPEN, QUINTON S MD	5/11/2010	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	70846	04	Otology, Laryngology, Rhinology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
23332	Fee-for-Service	1730583857	1730583857	1	1	GILLIAN, SABRINA M LCSW	7/8/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	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
23368	Fee-for-Service	1477878130	1477878130	1	1	GHAYAL, PAYAL P MD	10/5/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	138957	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
23392	Fee-for-Service	1942640354	1942640354	1	1	GAU, STEPHEN T MD	5/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141511	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN STREET	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
23429	Fee-for-Service	1750623625	1750623625	1	1	GOSTIC, WILLIAM J MD	7/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147592	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23437	Fee-for-Service	1629490495	1629490495	1	1	GOTTLIEB MEDICAL GROUP	4/11/2014	207R00000X	NA	Other	026	PHYSICIANS	34195	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 401	LOS ANGELES	CA	90036	4667	19	06037	34.05764121	-118.3603115	Los Angeles County
23444	Fee-for-Service	1740224021	1740224021	1	1	GOFNUNG, YAROSLAV A MD	5/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81752	67	Endocrinology	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
23450	Fee-for-Service	1467498634	1467498634	1	1	GENTRY, YVETTE M MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76174	09	Gynecology (D.O. only)	0	In state provider	None	461 34TH ST	None	OAKLAND	CA	94609	2815	01	06001	37.82196319	-122.2637023	Alameda County
23468	Fee-for-Service	1588816813	1588816813	1	1	GULATI, KAVITA MD	5/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	177550	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
23501	Fee-for-Service	1407934177	1407934177	1	1	GRAMYK, KEVIN MD	7/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	55136	20	Orthopedic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
23534	Fee-for-Service	1679998629	1679998629	1	1	GEARY, SEAN M LMFT	5/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
23536	Fee-for-Service	1275829756	1275829756	1	1	GODHWANI, ANIKA DO	7/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12411	01	General Practice	0	In state provider	None	3109 E WHITMORE AVE	None	CERES	CA	95307	2906	50	06099	37.5947885	-120.937644	Stanislaus County
23573	Fee-for-Service	1881736148	1881736148	1	1	GONZALEZ, ESTHER	12/15/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PROMPT MED EQUIP	7910 ADAMS ST	None	PARAMOUNT	CA	90723	4316	19	06037	33.89477522	-118.1610869	Los Angeles County
23593	Fee-for-Service	1669454385	1669454385	1	1	GOLDBERG, ZELANNA I MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67048	30	Radiology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
23606	Fee-for-Service	1881080273	1881080273	1	1	GOLDGAR, SARAH RACHEL MD	2/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146818	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
23634	Fee-for-Service	1659003135	1659003135	1	1	GONG, TIAN PT	10/4/2022	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
23692	Fee-for-Service	1558867036	1558867036	1	1	GUERRA, RICARDO MD	11/16/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	188585	None	None	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
23722	Fee-for-Service	1023193877	1023193877	1	1	GANOZA, DANIEL F	7/27/2020	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
23724	Fee-for-Service	1629490495	1629490495	1	1	GOTTLIEB MEDICAL GROUP	4/11/2014	207R00000X	NA	Other	026	PHYSICIANS	34195	03	Allergy	0	In state provider	None	5901 W OLYMPIC BLVD	STE 401	LOS ANGELES	CA	90036	4667	19	06037	34.05764121	-118.3603115	Los Angeles County
23727	Fee-for-Service	1982758413	1982758413	1	1	GRONENDYKE, JAMES M PHD	9/11/2012	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
23729	Fee-for-Service	1710121579	1710121579	1	1	GALARZA, DANIEL LCSW	8/24/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8826 OCEAN VIEW AVE	None	WHITTIER	CA	90605	1513	19	06037	33.95508998	-118.0201812	Los Angeles County
23736	Fee-for-Service	1467498634	1467498634	1	1	GENTRY, YVETTE M MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76174	15	Obstetrics (D.O. only)	0	In state provider	None	461 34TH ST	None	OAKLAND	CA	94609	2815	01	06001	37.82196319	-122.2637023	Alameda County
23748	Fee-for-Service	1730148214	1730148214	1	1	GHEYBI, FAHIM MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	36483	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
23753	Fee-for-Service	1740224021	1740224021	1	1	GOFNUNG, YAROSLAV A MD	5/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81752	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
23760	Fee-for-Service	1336160530	1336160530	1	1	GRAYZAR, JENNIFER A MD	7/1/1998	207P00000X	NA	Other	026	PHYSICIANS	65858	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
23797	Fee-for-Service	1700872421	1700872421	1	1	GARCIA, ROBERT MD	10/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 HWY 349 NORTH	None	IRAAN	TX	79744	0665	00	None	30.78975522	-101.8426733	Pecos County
23800	Fee-for-Service	1649458803	1649458803	1	1	GEBREMEDHIN, EFREM H MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100766	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
23819	Fee-for-Service	1881792208	1881792208	1	1	GARDIKAS, VASSI A MD	3/31/1991	208600000X	NA	General Surgery	026	PHYSICIANS	65732	None	None	0	In state provider	None	6175 N FRESNO ST	# 101	FRESNO	CA	93710	5207	10	06019	36.82630543	-119.78143	Fresno County
23856	Fee-for-Service	1639952781	1639952781	1	1	GOLDEN FLOWER MANOR LLC	10/24/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2411 E LA PALMA AVE	None	ANAHEIM	CA	92806	2240	30	06059	33.84730046	-117.88245	Orange County
23880	Fee-for-Service	1558858183	1558858183	1	1	GUZIK, PAUL DO	8/12/2024	207R00000X	NA	Other	026	PHYSICIANS	19162	41	Internal Medicine	0	In state provider	None	1745 N BROADWAY	STE 101	SANTA MARIA	CA	93454	1940	42	06083	34.971759	-120.4356175	Santa Barbara County
23883	Fee-for-Service	1669454385	1669454385	1	1	GOLDBERG, ZELANNA I MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67048	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
23894	Fee-for-Service	1003343211	1003343211	1	1	GURAN, ELYSE L MD	9/1/2022	207L00000X	NA	Other	026	PHYSICIANS	157862	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
23900	Fee-for-Service	1841552924	1841552924	1	1	GRAHAM, JEREMY J NP	4/15/2013	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
23912	Fee-for-Service	1497101737	1497101737	1	1	GARNER, DEBORAH CCC-SLP	12/11/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
23944	Fee-for-Service	1790789022	1790789022	1	1	GARCIA, RUEL T MD	6/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79067	10	Gastroenterology (M.D. only)	0	In state provider	None	2340 MONTPELIER DR	STE A	SAN JOSE	CA	95116	1622	43	06085	37.36500087	-121.8478263	Santa Clara County
23974	Fee-for-Service	1578007829	1578007829	1	1	GARFIELD BEACH CVS LLC	4/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2260 E THOMPSON BLVD	None	VENTURA	CA	93001	3537	56	06111	34.27369317	-119.2670827	Ventura County
23995	Fee-for-Service	1245950179	1245950179	1	2	GOLDEN STATE VAN RIDES LLC	1/16/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3920 EAGLE ROCK BLVD	SUITE C	LOS ANGELES	CA	90065	3668	19	06037	34.11936223	-118.230111	Los Angeles County
24004	Fee-for-Service	1851026959	1851026959	1	1	GONZALEZ, CELENE	2/10/2025	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
24028	Fee-for-Service	1467498634	1467498634	1	1	GENTRY, YVETTE M MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76174	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	461 34TH ST	None	OAKLAND	CA	94609	2815	01	06001	37.82196319	-122.2637023	Alameda County
24032	Fee-for-Service	1477631372	1477631372	1	1	GEISSERT, WILLIAM L MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	62194	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
24037	Fee-for-Service	1730148214	1730148214	1	1	GHEYBI, FAHIM MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	36483	30	Radiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
24044	Fee-for-Service	1497833412	1497833412	1	1	GANATRA, ANJALI M MD	12/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102211	34	Urology and Urological Surgery	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
24113	Fee-for-Service	1376684902	1376684902	1	1	GRAMER, JEFFREY R MD	8/31/1993	207R00000X	NA	Other	026	PHYSICIANS	42290	41	Internal Medicine	0	In state provider	None	942 MANNING AVE	None	LOS ANGELES	CA	90024	3219	19	06037	34.06340907	-118.4375014	Los Angeles County
24118	Fee-for-Service	1396803714	1396803714	1	1	GUSTIN, KATE R PHD	7/16/2013	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
24183	Fee-for-Service	1578634820	1578634820	1	1	GRADY, ELIZABETH D MD	5/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79216	40	Pediatrics	0	In state provider	None	100 TERMINAL AVE	None	MENLO PARK	CA	94025	1246	41	06081	37.47869451	-122.1676804	San Mateo County
24193	Fee-for-Service	1841231750	1841231750	1	1	GARFIELD BEACH CVS, LLC	12/12/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12031 BROOKHURST STREET	None	GARDEN GROVE	CA	92840	2814	30	06059	33.788115	-117.9588475	Orange County
24206	Fee-for-Service	1780346452	1780346452	1	1	GUZMAN-VALENCIA, ALEJANDRA M	1/17/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
24269	Fee-for-Service	1235107897	1235107897	1	1	GOODMAN, DENNIS A MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42299	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9850 GENESEE AVE	STE 940	LA JOLLA	CA	92037	1220	37	06073	32.882913	-117.226341	San Diego County
24325	Fee-for-Service	1881761740	1881761740	1	1	GODFREY, KEVIN D MD	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	37953	22	Pathology (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
24354	Fee-for-Service	1003851999	1003851999	1	1	GARFIELD BEACH CVS LLC	8/10/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5822 EDINGER AVE	None	HUNTINGTON BEACH	CA	92649	1705	30	06059	33.72992685	-118.0267913	Orange County
24358	Fee-for-Service	1821031196	1821031196	1	1	GAMOSO-BENHAMED, MARIBEL MD	5/23/2024	207L00000X	NA	Other	026	PHYSICIANS	183347	05	Anesthesiology	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
24362	Fee-for-Service	1730102310	1730102310	1	1	GESCHWIND, DANIEL H MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	76286	13	Neurology (M.D. only)	0	In state provider	None	300 UCLA PLAZA DR	STE B200	LOS ANGELES	CA	90024	0000	19	06037	34.06465655	-118.4461	Los Angeles County
24369	Fee-for-Service	1013988435	1013988435	1	1	GILLIN, SHAKHA MD	7/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70287	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
24372	Fee-for-Service	1669189494	1669189494	1	1	GONZALEZ, ADRIANA C LCSW	3/14/2023	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
24414	Fee-for-Service	1821034984	1821034984	1	1	GARFIELD BEACH CVS, LLC	2/20/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14330 CULVER DRIVE	None	IRVINE	CA	92604	0303	30	06059	33.70654758	-117.7857461	Orange County
24440	Fee-for-Service	1073529988	1073529988	1	1	GULLAHORN, KATHLEEN C MD	1/30/1997	207L00000X	NA	Other	026	PHYSICIANS	74274	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
24511	Fee-for-Service	1962428599	1962428599	1	2	GLASS, TAMYRA D MD	4/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	89437	08	Family Practice	0	In state provider	None	1141 I ST	None	REEDLEY	CA	93654	3314	10	06019	36.59417907	-119.4524568	Fresno County
24524	Fee-for-Service	1821356791	1821356791	1	1	GONZALEZ, RENE R MD	9/13/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	148659	08	Family Practice	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91931	1800	37	06073	32.62382113	-116.9960539	San Diego County
24558	Fee-for-Service	1235107897	1235107897	1	1	GOODMAN, DENNIS A MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42299	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9850 GENESEE AVE	STE 940	LA JOLLA	CA	92037	1220	37	06073	32.882913	-117.226341	San Diego County
24559	Fee-for-Service	1841359593	1841359593	1	1	GOLDBERG, STEVEN H MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49534	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
24573	Fee-for-Service	1619913142	1619913142	1	1	GILL, BARBARA LMFT	9/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28481 RANCHO CA ROAD	None	TEMECULA	CA	92590	3610	33	06065	33.49799525	-117.1575116	Riverside County
24583	Fee-for-Service	1841706769	1841706769	1	1	GATER, KELLIE M CNP	1/25/2022	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
24647	Fee-for-Service	1033192356	1033192356	1	1	GREGORY, KIMBERLY D MD	7/31/1989	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	68785	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	616 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
24663	Fee-for-Service	1427256577	1427256577	1	1	GAJARSA, JASON J MD	5/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99066	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11180 WARNER AVE	STE 353	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
24665	Fee-for-Service	1780123604	1780123604	1	1	GAHAN, LINDSAY M CRNA	5/18/2017	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
24675	Fee-for-Service	1942316898	1942316898	1	1	GONZALEZ, LESLIE M MD INC	11/1/2001	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	76307	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3771 KATELLA AVE	STE 110	LOS ALAMITOS	CA	90720	3110	30	06059	33.80319153	-118.067274	Orange County
24716	Fee-for-Service	1972731024	1972731024	1	1	GOMEZ, RICARDO JR MD	3/10/2015	207L00000X	NA	Other	026	PHYSICIANS	131630	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
24733	Fee-for-Service	1003977372	1003977372	1	1	GREASER III, LLOYD E MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86173	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
24756	Fee-for-Service	1306947262	1306947262	1	1	GRAY, JULIE A LCSW	7/11/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	28196	-	NOT APPLICABLE	0	In state provider	None	5715 S BROADWAY AVENUE	None	LOS ANGELES	CA	90037	4131	19	06037	33.990273	-118.2783255	Los Angeles County
24776	Fee-for-Service	1578049094	1578049094	1	1	GISONDA, SANDRA CCC-SLP	9/13/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	27393 YNEZ RD STE 153	None	TEMECULA	CA	92591	4605	33	06065	33.50698549	-117.1502918	Riverside County
24781	Fee-for-Service	1457693053	1457693053	1	1	GUTERMAN, ELAN L MD	7/7/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	134331	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
24783	Fee-for-Service	1104026970	1104026970	1	1	GONDI, NEELIMA MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109120	41	Internal Medicine	0	In state provider	None	450 N GREENFIELD AVE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
24814	Fee-for-Service	1073903381	1073903381	1	1	GENSEMER, ALEXANDRA NP	8/16/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
24816	Fee-for-Service	1013301290	1013301290	1	1	GOITIA, JESSE J JR MD	6/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145083	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
24827	Fee-for-Service	1801125836	1801125836	1	1	G & R MEDICAL CORPORATION	11/19/2010	207L00000X	NA	Other	026	PHYSICIANS	102650	05	Anesthesiology	0	In state provider	None	1200 B GALE WILSON	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
24845	Fee-for-Service	1235107897	1235107897	1	1	GOODMAN, DENNIS A MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42299	41	Internal Medicine	0	In state provider	None	9850 GENESEE AVE	STE 940	LA JOLLA	CA	92037	1220	37	06073	32.882913	-117.226341	San Diego County
24846	Fee-for-Service	1225217409	1225217409	1	1	GILBERTSON, BARBARA E DO	10/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	700 SOUTH J STREET	None	LAKEVIEW	OR	97630	1623	00	None	42.181335	-120.351489	Lake County
24881	Fee-for-Service	1982608303	1982608303	1	1	GHC OF SUNNYVALE LLC	5/9/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CEDAR CREST NURSING	797 E FREMONT AVE	None	SUNNYVALE	CA	94087	2805	43	06085	37.35232537	-122.0183236	Santa Clara County
24952	Fee-for-Service	1427256577	1427256577	1	1	GAJARSA, JASON J MD	5/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99066	41	Internal Medicine	0	In state provider	None	11180 WARNER AVE	STE 353	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
24964	Fee-for-Service	1508977141	1508977141	1	1	GONELLA, PAULA MD	2/28/1991	207P00000X	NA	Other	026	PHYSICIANS	72966	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
25047	Fee-for-Service	1801919220	1801919220	1	1	GOMEZ, ROSA M MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94489	01	General Practice	0	In state provider	None	38925 TRADE CENTER DR	STE H	PALMDALE	CA	93551	3655	19	06037	34.59028112	-118.1433053	Los Angeles County
25056	Fee-for-Service	1831458835	1831458835	1	1	GARG, NATASHA DO	10/16/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	13011	68	Hematology	0	In state provider	None	7777 MILLIKEN AVENUE	STE 110, 210, 330	RANCHO CUCAMONGA	CA	91730	6781	36	06071	34.10843256	-117.5570865	San Bernardino County
25156	Fee-for-Service	1124040902	1124040902	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1871 N MAIN ST	None	WALNUT CREEK	CA	94596	4106	07	06013	37.90476104	-122.0635969	Contra Costa County
25157	Fee-for-Service	1790304715	1790304715	1	1	GHELFI-DUNBAR, KATIE PSYD	10/3/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	353 PARK MARINA CIR	None	REDDING	CA	96001	1717	45	06089	40.57650059	-122.3737972	Shasta County
25186	Fee-for-Service	1336288943	1336288943	1	1	GLUCKMAN, RICHARD S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33891	13	Neurology (M.D. only)	0	In state provider	None	1360 W 6TH ST	STE 350	SAN PEDRO	CA	90732	3535	19	06037	33.73886546	-118.3075065	Los Angeles County
25199	Fee-for-Service	1265764393	1265764393	2	1	GARFIELD BEACH CVS, L.L.C.	4/20/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1035 PLACER	SUITE 110	REDDING	CA	96001	1170	45	06089	40.58349378	-122.3853903	Shasta County
25209	Fee-for-Service	1457399784	1457399784	1	1	GILBERT, PAUL K MD APC	2/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54181	20	Orthopedic Surgery	0	In state provider	None	39 CONGRESS ST	STE 201	PASADENA	CA	91105	3021	19	06037	34.13407645	-118.151226	Los Angeles County
25332	Fee-for-Service	1801043286	1801043286	1	1	GHATTAS, SAMEH W MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114099	01	General Practice	0	In state provider	None	4077 5TH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
25344	Fee-for-Service	1831458835	1831458835	1	1	GARG, NATASHA DO	10/16/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	13011	41	Internal Medicine	0	In state provider	None	7777 MILLIKEN AVENUE	STE 110, 210, 330	RANCHO CUCAMONGA	CA	91730	6781	36	06071	34.10843256	-117.5570865	San Bernardino County
25373	Fee-for-Service	1306235809	1306235809	1	1	GLICKMAN, EMILY N LMFT	1/22/2024	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
25383	Fee-for-Service	1306973748	1306973748	1	1	GAURAV UPADHYAY	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
25436	Fee-for-Service	1275760894	1275760894	1	1	GOODMAN, ELIZABETH L MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122813	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
25468	Fee-for-Service	1487451951	1487451951	1	1	GARABAN, MILITZA I BIRTH DOU	4/7/2025	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	10	06019	0	0	None
25473	Fee-for-Service	1932109048	1932109048	1	1	GUNNISON VALLEY HOSPITAL	6/4/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	711 N TAYLOR ST	None	GUNNISON	CO	81230	2243	00	None	38.5516616	-106.9243354	Gunnison County
25483	Fee-for-Service	1457609976	1457609976	1	1	GLOBAL PHARMACEUTICAL INC	5/30/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3779-3779 1/2 S WESTERN	None	LOS ANGELES	CA	90018	1067	19	06037	34.0179075	-118.3089886	Los Angeles County
25490	Fee-for-Service	1780962308	1780962308	1	1	GLASSER, DIANA MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123536	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3975 JACKSON ST	STE 110	RIVERSIDE	CA	92503	3946	33	06065	33.92729721	-117.4413503	Riverside County
25537	Fee-for-Service	1760657415	1760657415	1	1	GUPTA, AVANI P MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128355	30	Radiology	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2799	41	06081	37.48093988	-122.2531826	San Mateo County
25540	Fee-for-Service	1770144578	1770144578	1	1	G. P. R. PSYCHOLOGICAL SERVI	9/6/2023	261QM0855X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CES INC.	10737 LAUREL STREET	235	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10515337	-117.570867	San Bernardino County
25574	Fee-for-Service	1891372959	1891372959	1	1	GOODSELL, SCOTT	12/21/2024	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
25575	Fee-for-Service	1598787384	1598787384	2	1	GARFIELD BEACH CVS LLC	10/4/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1330 E 17TH ST	None	SANTA ANA	CA	92705	8500	30	06059	33.75989151	-117.850113	Orange County
25630	Fee-for-Service	1821069899	1821069899	1	1	GOWING,PETER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 STEWART PARKWAY	None	ROSEBURG	OR	97470	0000	00	None	43.2399838	-123.3665048	Douglas County
25648	Fee-for-Service	1871879361	1871879361	1	1	GUARDIAN ANGEL HOME HEALTH	7/19/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	717 S VICTORY BLVD	SUITE A	BURBANK	CA	91502	7171	19	06037	34.16843415	-118.3102541	Los Angeles County
25670	Fee-for-Service	1073620530	1073620530	1	2	GREEN, DONNIELLE L DO	10/14/2021	207R00000X	NA	Other	026	PHYSICIANS	18169	None	None	0	In state provider	None	225 JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.35500597	-121.8401901	Santa Clara County
25676	Fee-for-Service	1235236183	1235236183	1	1	GHAFFARI, ARSHIA DO	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8210	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
25742	Fee-for-Service	1104255348	1104255348	1	1	GUERRERO-WOOLEY, RICHELLE L	7/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149836	41	Internal Medicine	0	In state provider	MD	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
25758	Fee-for-Service	1760585897	1760585897	1	1	GORMAN, MICHAEL R MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68098	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
25759	Fee-for-Service	1932109048	1932109048	1	1	GUNNISON VALLEY HOSPITAL	6/4/2011	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	711 N TAYLOR ST	None	GUNNISON	CO	81230	2243	00	None	38.5516616	-106.9243354	Gunnison County
25787	Fee-for-Service	1477853638	1477853638	1	1	GERBER, BRIDGET M PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
25859	Fee-for-Service	1235499484	1235499484	1	1	GARCIA, ANDREW D LMFT	12/5/2018	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
25873	Fee-for-Service	1912082686	1912082686	1	1	GONZALES, HELADIO MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	66749	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
25880	Fee-for-Service	1790149094	1790149094	1	1	GOLZY, NIMA MD	5/13/2019	207R00000X	NA	Other	026	PHYSICIANS	151798	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
25927	Fee-for-Service	1407081235	1407081235	1	1	GARRITANO, FRANK G MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142527	04	Otology, Laryngology, Rhinology	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
25946	Fee-for-Service	1821318809	1821318809	1	1	GUCE, GARRY M MD	11/20/2020	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
25949	Fee-for-Service	1265639579	1265639579	1	2	GIEL, ANNE L LMFT	11/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5910 CLARK ROAD	SUITE M-3	PARADISE	CA	95969	4750	04	06007	39.75749014	-121.6070408	Butte County
25974	Fee-for-Service	1629631262	1629631262	1	1	GUILFOYLE, JESSICA LMFT	1/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ICES	24681 LA PLAZA	SUITE 333	DANA POINT	CA	92629	5701	30	06059	33.46845068	-117.6992116	Orange County
25977	Fee-for-Service	1891717682	1891717682	2	1	GARFIELD BEACH CVS LLC	12/19/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3405 MCHENRY AVE	None	MODESTO	CA	95350	1445	50	06099	37.68742407	-120.9943052	Stanislaus County
25983	Fee-for-Service	1093277931	1093277931	1	1	GREENWAY, TYLER MD	2/19/2024	207L00000X	NA	Other	026	PHYSICIANS	180110	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
26024	Fee-for-Service	1851376982	1851376982	1	1	GRONINGER, KIMBERLY A OT	2/9/2021	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
26048	Fee-for-Service	1073582052	1073582052	1	1	GERDES, CLINT MD	1/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185970	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
26085	Fee-for-Service	1922033588	1922033588	1	1	GWERDER, DEBRA 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)	DESERT VISTA BEHAVIORAL	570 W BROWN RD	None	MESA	AZ	85201	3227	00	None	33.434577	-111.8444355	Maricopa County
26088	Fee-for-Service	1740239748	1740239748	1	1	GALLEGOS, EMMANUEL L MD	10/1/1998	207P00000X	NA	Other	026	PHYSICIANS	65968	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
26091	Fee-for-Service	1124343108	1124343108	1	1	GOOD, RYAN J MD	1/18/2018	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
26115	Fee-for-Service	1063406429	1063406429	1	1	GOVINDAN, KALYANI MD	11/1/2020	207L00000X	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
26146	Fee-for-Service	1922230655	1922230655	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6000 SEPULVEDA BLVD	STE 2250	CULVER CITY	CA	90230	6478	19	06037	33.985512	-118.393524	Los Angeles County
26177	Fee-for-Service	1942833660	1942833660	1	4	GRACE SPEECH THERAPY CORP	3/13/2023	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
26188	Fee-for-Service	1669418729	1669418729	1	1	GARFIELD BEACH CVS, LLC	10/26/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1030 COLORADO BLVD	None	EAGLE ROCK	CA	90041	2502	19	06037	34.13750652	-118.1889548	Los Angeles County
26209	Fee-for-Service	1730401753	1730401753	1	1	GUAJARDO KRALJEVIC, CAROLINA	2/15/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	A CCC-SLP	2160 WEST ADAMS BLVD.	None	LOS ANGELES	CA	90018	2039	19	06037	34.03262662	-118.3138579	Los Angeles County
26253	Fee-for-Service	1225511389	1225511389	1	1	GONZALEZ, RICARDO LMFT	7/19/2024	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
26291	Fee-for-Service	1952480550	1952480550	1	1	GRECULA, MICHAEL J MD	11/17/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	71665	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
26305	Fee-for-Service	1598961872	1598961872	1	1	GARCIA, PATRICIA MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116628	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
26311	Fee-for-Service	1174667034	1174667034	1	1	GARDELLA, DEAN MD	7/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120926	None	None	0	In state provider	None	44725 10TH ST W	STE 150	LANCASTER	CA	93534	3000	19	06037	34.695693	-118.1480965	Los Angeles County
26333	Fee-for-Service	1194155408	1194155408	1	1	GRIEB, ERIN MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129297	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
26346	Fee-for-Service	1750449336	1750449336	1	1	GARFIELD HEMATOLOGY &	2/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	ONCOLOGY CONSUL MED GRP	600 N GARFIELD AVE	STE 200	MONTEREY PARK	CA	91754	1169	19	06037	34.06820797	-118.1228835	Los Angeles County
26351	Fee-for-Service	1881768224	1881768224	1	1	GRIMM, MARILEN M OT	2/20/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2813	19	06037	34.15937082	-118.2644042	Los Angeles County
26356	Fee-for-Service	1114454899	1114454899	1	1	GU, GRACE Y MD	9/30/2021	207RA0401X	NA	Other	026	PHYSICIANS	172827	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
26366	Fee-for-Service	1629347760	1629347760	1	1	GREGORY, DANIEL CRNA	3/31/2025	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
26382	Fee-for-Service	1477244861	1477244861	1	1	GENERATIONAL WELLNESS AND NU	5/25/2023	251J00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	RSING SERVICES INC	625 COTTONWOOD ST	None	WOODLAND	CA	95695	3614	57	06113	38.67292981	-121.793308	Yolo County
26388	Fee-for-Service	1821177833	1821177833	1	1	GARCIA, ANTONIO M MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49168	40	Pediatrics	0	In state provider	None	586 E MISSION BLVD	None	POMONA	CA	91766	1938	19	06037	34.05520922	-117.7448047	Los Angeles County
26411	Fee-for-Service	1285652115	1285652115	1	1	GADDAM, SWAPAN 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
26454	Fee-for-Service	1437219441	1437219441	1	1	GREEN, CHONA B MD	2/8/2015	2084P0805X	NA	Psychiatry	026	PHYSICIANS	53508	36	Psychiatry	0	In state provider	None	23121 PLAZA POINTE DR	STE 150	LAGUNA HILLS	CA	92653	1468	30	06059	33.6265559	-117.7229842	Orange County
26480	Fee-for-Service	1265541064	1265541064	1	1	GOLDMAN, MARTIN L MD	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	22286	30	Radiology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
26487	Fee-for-Service	1336376268	1336376268	1	1	GARFIELD BEACH CVS LLC	2/17/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3290 CHINO HILLS PKWY	None	CHINO HILLS	CA	91709	4270	36	06071	33.98253729	-117.7332346	San Bernardino County
26511	Fee-for-Service	1871574996	1871574996	1	1	GUPTA, RAKESH CHANDER MD	1/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44586	41	Internal Medicine	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
26581	Fee-for-Service	1649386707	1649386707	1	2	GUPTA, PRAVEEN D	1/24/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	25680	01	General Practice	0	In state provider	None	2105 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
26606	Fee-for-Service	1649386707	1649386707	1	3	GUPTA, PRAVEEN D	4/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	25680	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	14608 VICTORY BLVD	None	VAN NUYS	CA	91411	1621	19	06037	34.18663548	-118.451151	Los Angeles County
26633	Fee-for-Service	1750449336	1750449336	1	1	GARFIELD HEMATOLOGY &	2/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ONCOLOGY CONSUL MED GRP	600 N GARFIELD AVE	STE 200	MONTEREY PARK	CA	91754	1169	19	06037	34.06820797	-118.1228835	Los Angeles County
26666	Fee-for-Service	1376768168	1376768168	1	1	GLENDALE MEDICAL ARTS CENTER	10/28/1992	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY INC	2716 GRIFFITH PARK BLVD	None	LOS ANGELES	CA	90027	3343	19	06037	34.10743465	-118.2730699	Los Angeles County
26678	Fee-for-Service	1902332349	1902332349	1	1	GO, JONATHAN DO	9/27/2021	390200000X	NA	Other	026	PHYSICIANS	18903	None	None	0	In state provider	None	2619 E COLORADO BLVD	SUITE 150	PASADENA	CA	91107	3747	19	06037	34.14616014	-118.0964013	Los Angeles County
26753	Fee-for-Service	1033319173	1033319173	1	1	GHOBRIAL, MONA M	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116629	None	None	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
26771	Fee-for-Service	1104802594	1104802594	1	1	GREENE, DAVID A MD	7/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148038	38	Geriatrics	0	In state provider	None	3536 MENDOCINO AVE	SUITE 300	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
26784	Fee-for-Service	1245583087	1245583087	1	1	GARCIA, TIFFANY F LMFT	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	99470	-	NOT APPLICABLE	0	In state provider	None	1200 N MAIN ST	STE 100B, 301, 500	SANTA ANA	CA	92701	3630	30	06059	33.755175	-117.8676195	Orange County
26798	Fee-for-Service	1871574996	1871574996	1	1	GUPTA, RAKESH CHANDER MD	1/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44586	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
26822	Fee-for-Service	1952757064	1952757064	1	1	GAW, CYNTHIA MD	10/15/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	150552	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
26902	Fee-for-Service	1417379041	1417379041	1	1	GUNJA, ATEKA Z MD	3/23/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	153985	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
26920	Fee-for-Service	1750551164	1750551164	1	1	GARFIELD BEACH CVS, LLC	10/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 ALAMEDA ST.	None	WALNUT PARK	CA	90255	3738	19	06037	33.97203055	-118.234228	Los Angeles County
26922	Fee-for-Service	1750449336	1750449336	1	1	GARFIELD HEMATOLOGY &	2/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	ONCOLOGY CONSUL MED GRP	600 N GARFIELD AVE	STE 200	MONTEREY PARK	CA	91754	1169	19	06037	34.06820797	-118.1228835	Los Angeles County
26959	Fee-for-Service	1245770676	1245770676	1	1	GRANADA HILLS CARE HOMES	10/18/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11014 MONOGRAM AVENUE	None	GRANADA HILLS	CA	91344	5216	19	06037	34.27061618	-118.4923366	Los Angeles County
26971	Fee-for-Service	1427136282	1427136282	1	1	GOLDMAN, JAY MD	1/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71983	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
26975	Fee-for-Service	1669553418	1669553418	1	1	GRAY, ANDREA MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62009	40	Pediatrics	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
26979	Fee-for-Service	1801833843	1801833843	1	1	GREEN, DONALD R DPM	8/21/1996	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	108 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3007	37	06073	32.74827545	-117.1636605	San Diego County
26986	Fee-for-Service	1710372420	1710372420	1	1	GIBSON, AMANDA MD	3/2/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	145580	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
26992	Fee-for-Service	1952553844	1952553844	1	1	GARFIELD BEACH CVS LLC	4/20/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11950 DE PALMA RD	None	CORONA	CA	92883	8499	33	06065	33.74616594	-117.4512515	Riverside County
27021	Fee-for-Service	1336600956	1336600956	1	1	GIRMA, BRUKETAWIT T MD	9/1/2022	390200000X	NA	Other	026	PHYSICIANS	176690	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
27022	Fee-for-Service	1912734187	1912734187	1	1	GADDIES, LORETTA BIRTH DOUL	10/4/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
27030	Fee-for-Service	1871347989	1871347989	1	1	GENERATION CHANGERS TITLE 1	12/5/2024	261QR0405X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	740 FRESNO ST	None	FRESNO	CA	93706	3115	10	06019	36.72716986	-119.8045484	Fresno County
27050	Fee-for-Service	1649324500	1649324500	1	1	GOLD, JERRY E	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
27057	Fee-for-Service	1104802594	1104802594	1	1	GREENE, DAVID A MD	7/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148038	41	Internal Medicine	0	In state provider	None	3536 MENDOCINO AVE	SUITE 300	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
27062	Fee-for-Service	1639206543	1639206543	1	1	GARRELS, GERALD J	8/1/1993	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4001 MACDONALD AVE	None	RICHMOND	CA	94805	2231	07	06013	37.93347862	-122.3314451	Contra Costa County
27063	Fee-for-Service	1457410110	1457410110	1	1	GORDON, DAVID M MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42527	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
27067	Fee-for-Service	1003955519	1003955519	1	1	GARCIA-NIQUE, LUIS O MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	33647	None	None	0	In state provider	None	3010 W ORANGE AVE	STE 202	ANAHEIM	CA	92804	3171	30	06059	33.82472315	-117.994133	Orange County
27068	Fee-for-Service	1760585897	1760585897	1	2	GORMAN, MICHAEL R MD	10/12/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	68098	-	NOT APPLICABLE	0	In state provider	None	800 SCENIC DR	BLDG 4	MODESTO	CA	95350	6131	50	06099	37.64722447	-120.9836925	Stanislaus County
27082	Fee-for-Service	1649263252	1649263252	1	1	GANDHI, NIRAV D MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76927	45	Nephrology (Renal-Kidney)	0	In state provider	None	1801 W ROMNEYA DR	STE 207	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
27088	Fee-for-Service	1912979022	1912979022	1	1	GEISSE, LAWRENCE J MD	1/1/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	51765	18	Ophthalmology	0	In state provider	None	10861 CHERRY ST	STE 204	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
27106	Fee-for-Service	1740480813	1740480813	1	1	GULATI, NEIL MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65100	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
27109	Fee-for-Service	1407210768	1407210768	1	1	GILMORE, AMBER H MD	10/22/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169012	08	Family Practice	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
27114	Fee-for-Service	1780611145	1780611145	1	1	GAUGHAN, COLLEEN B MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93822	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
27172	Fee-for-Service	1053550772	1053550772	1	1	GALLEGO, GLORIA LMFT	6/29/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	36540	-	NOT APPLICABLE	0	In state provider	None	2309 DALY ST	None	LOS ANGELES	CA	90031	2230	19	06037	34.07225651	-118.2156318	Los Angeles County
27181	Fee-for-Service	1801536867	1801536867	1	4	GALEN INPATIENT PHYSICIANS,	6/1/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
27188	Fee-for-Service	1407276553	1407276553	1	1	GUO, CHU-YUEH	6/11/2018	390200000X	NA	Other	026	PHYSICIANS	150722	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
27210	Fee-for-Service	1205255940	1205255940	1	1	GUZMAN, ALEXIS MD	8/3/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	140857	08	Family Practice	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
27215	Fee-for-Service	1114131752	1114131752	1	1	GOPARAJU, MADHAVI MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124519	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
27235	Fee-for-Service	1801818414	1801818414	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27320 W LUGONIA AVE	None	REDLANDS	CA	92374	2041	36	06071	34.07238	-117.2074635	San Bernardino County
27265	Fee-for-Service	1912360769	1912360769	1	1	GUERRERO, DAHLIA MD	3/18/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171046	None	None	0	In state provider	None	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
27349	Fee-for-Service	1457410110	1457410110	1	1	GORDON, DAVID M MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42527	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
27355	Fee-for-Service	1588731418	1588731418	1	1	GHANSHANI, ANISHA S MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64811	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
27370	Fee-for-Service	1649263252	1649263252	1	1	GANDHI, NIRAV D MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76927	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DR	STE 207	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
27385	Fee-for-Service	1497791339	1497791339	1	1	GRUNVALD, EDUARDO L MD	4/1/1999	207R00000X	NA	Other	026	PHYSICIANS	65336	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
27441	Fee-for-Service	1255658928	1255658928	1	1	GASTROENTEROLOGY ASSOC	1/23/1997	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1825 SONOMA ST	None	REDDING	CA	96001	2519	45	06089	40.5756004	-122.3928987	Shasta County
27444	Fee-for-Service	1487765913	1487765913	1	1	GOODMAN, DANIEL H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78384	77	Infectious Disease	0	In state provider	None	45 CASTRO ST	STE 125	SAN FRANCISCO	CA	94114	1032	38	06075	37.76829732	-122.4357056	San Francisco County
27445	Fee-for-Service	1346352879	1346352879	1	1	GELBART AND ASSOCIATES, A PS	8/10/2018	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	YCHOLOGICAL CORPORATION	3333 SKYPARK DR	SUITE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
27446	Fee-for-Service	1194744086	1194744086	1	1	GLASSBURG, ERIC A MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55994	41	Internal Medicine	0	In state provider	None	2000 O STREET	SUITE 210	SACRAMENTO	CA	95811	5286	34	06067	38.57106572	-121.4822412	Sacramento County
27469	Fee-for-Service	1801536867	1801536867	1	4	GALEN INPATIENT PHYSICIANS,	6/1/2022	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
27484	Fee-for-Service	1780903203	1780903203	1	1	GOLTSER, ANATOLIY MD	1/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146265	None	None	0	In state provider	None	1065 BUCKS LAKE RD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
27499	Fee-for-Service	1689158644	1689158644	1	1	GARFIELD BEACH CVS LLC	12/14/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	390 N BREA BLVD	None	BREA	CA	92821	4005	30	06059	33.92459117	-117.895965	Orange County
27516	Fee-for-Service	1962768374	1962768374	1	1	GREENWOOD, ELENI A MD	8/26/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	129641	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
27527	Fee-for-Service	1881197200	1881197200	1	1	GENTRY, TANYA N DO	7/1/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	20574	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
27555	Fee-for-Service	1922251792	1922251792	1	1	GRIGORIYAN, ARTUR MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136599	41	Internal Medicine	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
27590	Fee-for-Service	1538271507	1538271507	1	1	GRAEVE JONATHAN 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	2800 10TH AVE N	None	BILLING	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
27595	Fee-for-Service	1194709188	1194709188	1	1	GE, LI L MD	1/19/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	162613	None	None	0	In state provider	None	6121 N THESTA AVE	SUITE 204	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
27716	Fee-for-Service	1821381732	1821381732	1	1	GREENE, CHRISTINA L MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115814	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
27726	Fee-for-Service	1518023126	1518023126	1	1	GHADIR, SHAHIN MD	3/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74590	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
27732	Fee-for-Service	1346352879	1346352879	1	1	GELBART AND ASSOCIATES, A PS	9/10/2018	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	YCHOLOGICAL CORPORATION	3333 SKYPARK DR	SUITE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
27735	Fee-for-Service	1174620504	1174620504	1	1	GOEBEL, ROBERT H MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38910	42	Nuclear Medicine	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
27738	Fee-for-Service	1477567634	1477567634	1	1	GILLOGLEY, MICHAEL J MD	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	53031	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
27755	Fee-for-Service	1972764066	1972764066	2	1	GARFIELD BEACH CVS LLC	5/30/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 COMMERCE AVE	None	ATWATER	CA	95301	5213	24	06047	37.34275386	-120.6106243	Merced County
27769	Fee-for-Service	1609436682	1609436682	1	1	GINDI, JACOB E MD	6/9/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176843	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
27781	Fee-for-Service	1275822090	1275822090	1	1	GRANT, TERRANCE R MD	11/2/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184468	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
27782	Fee-for-Service	1639369259	1639369259	1	1	GWALTNEY, ROBIN M MD	11/18/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175581	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
27793	Fee-for-Service	1366572141	1366572141	1	1	GLOBAL HEALTHCARE SERVICES	6/1/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	400 12TH STREET	STE 25	MODESTO	CA	95354	2415	50	06099	37.6364199	-120.9917894	Stanislaus County
27811	Fee-for-Service	1508308651	1508308651	1	1	GAGLIARDI, ERICA R NP	7/31/2023	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
27813	Fee-for-Service	1376598474	1376598474	1	1	GAENSLER, ERIK MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56651	01	General Practice	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
27842	Fee-for-Service	1467851337	1467851337	1	1	GIESE, JENNIFER E DO	1/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12838	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
27844	Fee-for-Service	1922251792	1922251792	1	1	GRIGORIYAN, ARTUR MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136599	66	Emergency Medicine (Urgent Care)	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
27861	Fee-for-Service	1912137423	1912137423	1	2	GILTAJI, VANUI PSYD	6/30/2020	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
27862	Fee-for-Service	1477879823	1477879823	1	1	GOLLOGLY, HEIDRUN E MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134761	18	Ophthalmology	0	In state provider	None	114 MISSION RANCH BLVD	SUITE 50	CHICO	CA	95926	5137	04	06007	39.75356438	-121.8600403	Butte County
27881	Fee-for-Service	1679743405	1679743405	1	1	GRUBER, CHRISTOPHER A MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99001	08	Family Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
27903	Fee-for-Service	1114351467	1114351467	1	1	GKN RX	9/12/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1471 B ST	STE R	LIVINGSTON	CA	95334	1426	24	06047	37.38601696	-120.7221808	Merced County
27914	Fee-for-Service	1205908027	1205908027	1	1	GU, KATHY H MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67285	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
27943	Fee-for-Service	1942293006	1942293006	1	1	GUREGHIAN, ERIC J MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60427	41	Internal Medicine	0	In state provider	None	612 E JANSS RD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
27967	Fee-for-Service	1750459137	1750459137	1	1	GISSIBLE, LOREN W LCSW	4/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25939	-	NOT APPLICABLE	0	In state provider	None	1340 TULLY ROAD	301 AND 304	SAN JOSE	CA	95122	3055	43	06085	37.31710924	-121.8334186	Santa Clara County
27973	Fee-for-Service	1538377536	1538377536	1	1	GRAHAM, ALEC	2/8/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7777 ALVARADO ROAD	STE 408A	LA MESA	CA	91941	3648	37	06073	32.7725521	-117.0315402	San Diego County
28000	Fee-for-Service	1851469266	1851469266	1	1	GAST, KIA M PT	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 LAKEVIEW HWY	None	PETALUMA	CA	94954	5698	49	06097	38.32168809	-122.6254468	Sonoma County
28021	Fee-for-Service	1346352879	1346352879	1	1	GELBART AND ASSOCIATES, A PS	8/10/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	YCHOLOGICAL CORPORATION	3333 SKYPARK DR	SUITE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
28023	Fee-for-Service	1174620504	1174620504	1	1	GOEBEL, ROBERT H MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38910	78	Neoplastic Diseases/Oncology	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
28027	Fee-for-Service	1477567634	1477567634	1	1	GILLOGLEY, MICHAEL J MD	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	53031	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
28063	Fee-for-Service	1861450579	1861450579	1	1	GERALD CHAMPION REGIONAL MED	5/22/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2669 SCENIC DR	None	ALAMOGORDO	NM	88310	8700	00	None	32.92683131	-105.9341287	Otero County
28070	Fee-for-Service	1184222630	1184222630	1	1	GENTLE CARE HOSPICE SERVICES	10/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CORP	490 S ROSEMEAD BLVD	SUITE 3	PASADENA	CA	91107	4958	19	06037	34.13808	-118.073204	Los Angeles County
28104	Fee-for-Service	1013183599	1013183599	1	1	GESTHALTER, YARON B MD	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151185	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
28129	Fee-for-Service	1922251792	1922251792	1	1	GRIGORIYAN, ARTUR MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136599	29	Pulmonary Diseases (M.D. only)	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
28136	Fee-for-Service	1952174203	1952174203	1	1	GIORGI, ASHLEY NP	12/12/2023	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
28155	Fee-for-Service	1366400921	1366400921	1	1	GARCIA, ROD A OD	8/2/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
28212	Fee-for-Service	1972546695	1972546695	1	1	GILBERT, HARVEY A, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28372	01	General Practice	0	In state provider	INC	311 S HAM LN	None	LODI	CA	95242	3512	39	06077	38.12935173	-121.2883815	San Joaquin County
28281	Fee-for-Service	1285675108	1285675108	1	1	GARFIELD BEACH CVS, LLC	11/16/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9045 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1829	19	06037	34.06708032	-118.3891948	Los Angeles County
28296	Fee-for-Service	1356429195	1356429195	1	1	GEORGE, MICHAEL J MD	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	70254	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
28298	Fee-for-Service	1174745525	1174745525	1	1	GROSS, THOMAS W MD	10/31/1990	207P00000X	NA	Other	026	PHYSICIANS	65532	08	Family Practice	0	In state provider	None	24 W EL ROSE DR	None	PETALUMA	CA	94952	4023	49	06097	38.22308352	-122.646555	Sonoma County
28300	Fee-for-Service	1922049832	1922049832	1	1	GARFIELD BEACH CVS, LLC	9/21/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2037 VERDUGO BLVD	None	MONTROSE	CA	91020	1626	19	06037	34.20478879	-118.2210421	Los Angeles County
28308	Fee-for-Service	1295925360	1295925360	1	1	GERARDO, MARTIN B MD	3/13/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	100776	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
28314	Fee-for-Service	1588672596	1588672596	1	1	GILL, NARINDER S MD	8/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90393	29	Pulmonary Diseases (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
28351	Fee-for-Service	1861450579	1861450579	1	1	GERALD CHAMPION REGIONAL MED	5/22/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2669 SCENIC DR	None	ALAMOGORDO	NM	88310	8700	00	None	32.92683131	-105.9341287	Otero County
28363	Fee-for-Service	1184222630	1184222630	1	1	GENTLE CARE HOSPICE SERVICES	10/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CORP	490 S ROSEMEAD BLVD	SUITE 3	PASADENA	CA	91107	4958	19	06037	34.13808	-118.073204	Los Angeles County
28379	Fee-for-Service	1629731336	1629731336	1	1	GEORGE, ROSE K NP	1/1/2022	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
28395	Fee-for-Service	1467617282	1467617282	1	1	GARFIELD BEACH CVS LLC	3/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 N WESTWOOD ST	None	PORTERVILLE	CA	93257	9286	54	06107	36.080649	-119.0707845	Tulare County
28405	Fee-for-Service	1851503155	1851503155	1	1	GHARIBSHAHI, SHAHRAM MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116581	13	Neurology (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
28482	Fee-for-Service	1558865881	1558865881	1	1	GUZMAN, DANIEL E MD	7/19/2021	208M00000X	NA	Other	026	PHYSICIANS	166185	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
28502	Fee-for-Service	1972546695	1972546695	1	1	GILBERT, HARVEY A, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	28372	78	Neoplastic Diseases/Oncology	0	In state provider	INC	311 S HAM LN	None	LODI	CA	95242	3512	39	06077	38.12935173	-121.2883815	San Joaquin County
28550	Fee-for-Service	1619496346	1619496346	1	1	GUTIERREZ, KARELY LCSW	2/10/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
28570	Fee-for-Service	1023076007	1023076007	1	1	GARTH LECHEMINANT,MD	2/2/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2490 S WOODWORTH LOOP	STE 450	PALMER	AK	99645	7407	00	None	61.562871	-149.256126	Matanuska-Susitna Borough
28581	Fee-for-Service	1720166267	1720166267	1	1	GURUNG, SIDHARTHA MD	8/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93538	08	Family Practice	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
28584	Fee-for-Service	1942204318	1942204318	1	1	GHC OF NEWPORT BEACH,	12/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1555 SUPERIOR AVE	None	NEWPORT BEACH	CA	92663	3628	30	06059	33.6307388	-117.9290205	Orange County
28620	Fee-for-Service	1659958619	1659958619	1	1	GUTIERREZ, JONATHAN DO	7/18/2023	390200000X	NA	Other	026	PHYSICIANS	20790	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
28631	Fee-for-Service	1659391134	1659391134	1	1	GANESAN, USHA V MD	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73506	40	Pediatrics	0	In state provider	None	710 N EUCLID STREET	SUITE 106	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
28638	Fee-for-Service	1710085980	1710085980	1	1	GUELLICH, FRANK G MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53695	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
28673	Fee-for-Service	1932244662	1932244662	1	1	GORDON, PETER M LMFT	8/20/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	620 N CALLE MARCUS	None	PALM SPRINGS	CA	92262	6149	33	06065	33.83232132	-116.5290731	Riverside County
28678	Fee-for-Service	1750309381	1750309381	1	1	GREENDALE, GALE A MD	6/30/1991	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	66482	41	Internal Medicine	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
28679	Fee-for-Service	1023038601	1023038601	1	1	GUEST, MATTHEW E MD	11/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91381	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
28682	Fee-for-Service	1912495722	1912495722	1	1	GALURA, GIAN MARCO MD	7/8/2024	207R00000X	NA	Other	026	PHYSICIANS	192349	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
28688	Fee-for-Service	1457977563	1457977563	1	1	GONZALEZ GUZMAN, JENNY T MD	4/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
28694	Fee-for-Service	1952347452	1952347452	1	1	GLIDDEN, HOWARD J PHD	9/17/2020	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E HERNDON AVE	SUITE 150	FRESNO	CA	93720	3359	10	06019	36.8375615	-119.7575595	Fresno County
28700	Fee-for-Service	1932863206	1932863206	1	1	GALAIF, ELISHA PHD	3/31/2022	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
28712	Fee-for-Service	1235339029	1235339029	1	1	GARCIA, BRAULIO LCSW	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25135	-	NOT APPLICABLE	0	In state provider	None	1930 MARKET ST	None	SAN FRANCISCO	CA	94102	6228	38	06075	37.77037155	-122.4255051	San Francisco County
28735	Fee-for-Service	1831568120	1831568120	1	1	G&Z SERVICES INC	7/20/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17609 VENTURA BLVD	STE LL06	ENCINO	CA	91316	5137	19	06037	34.16197507	-118.5167485	Los Angeles County
28736	Fee-for-Service	1023269750	1023269750	1	1	GOETZ, JAMES K PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	65 THIRD ST	STE 29B	PT REYES STA	CA	94956	0910	21	06041	38.06766892	-122.8068687	Marin County
28761	Fee-for-Service	1982832127	1982832127	1	1	GRAMMY, SEAN S DO	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13122	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
28772	Fee-for-Service	1174943146	1174943146	1	1	GREER, ROBERT D MD	8/20/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	168700	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6555 COYLE AVENUE	STE 215	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
28789	Fee-for-Service	1659317121	1659317121	1	1	GISONDI, MICHAEL A MD	5/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	73214	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
28824	Fee-for-Service	1659637403	1659637403	1	1	GRIFFIN, KELLY A MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128061	01	General Practice	0	In state provider	None	271 TURN PIKE DRIVE	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
28835	Fee-for-Service	1861695686	1861695686	1	1	GULATI, MANVI	7/27/2015	No Taxonomy Provided	NA	None	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
28879	Fee-for-Service	1649386707	1649386707	1	1	GUPTA, PRAVEEN D	1/1/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	25680	None	None	0	In state provider	ORATION	9435 VENICE BLVD	None	CULVER CITY	CA	90232	2623	19	06037	34.02524415	-118.3957738	Los Angeles County
28888	Fee-for-Service	1790702777	1790702777	1	1	GALLIVAN, WILLIAM R JR	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73901	20	Orthopedic Surgery	0	In state provider	None	2324 BATH ST	None	SANTA BARBARA	CA	93105	4330	42	06083	34.43130628	-119.7229224	Santa Barbara County
28900	Fee-for-Service	1386796761	1386796761	1	1	GOTTLIEB, NANCY LMFT	2/24/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	133 E HALEY STREET	None	SANTA BARBARA	CA	93101	2330	42	06083	34.41883725	-119.6933889	Santa Barbara County
28905	Fee-for-Service	1861436222	1861436222	1	1	GARFIELD BEACH CVS, LLC	2/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1564 W BASELINE AVE	None	SAN BERNARDINO	CA	92411	1712	36	06071	34.1213793	-117.3211044	San Bernardino County
28923	Fee-for-Service	1083745178	1083745178	1	1	GARIBALDI, CARLO G	7/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9267	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
28932	Fee-for-Service	1396839395	1396839395	1	1	GAJDA, DAVID J MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88865	18	Ophthalmology	0	In state provider	None	6283 CLARK RD	SUITE 10	PARADISE	CA	95969	4100	04	06007	39.7674117	-121.6005321	Butte County
28970	Fee-for-Service	1912495722	1912495722	1	1	GALURA, GIAN MARCO MD	7/8/2024	207R00000X	NA	Other	026	PHYSICIANS	192349	10	Gastroenterology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
28995	Fee-for-Service	1881855971	1881855971	2	1	GARFIELD BEACH CVS LLC	3/29/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2185 BRONZE STAR DR	None	WOODLAND	CA	95776	5406	57	06113	38.672685	-121.723788	Yolo County
29058	Fee-for-Service	1285668624	1285668624	1	1	GUPTA, ARPANA	8/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76933	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
29065	Fee-for-Service	1801831078	1801831078	1	1	GR0SSBERG, SCOTT E MD	6/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95432	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
29076	Fee-for-Service	1912018367	1912018367	1	1	GISELE E ISHAK	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	NE# 100	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
29107	Fee-for-Service	1588399067	1588399067	1	1	GATY-DELIA, CATHRYN P LCSW	6/20/2024	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
29110	Fee-for-Service	1356450423	1356450423	3	1	GOLDEN VALLEY MEDICAL	11/15/2016	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	424 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	4014	36	06071	34.13601852	-117.2924505	San Bernardino County
29117	Fee-for-Service	1730583857	1730583857	1	2	GILLIAN, SABRINA M LCSW	5/26/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	44105 15TH STREET WEST	UNITS 401/3/5/7	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
29143	Fee-for-Service	1750715629	1750715629	2	1	GARFIELD BEACH CVS LLC	12/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	701 RIO RANCHO ROAD	None	POMONA	CA	91766	7018	19	06037	34.03370291	-117.7554361	Los Angeles County
29165	Fee-for-Service	1225253024	1225253024	1	1	GADGIL, UDAY G MD INC	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	40126	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	315 N 3RD AVE	STE 305	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
29166	Fee-for-Service	1902828510	1902828510	2	1	GARFIELD BEACH CVS LLC	4/27/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10424 TRINITY PKWY	None	STOCKTON	CA	95219	7225	39	06077	38.051685	-121.3727715	San Joaquin County
29168	Fee-for-Service	1649386707	1649386707	1	1	GUPTA, PRAVEEN D	6/4/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ORATION	9435 VENICE BLVD	None	CULVER CITY	CA	90232	2623	19	06037	34.02524415	-118.3957738	Los Angeles County
29207	Fee-for-Service	1801090998	1801090998	1	1	GUPTA S.PAULA 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
29242	Fee-for-Service	1861619223	1861619223	1	1	GORDON, YVONNE A LMFT	10/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
29269	Fee-for-Service	1346805934	1346805934	1	1	GLENCARE HOSPICE SERVICES	1/11/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	639 S GLENWOOD PL	STE 207	BURBANK	CA	91506	2819	19	06037	34.16551979	-118.3138484	Los Angeles County
29276	Fee-for-Service	1659834364	1659834364	1	1	GILL, KIRIT DO	2/2/2025	207R00000X	NA	Other	026	PHYSICIANS	23475	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
29287	Fee-for-Service	1760505945	1760505945	1	1	GARITE, THOMAS J MD	8/14/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	27105	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	DEPT OB GYN	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
29327	Fee-for-Service	1811095136	1811095136	1	1	GROSSMONT OUTPATIENT SURGICA	8/20/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	L CENTER	5565 GROSSMONT CENTER DR	BLDG. 3 SUITE 250	LA MESA	CA	91942	3026	37	06073	32.77978322	-117.0094766	San Diego County
29393	Fee-for-Service	1063510857	1063510857	1	1	GUPTA, JYOTI MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155105	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
29439	Fee-for-Service	1710907514	1710907514	1	1	GROVE, DOUGLAS P MD	10/1/2000	207L00000X	NA	Other	026	PHYSICIANS	52338	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
29449	Fee-for-Service	1275666182	1275666182	1	1	GAGNEJA, PRITI MD	1/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98485	41	Internal Medicine	0	In state provider	None	317 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42967671	-119.7228362	Santa Barbara County
29454	Fee-for-Service	1225253024	1225253024	1	1	GADGIL, UDAY G MD INC	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	40126	41	Internal Medicine	0	In state provider	None	315 N 3RD AVE	STE 305	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
29484	Fee-for-Service	1891530366	1891530366	1	1	GAU, JANICE PT	7/26/2024	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
29485	Fee-for-Service	1538104435	1538104435	1	1	GARFIELD BEACH CVS, LLC	2/14/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12444 BEACH BLVD	None	STANTON	CA	90680	3930	30	06059	33.78145	-117.992725	Orange County
29525	Fee-for-Service	1578681839	1578681839	1	1	GUTIERREZ-JAUREGUI, MONICA J	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52429	-	NOT APPLICABLE	0	In state provider	LMFT	1303 WEST WALNUT PARKWAY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
29529	Fee-for-Service	1437314887	1437314887	1	1	GUSTAVO LOZADA MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 WASHINGTON ST	None	BOSTON	MA	02111	1552	00	None	42.349662	-71.063514	Suffolk County
29544	Fee-for-Service	1013241009	1013241009	1	1	GILL, HARPREET K MD	11/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109262	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
29554	Fee-for-Service	1790774784	1790774784	1	1	GILL, BALJINDER S MD	9/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76448	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
29555	Fee-for-Service	1013797539	1013797539	1	1	GOINS, CONSTANCE E LCSW	10/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
29560	Fee-for-Service	1346805934	1346805934	1	1	GLENCARE HOSPICE SERVICES	1/11/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	639 S GLENWOOD PL	STE 207	BURBANK	CA	91506	2819	19	06037	34.16551979	-118.3138484	Los Angeles County
29581	Fee-for-Service	1427375757	1427375757	1	1	GAY, ANNA CARD MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125419	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
29592	Fee-for-Service	1114048162	1114048162	1	1	GREEN, BARRY SETH OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	923 GRAVENSTEIN AVE	None	SEBASTOPOL	CA	95472	4501	49	06097	38.39235965	-122.8177253	Sonoma County
29619	Fee-for-Service	1932304342	1932304342	1	1	GUNTA, SUJANA S MD	2/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109056	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
29632	Fee-for-Service	1114493285	1114493285	1	1	G&A MEDICAL TRANSPORTATION	6/4/2018	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	1920 W PRINCETON AVE	STE 20	VISALIA	CA	93277	4473	54	06107	36.315765	-119.3129235	Tulare County
29646	Fee-for-Service	1326440439	1326440439	1	1	GRAY, LISA M NP	1/29/2021	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
29650	Fee-for-Service	1366416497	1366416497	1	1	GARG, RUCHIRA MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55424	35	Pediatric Cardiology (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
29651	Fee-for-Service	1215979422	1215979422	1	1	GURALNICK, SUSAN MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153750	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
29667	Fee-for-Service	1275735383	1275735383	1	1	GHADIALI, MURTAZA T MD	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98774	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
29677	Fee-for-Service	1063510857	1063510857	1	1	GUPTA, JYOTI MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155105	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
29686	Fee-for-Service	1063778173	1063778173	1	1	GHARIBIAN, NAYIRI G DO	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13112	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
29706	Fee-for-Service	1174918239	1174918239	1	1	GILL, SIMARJEET S MD	12/29/2018	208M00000X	NA	Other	026	PHYSICIANS	144231	None	None	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
29712	Fee-for-Service	1407812035	1407812035	1	1	GLYNN, CHRISTOPHER P MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	5330 SOUTH HWY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
29729	Fee-for-Service	1891808622	1891808622	1	1	GIVNER, ANDREW S MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95678	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
29737	Fee-for-Service	1295741759	1295741759	1	1	GLENN EISEN MD	10/7/2015	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
29739	Fee-for-Service	1376036707	1376036707	1	1	GATTU, RISHABH MD	8/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
29744	Fee-for-Service	1396811568	1396811568	1	1	GILL, NIKITA MD INC	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77028	41	Internal Medicine	0	In state provider	None	2626 EDITH AVE	STE C	REDDING	CA	96001	3056	45	06089	40.57103976	-122.3974622	Shasta County
29747	Fee-for-Service	1659726206	1659726206	1	1	GUIDRY, KAISHAUNA MD	6/11/2024	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	155393	41	Internal Medicine	0	In state provider	None	5725 RALSTON ST	STE 101	VENTURA	CA	93003	6053	56	06111	34.26095488	-119.2125269	Ventura County
29759	Fee-for-Service	1871077420	1871077420	1	1	GUTIERREZ, PRISCILLA J DOULA	3/17/2025	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	33	06065	0	0	None
29821	Fee-for-Service	1023559697	1023559697	1	1	GENESIS COMPREHENSIVE MEDICA	5/11/2023	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	L GROUP	191 S BUENA VISTA ST STE	None	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
29876	Fee-for-Service	1356561062	1356561062	1	2	GRAMMER, BEVERLEY F RN	5/22/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	220 HUNTINGTON CT	None	APTOS	CA	95003	4258	44	06087	36.98155588	-121.8714759	Santa Cruz County
29920	Fee-for-Service	1285980425	1285980425	1	1	GARFIELD BEACH CVS LLC	5/10/2013	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	591 COUNTRY CLUB DR	STE C	SIMI VALLEY	CA	93065	7691	56	06111	34.25284315	-118.81049	Ventura County
29945	Fee-for-Service	1275648875	1275648875	1	1	GUERIN, CHRIS K MD	12/1/1983	193400000X	NA	Other	026	PHYSICIANS	47081	41	Internal Medicine	0	In state provider	None	3927 WARING RD	STE C	OCEANSIDE	CA	92056	4458	37	06073	33.18776771	-117.2893136	San Diego County
29946	Fee-for-Service	1922042282	1922042282	1	1	GARFIELD BEACH CVS, LLC	2/3/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3960 BROAD ST.	None	SAN LUIS OBISPO	CA	93401	7018	40	06079	35.24870818	-120.6431996	San Luis Obispo County
29957	Fee-for-Service	1164473716	1164473716	1	1	GAYNOR, JEFFREY M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37015	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
29976	Fee-for-Service	1780765073	1780765073	1	1	GROOTENDORST, JOHN E DC	11/16/2007	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	900 W YOSEMITE AVE	None	MADERA	CA	93637	4555	20	06039	36.95534722	-120.0691832	Madera County
29996	Fee-for-Service	1467784389	1467784389	1	1	GREGORY, ANTHONY C II MD	10/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140370	18	Ophthalmology	0	In state provider	None	855 W FOOTHILL BLVD	None	MONROVIA	CA	91016	1938	19	06037	34.1511692	-118.0177106	Los Angeles County
30032	Fee-for-Service	1396811568	1396811568	1	1	GILL, NIKITA MD INC	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77028	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2626 EDITH AVE	STE C	REDDING	CA	96001	3056	45	06089	40.57103976	-122.3974622	Shasta County
30048	Fee-for-Service	1124382312	1124382312	1	1	GRANADOS, MARNIE L MD	1/2/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	121169	40	Pediatrics	0	In state provider	None	1120 W LA VETA AVE	STE 125	ORANGE	CA	92868	4235	30	06059	33.78029455	-117.864369	Orange County
30059	Fee-for-Service	1619651650	1619651650	1	1	GANADEN, GLEN U PT	9/25/2023	225100000X	NA	Physical Therapist	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
30064	Fee-for-Service	1760818173	1760818173	1	1	GRAM, KELLY B MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132227	01	General Practice	0	In state provider	None	450 EAST ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
30073	Fee-for-Service	1346353406	1346353406	1	1	GILL, DEBORAH A MD	4/16/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	92607	18	Ophthalmology	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
30083	Fee-for-Service	1518359827	1518359827	1	1	GHARIBJANIANS, ADRENA	7/13/2015	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
30108	Fee-for-Service	1427045848	1427045848	1	1	GRUIDL, MARK R NP	4/13/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	290 HEATHER CT	None	TEMPLETON	CA	93465	9738	40	06079	35.55288	-120.7176565	San Luis Obispo County
30113	Fee-for-Service	1144324427	1144324427	1	1	GRIGGS, ROBERT P MD	1/22/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182680	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
30166	Fee-for-Service	1356561062	1356561062	1	2	GRAMMER, BEVERLEY F RN	5/22/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	220 HUNTINGTON CT	None	APTOS	CA	95003	4258	44	06087	36.98155588	-121.8714759	Santa Cruz County
30167	Fee-for-Service	1376617969	1376617969	1	1	GARRIGAN, SHANNON M MD	12/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80710	08	Family Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
30184	Fee-for-Service	1972928042	1972928042	1	1	GARCIA-ENRIGHT, MARTHA S LMF	5/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
30189	Fee-for-Service	1093911356	1093911356	2	1	GOSS, BRITTANY L DO	6/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11329	83	Rheumatology	0	In state provider	None	3273 CLAREMONT WAY	SUITE 209	NAPA	CA	94558	3329	28	06055	38.32062499	-122.3012501	Napa County
30199	Fee-for-Service	1700838448	1700838448	1	1	GIBSON, DOUGLAS N MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69985	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
30205	Fee-for-Service	1265543599	1265543599	1	1	GOLDWYN, BENZION G MD	10/1/1996	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	83072	04	Otology, Laryngology, Rhinology	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
30207	Fee-for-Service	1710720982	1710720982	1	1	GOMEZ, SABRINA E NP	9/3/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1901 W LUGONIA AVE	SUITE 240	REDLANDS	CA	92374	9703	36	06071	34.07027851	-117.218421	San Bernardino County
30228	Fee-for-Service	1023134749	1023134749	1	1	GIROLAMI, MICHAEL H MD	7/7/2017	174400000X	NA	Other	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	A MEDICAL CORPORATION	1750 EL CAMINO REAL	11	BURLINGAME	CA	94010	3208	41	06081	37.59392355	-122.3819595	San Mateo County
30238	Fee-for-Service	1770650533	1770650533	1	1	GHAZARIAN, ANITA OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
30263	Fee-for-Service	1164992343	1164992343	1	1	GEVORGYAN MEDICAL CENTER INC	2/17/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	606 34TH ST	None	BAKERSFIELD	CA	93301	2208	15	06029	35.39051746	-119.008611	Kern County
30297	Fee-for-Service	1437722121	1437722121	1	1	GARCIA, RUBY LCSW	2/26/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
30299	Fee-for-Service	1114190113	1114190113	1	1	GREENE, SARAH C MD	7/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115422	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
30300	Fee-for-Service	1053323253	1053323253	1	1	GOLDSTEIN, ARTHUR I MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	15683	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	BLDG 16	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
30306	Fee-for-Service	1518904747	1518904747	1	1	GOBEL, REGINALD 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	1055 N CURTIS RD	None	BOISE	ID	83706	1309	00	None	43.61455048	-116.256231	Ada County
30312	Fee-for-Service	1861159774	1861159774	1	1	GREEN ORCHID HOME HEALTH, IN	10/29/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC.	225 E. BROADWAY	STE B117A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
30331	Fee-for-Service	1245611532	1245611532	1	1	GROWDON, MATTHEW E MD	6/5/2020	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	168455	38	Geriatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
30334	Fee-for-Service	1285782177	1285782177	1	1	GIRARD, MICHAEL S MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80876	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
30345	Fee-for-Service	1306834924	1306834924	1	1	GAY, MARCIA A NP	1/13/2011	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6221 CENTURY HILL DR	None	RIVERSIDE	CA	92506	4666	33	06065	33.93725582	-117.3553828	Riverside County
30371	Fee-for-Service	1710605472	1710605472	1	1	GOLDIN ENTERPRISES	10/3/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6525 ROSEMEAD BLVD	None	PICO RIVERA	CA	90660	3501	19	06037	33.98605773	-118.0950022	Los Angeles County
30384	Fee-for-Service	1720024888	1720024888	1	1	GARFIELD BEACH CVS LLC	5/2/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17642 E 17TH ST	None	TUSTIN	CA	92780	1937	30	06059	33.75969639	-117.8239472	Orange County
30385	Fee-for-Service	1710197017	1710197017	1	1	GRIDER GORDON DO	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1833 N POWER RD	None	MESA	AZ	85205	3799	00	None	33.449229	-111.6835875	Maricopa County
30419	Fee-for-Service	1629310735	1629310735	1	1	GOTTFRIED BLACKMORE, ANDRES	5/22/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	136219	10	Gastroenterology (M.D. only)	0	In state provider	C MD	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
30448	Fee-for-Service	1144526179	1144526179	1	1	GARY W HALL CHIROPRACTIC	1/30/2018	193400000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	200 AUTO CENTER CT	None	MODESTO	CA	95356	1573	50	06099	37.70179452	-120.9926655	Stanislaus County
30475	Fee-for-Service	1093911356	1093911356	2	1	GOSS, BRITTANY L DO	6/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11329	41	Internal Medicine	0	In state provider	None	3273 CLAREMONT WAY	SUITE 209	NAPA	CA	94558	3329	28	06055	38.32062499	-122.3012501	Napa County
30519	Fee-for-Service	1417292947	1417292947	1	1	GANGAPURKAR, BHAKTI A MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130564	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
30536	Fee-for-Service	1306390828	1306390828	1	1	GSR HOME HEALTH INC	11/22/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14349 VICTORY BLVD	STE 200	VAN NUYS	CA	91401	6515	19	06037	34.18669646	-118.4460435	Los Angeles County
30543	Fee-for-Service	1114285657	1114285657	2	1	GALEN INPATIENT PHYSICIANS P	1/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
30551	Fee-for-Service	1972657575	1972657575	1	1	GARZA, ROBERT LCSW	2/28/2022	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
30571	Fee-for-Service	1790304921	1790304921	1	1	GARCIA, LORENA MD	6/29/2023	2086S0120X	NA	General Surgery	026	PHYSICIANS	186305	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
30597	Fee-for-Service	1568494250	1568494250	1	1	GYAMFI-BANNERMAN, CYNTHIA M	7/26/2021	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173188	None	None	0	In state provider	D	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
30612	Fee-for-Service	1316119357	1316119357	1	1	GESLANI, VAN F MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109293	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
30617	Fee-for-Service	1740217512	1740217512	1	1	GORDON, 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	4444 N 32ND ST	STE 175	PHOENIX	AZ	85018	3999	00	None	33.502041	-112.013424	Maricopa County
30621	Fee-for-Service	1902840275	1902840275	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6775 QUAIL HILL PKWY	None	IRVINE	CA	92603	4233	30	06059	33.655086	-117.7777125	Orange County
30733	Fee-for-Service	1790104990	1790104990	1	1	GUSLAND, DANIELE Y MD	8/10/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169288	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
30741	Fee-for-Service	1316323579	1316323579	1	1	GATE DIALYSIS LLC	7/10/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4200 N GOLDEN STATE BLVD	None	TURLOCK	CA	95382	8840	50	06099	37.53137154	-120.887577	Stanislaus County
30753	Fee-for-Service	1831131143	1831131143	1	1	GUILLERMO A CORTINAS	4/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RENAISSANCE EMERGENCY	5501 S MCCOLL RD	None	EDINBURG	TX	78539	9152	00	None	26.25257119	-98.20410216	Hidalgo County
30771	Fee-for-Service	1538230503	1538230503	1	1	GUPTA, NIGEL MD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69371	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
30786	Fee-for-Service	1063096816	1063096816	1	1	GAY, UNIESIA K LCSW	3/30/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
30791	Fee-for-Service	1801299094	1801299094	1	1	GERRY, ARIANNA A PHD	1/1/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94303	3341	43	06085	37.43304542	-122.1759654	Santa Clara County
30814	Fee-for-Service	1760555759	1760555759	1	1	GAOGHAGAN, JILL B MD	12/31/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70797	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
30836	Fee-for-Service	1700206844	1700206844	1	1	GREAVES, GIOVANNI H MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156664	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
30840	Fee-for-Service	1497062368	1497062368	1	1	GUTSTEIN, HOLLY R LMFT	6/21/2019	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
30858	Fee-for-Service	1790965945	1790965945	1	1	GRIGOR GRIGORYAN	5/27/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PALMDALE MED SUPPLY & EQ	2720 EAST PALMDALE BLVD	STE 124	PALMDALE	CA	93550	4930	19	06037	34.58012347	-118.0800855	Los Angeles County
30929	Fee-for-Service	1700568128	1700568128	1	1	GARCIA, JESSIE NP	9/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	19	06037	34.05101259	-118.217259	Los Angeles County
30961	Fee-for-Service	1134518004	1134518004	1	1	GARFIELD BEACH CVS LLC	5/4/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12746 W JEFFERSON BLVD	SUITE 3160	PLAYA VISTA	CA	90094	2778	19	06037	33.97751255	-118.417598	Los Angeles County
31033	Fee-for-Service	1659439354	1659439354	1	1	GATCHALIAN, LYNDA P	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
31047	Fee-for-Service	1053374371	1053374371	1	1	GERDES, ERIC H DO	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8299	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
31069	Fee-for-Service	1730171059	1730171059	2	1	GWON, SEUNG S MD	10/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81046	02	General Surgery	0	In state provider	None	1699 W MAIN ST	STE D	EL CENTRO	CA	92243	2235	13	06025	32.79277349	-115.573878	Imperial County
31108	Fee-for-Service	1245606540	1245606540	1	1	GOOSHERST, LINDSEY DO	1/3/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16552	08	Family Practice	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
31126	Fee-for-Service	1629735097	1629735097	1	1	GONZALEZ-GALDAMEZ, WILVER IS	12/27/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RAEL PT	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
31151	Fee-for-Service	1932226701	1932226701	1	1	GRAHN, SARAH W MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80722	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
31160	Fee-for-Service	1326058348	1326058348	1	1	GOPEZ, MARIA R MD INC	8/24/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	73104	None	None	0	In state provider	None	81767 DR CARREON BLVDD	STE 100	INDIO	CA	92201	5590	33	06065	33.70738112	-116.237755	Riverside County
31167	Fee-for-Service	1841262037	1841262037	1	1	GILL, RAJWINDER OD	10/12/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
31175	Fee-for-Service	1356987432	1356987432	1	1	GOULD, JENNA	4/21/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
31223	Fee-for-Service	1265774152	1265774152	1	1	GUPTA, NEHA MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132990	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
31260	Fee-for-Service	1912408626	1912408626	1	1	GORAB, ALEXANDRA H MD	9/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160101	None	None	0	In state provider	None	1310 W STEWART DRIVE	506	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
31261	Fee-for-Service	1710120118	1710120118	1	1	GOLLAPALLE, MYTHRI R MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119469	01	General Practice	0	In state provider	None	669 SOUTHLAND MALL DR	None	HAYWARD	CA	94545	2150	01	06001	37.65057903	-122.0989283	Alameda County
31329	Fee-for-Service	1164442067	1164442067	1	1	GOLD, PHILIP M MD	5/28/1987	207RP1001X	NA	Pulmonology	026	PHYSICIANS	20753	29	Pulmonary Diseases (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
31356	Fee-for-Service	1730171059	1730171059	2	1	GWON, SEUNG S MD	10/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81046	07	Dermatology	0	In state provider	None	1699 W MAIN ST	STE D	EL CENTRO	CA	92243	2235	13	06025	32.79277349	-115.573878	Imperial County
31370	Fee-for-Service	1366499774	1366499774	1	1	GIEM, PAUL MD	1/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	38778	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25333 BARTON RD	None	LOMA LINDA	CA	92354	3123	36	06071	34.04801656	-117.251334	San Bernardino County
31389	Fee-for-Service	1740368596	1740368596	1	1	GAVALLOS, GEORGE P MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91903	34	Urology and Urological Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
31429	Fee-for-Service	1306498027	1306498027	1	1	GREER, KALANA R PSYD	5/1/2020	103TC0700X	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
31439	Fee-for-Service	1265585061	1265585061	1	1	GERKE, THOMAS J MD INC	4/1/1998	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	59290	01	General Practice	0	In state provider	COAST MEDICAL CLINIC	4055 E OLYMPIC BLVD	STE 207	LOS ANGELES	CA	90023	3345	19	06037	34.01891453	-118.187568	Los Angeles County
31456	Fee-for-Service	1912488487	1912488487	1	1	GARFIELD BEACH CVS LLC	2/8/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27551 PUERTA REAL	None	MISSION VIEJO	CA	92691	6321	30	06059	33.56296089	-117.6710589	Orange County
31463	Fee-for-Service	1508037078	1508037078	1	1	GRANT, DARCY E MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102856	40	Pediatrics	0	In state provider	None	1300 BANCROFT AVE	STE 204	SAN LEANDRO	CA	94577	5147	01	06001	37.72690979	-122.1477291	Alameda County
31477	Fee-for-Service	1912348293	1912348293	1	1	GRAY, KELSEY E MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135919	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
31551	Fee-for-Service	1184988008	1184988008	1	1	GAUGHEN, KELLY M DO	4/25/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	22401	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
31575	Fee-for-Service	1750080800	1750080800	1	1	GRAMLICH, KELLI NP	7/9/2024	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
31616	Fee-for-Service	1164442067	1164442067	1	1	GOLD, PHILIP M MD	5/28/1987	207RP1001X	NA	Pulmonology	026	PHYSICIANS	20753	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
31617	Fee-for-Service	1205275476	1205275476	1	1	GRIFFIN, DIAMOND R LCSW	12/20/2022	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
31645	Fee-for-Service	1841908464	1841908464	1	1	GEPHART, AMANDA PHD	12/29/2022	103T00000X	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
31660	Fee-for-Service	1073615605	1073615605	1	1	GEARY, SIU MING J MD	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82524	41	Internal Medicine	0	In state provider	None	15025 INNOVATION DR	None	SAN DIEGO	CA	92128	3409	37	06073	32.98956795	-117.0767228	San Diego County
31677	Fee-for-Service	1114434552	1114434552	1	2	GOLDEN VALLEY HEALTH CENTERS	7/23/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2240 W MONTE VISTA AVE	None	TURLOCK	CA	95382	9667	50	06099	37.52173653	-120.8741705	Stanislaus County
31726	Fee-for-Service	1265585061	1265585061	1	1	GERKE, THOMAS J MD INC	4/1/1998	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	59290	41	Internal Medicine	0	In state provider	COAST MEDICAL CLINIC	4055 E OLYMPIC BLVD	STE 207	LOS ANGELES	CA	90023	3345	19	06037	34.01891453	-118.187568	Los Angeles County
31783	Fee-for-Service	1578274627	1578274627	1	1	GAUTAM PAREEK MD INC	6/20/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3755 BEACON AVE	None	FREMONT	CA	94538	1411	01	06001	37.54813209	-121.9825183	Alameda County
31824	Fee-for-Service	1902977218	1902977218	1	1	GOLDEN AGE ADULT DAY HEALTH	1/6/2014	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER INC	18332 VENTURA BLVD	None	TARZANA	CA	91356	4219	19	06037	34.16710415	-118.5320031	Los Angeles County
31832	Fee-for-Service	1134160203	1134160203	1	1	GILBERT, PATRICIA L MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	67441	36	Psychiatry	0	In state provider	None	1679 E MAIN STREET	#205	EL CAJON	CA	92021	5212	37	06073	32.81117533	-116.9193178	San Diego County
31852	Fee-for-Service	1619975679	1619975679	1	1	GLUCK, GABRIEL MD	8/11/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	166320	20	Orthopedic Surgery	0	In state provider	None	3525 LOMA VISTA ROAD	SUITE A	VENTURA	CA	93003	3165	56	06111	34.27680789	-119.2480851	Ventura County
31873	Fee-for-Service	1982646238	1982646238	1	1	GARFIELD BEACH CVS LLC	10/28/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23841 MALIBU ROAD	None	MALIBU	CA	90265	4644	19	06037	34.03351086	-118.6939482	Los Angeles County
31911	Fee-for-Service	1952351777	1952351777	1	1	GABRIEL, NICK H DO	12/18/2019	208600000X	NA	General Surgery	026	PHYSICIANS	17467	02	General Surgery	0	In state provider	None	2526 SISTER MARY COLUMBA	1ST FLOOR	RED BLUFF	CA	96080	4327	52	06103	40.14934389	-122.2195713	Tehama County
31921	Fee-for-Service	1386831121	1386831121	1	1	GOMEZ, SHANNON L LCSW	5/20/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER 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
31965	Fee-for-Service	1114434552	1114434552	1	2	GOLDEN VALLEY HEALTH CENTERS	7/16/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2240 W MONTE VISTA AVE	None	TURLOCK	CA	95382	9667	50	06099	37.52173653	-120.8741705	Stanislaus County
31980	Fee-for-Service	1023228053	1023228053	1	1	GADDINI, MICHAEL PT	12/1/2023	2251S0007X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
32017	Fee-for-Service	1467977561	1467977561	1	1	GILBRETH, ANNA NP	3/5/2023	363LP0200X	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
32024	Fee-for-Service	1871538199	1871538199	1	1	GARFIELD BEACH CVS, LLC	9/3/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 S. CENTRAL AVE.	None	COMPTON	CA	90220	4104	19	06037	33.88768414	-118.2500318	Los Angeles County
32069	Fee-for-Service	1942427463	1942427463	1	1	GIACONI, JOSEPH C MD	1/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88998	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
32080	Fee-for-Service	1093254518	1093254518	1	1	GURUNG, ASURUPI NP	5/29/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1240 BROADWAY	None	EL CAJON	CA	92021	4994	37	06073	32.80773552	-116.9384985	San Diego County
32095	Fee-for-Service	1568748424	1568748424	1	1	GRANTHAM, ERIN C MD	3/15/2024	208800000X	NA	Other	026	PHYSICIANS	None	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
32122	Fee-for-Service	1588242689	1588242689	1	1	GAW, HERMIONE MD	11/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187395	08	Family Practice	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
32128	Fee-for-Service	1437109949	1437109949	1	1	GALLOWAY, MICHAEL T MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76202	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
32162	Fee-for-Service	1427206424	1427206424	2	1	GARFIELD BEACH CVS LLC	2/26/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5680 BALBOA AVE	None	SAN DIEGO	CA	92111	2706	37	06073	32.82275828	-117.1783455	San Diego County
32221	Fee-for-Service	1891869244	1891869244	3	1	GARFIELD BEACH CVS, L.L.C.	3/13/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	420 E 2ND ST	None	CALEXICO	CA	92231	2847	13	06025	32.6666527	-115.4925262	Imperial County
32229	Fee-for-Service	1851567473	1851567473	1	1	GYASI, ASKIA A DO	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14341	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
32253	Fee-for-Service	1114434552	1114434552	1	2	GOLDEN VALLEY HEALTH CENTERS	7/23/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2240 W MONTE VISTA AVE	None	TURLOCK	CA	95382	9667	50	06099	37.52173653	-120.8741705	Stanislaus County
32254	Fee-for-Service	1235491598	1235491598	1	1	GODFREY, JAMES MD	1/7/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	170991	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
32258	Fee-for-Service	1609947860	1609947860	1	1	GYDEN, CHARLES	8/13/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	426 W MANCHESTER BLVD	None	INGLEWOOD	CA	90301	1110	19	06037	33.96155982	-118.3631927	Los Angeles County
32271	Fee-for-Service	1780963777	1780963777	1	1	GODWIN, NEAL DO	10/21/2014	207R00000X	NA	Other	026	PHYSICIANS	13484	41	Internal Medicine	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
32292	Fee-for-Service	1568099893	1568099893	1	1	GERONDALE, JOSEPH A MD	11/3/2022	207P00000X	NA	Other	026	PHYSICIANS	177989	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
32296	Fee-for-Service	1740324151	1740324151	1	1	GILBERT, GREGORY H MD	6/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75504	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
32307	Fee-for-Service	1497729735	1497729735	1	1	GRANDIS, JENNIFER R MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140312	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
32309	Fee-for-Service	1073566261	1073566261	1	1	GUPTA, NIRAJ P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92943	36	Psychiatry	0	In state provider	None	WEST 5TH AVE & ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.741948	-121.848921	Butte County
32317	Fee-for-Service	1912698135	1912698135	1	1	GUARDIAN FLIGHT LLC	10/7/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	1500 W 12TH ST	UNIT B	PARKER	AZ	85344	5532	00	None	34.14527022	-114.2954216	La Paz County
32336	Fee-for-Service	1114978871	1114978871	1	1	GIANNOTTA, STEVEN L MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	36283	14	Neurological Surgery	0	In state provider	None	2250 ALCAZAR ST	None	LOS ANGELES	CA	90089	0229	19	06037	34.06313563	-118.1997071	Los Angeles County
32393	Fee-for-Service	1033675483	1033675483	1	1	GRULLON, EMILY D OT	8/12/2021	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	15928 VENTURA BLVD	STE 218	ENCINO	CA	91436	4413	19	06037	34.15585301	-118.4801465	Los Angeles County
32404	Fee-for-Service	1184866584	1184866584	1	1	GOLDBERG, ROGER A MD	7/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130614	None	None	0	In state provider	None	122 LA CASA VIA	SUITE 223	WALNUT CREEK	CA	94598	3104	07	06013	37.91198028	-122.041845	Contra Costa County
32415	Fee-for-Service	1437109949	1437109949	1	1	GALLOWAY, MICHAEL T MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76202	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
32455	Fee-for-Service	1154519213	1154519213	2	1	GIRGIS, BAHAA B MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	64665	41	Internal Medicine	0	In state provider	None	9194 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3802	33	06065	33.92351463	-117.4408298	Riverside County
32477	Fee-for-Service	1225145543	1225145543	1	1	GJELTEMA, KENNETH J MD	1/5/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	58053	08	Family Practice	0	In state provider	None	500 SAN PABLO AVE	STE 200	EL CERRITO	CA	94530	0000	07	06013	37.89781848	-122.3014067	Alameda County
32504	Fee-for-Service	1114405099	1114405099	1	1	GARCIA, FRANCISKA N RCP	8/27/2018	227900000X	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
32539	Fee-for-Service	1063421782	1063421782	1	1	GIBSON, 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	77 W. FOREST AVE.	SUITE #207	FLAGSTAFF	AZ	86001	0000	00	None	35.210619	-111.6436275	Coconino County
32555	Fee-for-Service	1942224811	1942224811	1	1	GOLDEN, DONALD E MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	72192	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
32559	Fee-for-Service	1235323205	1235323205	2	1	GARFIELD BEACH CVS LLC	6/15/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	651 W SEPULVEDA BLVD	None	CARSON	CA	90745	6314	19	06037	33.80880659	-118.2867365	Los Angeles County
32565	Fee-for-Service	1366871675	1366871675	2	1	GARFIELD BEACH CVS, L.L.C.	2/4/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 W LAKE ST	None	MOUNT SHASTA	CA	96067	2225	47	06093	41.31304215	-122.3125559	Siskiyou County
32622	Fee-for-Service	1437928207	1437928207	1	1	GET WELL LLC	2/9/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	406 W BASELINE RD	None	GLENDORA	CA	91740	4801	19	06037	34.1212917	-117.8699341	Los Angeles County
32648	Fee-for-Service	1356466973	1356466973	1	1	GUNN, TIMOTHY PSYD	6/14/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
32651	Fee-for-Service	1346311107	1346311107	1	1	GRAHAM, ALISON N MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7418	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
32652	Fee-for-Service	1841603065	1841603065	1	1	GARFIELD BEACH CVS LLC	1/21/2015	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	210 WEST 7TH STREET	None	LOS ANGELES	CA	90014	1834	19	06037	34.04470437	-118.2526158	Los Angeles County
32659	Fee-for-Service	1710079314	1710079314	1	1	GELB, ROBERT I MD	9/8/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	54043	20	Orthopedic Surgery	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
32683	Fee-for-Service	1376565986	1376565986	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	67750 E PALM CANYON DR	None	CATHEDRAL CITY	CA	92234	5441	33	06065	33.789816	-116.4807945	Riverside County
32701	Fee-for-Service	1770940561	1770940561	1	1	GREENBRIAR EMERGENCY	2/1/2016	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MEDICAL GROUP	501 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39674221	-122.8201502	Sonoma County
32723	Fee-for-Service	1548616873	1548616873	2	1	GORDON-WOLLIN, EVAN R DO	6/8/2023	207R00000X	NA	Other	026	PHYSICIANS	16019	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
32730	Fee-for-Service	1083619753	1083619753	1	1	GOMEZ, HAROLD A RN	6/1/1999	164W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1220 S GLENDORA AVENUE	None	WEST COVINA	CA	91790	4924	19	06037	34.05486662	-117.9389631	Los Angeles County
32734	Fee-for-Service	1811084817	1811084817	1	1	GOYAL, ARCHANA MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	86780	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
32842	Fee-for-Service	1275589319	1275589319	1	1	GUNDLING, KATHERINE E MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	66672	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
32845	Fee-for-Service	1942224811	1942224811	1	1	GOLDEN, DONALD E MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	72192	41	Internal Medicine	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
32878	Fee-for-Service	1720406234	1720406234	1	1	GLODOWSKI, CARA A CCC-SLP	5/15/2024	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
32890	Fee-for-Service	1205882511	1205882511	1	1	GALA, RAJEEV S MD	2/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94959	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA LN	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
32936	Fee-for-Service	1003846130	1003846130	1	2	GENTIVA CERTIFIED HEALTHCARE	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2525 CAMINO DEL RIO S	SUITE 220	SAN DIEGO	CA	92108	3719	37	06073	32.76765181	-117.1387992	San Diego County
32940	Fee-for-Service	1558724732	1558724732	1	1	GOLZ, ANDREW G MD	10/14/2022	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	171152	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
33021	Fee-for-Service	1649470527	1649470527	1	1	GREG. HANSEN MD	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
33035	Fee-for-Service	1578066387	1578066387	1	1	GHASSEMLOU, MICHAEL MD	11/13/2024	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	190658	30	Radiology	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
33039	Fee-for-Service	1558356436	1558356436	1	1	GLENDALE CV OPERATING	4/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMPANY LLC	1208 S CENTRAL AVE	None	GLENDALE	CA	91204	2504	19	06037	34.131771	-118.257792	Los Angeles County
33044	Fee-for-Service	1689607194	1689607194	1	1	GORDON, MARTIN L MD	5/1/1999	207L00000X	NA	Other	026	PHYSICIANS	25996	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
33058	Fee-for-Service	1437378114	1437378114	1	2	GLOBAL HOME HEALTHCARE	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICE INC	221 N SAN DIMAS AVE	STE B	SAN DIMAS	CA	91773	2664	19	06037	34.109532	-117.8071585	Los Angeles County
33081	Fee-for-Service	1659350734	1659350734	1	1	GLICKMAN, PETER MD	6/17/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1401 N TUSTIN AVE.,	SUITE 170	SANTA ANA	CA	92705	8679	30	06059	33.757254	-117.8341425	Orange County
33133	Fee-for-Service	1831162726	1831162726	1	1	GOYAL, ALKA MD	1/23/2020	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	167221	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
33162	Fee-for-Service	1386757680	1386757680	1	1	GROVER, JOETSNA MD	8/2/2017	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	43590	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
33257	Fee-for-Service	1760926083	1760926083	1	1	GAO, LINA NP	12/22/2016	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
33264	Fee-for-Service	1194325084	1194325084	1	1	GOLUB, RIMMA NP	1/11/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2121 WILSHIRE BLVD	#303	SANTA MONICA	CA	90403	5743	19	06037	34.03262306	-118.4817131	Los Angeles County
33268	Fee-for-Service	1780641399	1780641399	1	1	GREEN, ADRIENNE L MD	10/31/1995	207R00000X	NA	Other	026	PHYSICIANS	55428	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
33294	Fee-for-Service	1275605073	1275605073	1	1	GAVASKAR, SMITA MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62480	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
33302	Fee-for-Service	1003190281	1003190281	1	1	GONZALES, SANDRA LCSW	3/31/2020	101YM0800X	NA	Other	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
33332	Fee-for-Service	1659777944	1659777944	1	1	GIRARD, DAVID A MD	7/16/2018	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	137390	13	Neurology (M.D. only)	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 120	PASADENA	CA	91105	3149	19	06037	34.13101049	-118.151532	Los Angeles County
33340	Fee-for-Service	1962226316	1962226316	1	1	GUTIERREZ, KRISTIN	12/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1625 EAST MAIN ST.	STE 104	EL CAJON	CA	92021	5223	37	06073	32.80969963	-116.9203429	San Diego County
33371	Fee-for-Service	1063714665	1063714665	1	1	GUTIERREZ, ALEJANDRA LMFT	12/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5401 BUSINESS PARK S	STE 208	BAKERSFIELD	CA	93309	1661	15	06029	35.35832463	-119.0598951	Kern County
33377	Fee-for-Service	1487099909	1487099909	1	1	GHALI, BASSEM W MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141882	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
33389	Fee-for-Service	1427566488	1427566488	1	1	GOB, JOANNA OT	3/23/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	16800 ASTON	STE 175	IRVINE	CA	92606	4820	30	06059	33.70035445	-117.8435881	Orange County
33469	Fee-for-Service	1043657430	1043657430	1	1	GREENFIELD, LISA M MD	6/19/2018	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
33485	Fee-for-Service	1528280187	1528280187	1	1	GRIMES, ALISON M	6/1/1996	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
33500	Fee-for-Service	1700821501	1700821501	2	1	GARFIELD BEACH CVS, LLC	4/10/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	596 LONG BEACH BLVD	None	LONG BEACH	CA	90802	2401	19	06037	33.773769	-118.189282	Los Angeles County
33501	Fee-for-Service	1437194230	1437194230	1	1	GARFIELD BEACH CVS LLC	12/31/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2532 W VALLEY BLVD	None	ALHAMBRA	CA	91803	1934	19	06037	34.07691174	-118.1511557	Los Angeles County
33509	Fee-for-Service	1386133411	1386133411	1	1	GAMBLE, JAN M AU	8/20/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1100 TRANCAS ST	STE 210	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
33516	Fee-for-Service	1225140270	1225140270	1	1	GELVEZ,JAVIER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3584 S HILLS AVE	None	FORTWORTH	TX	76109	3600	00	None	32.69639839	-97.36952595	Tarrant County
33558	Fee-for-Service	1871734756	1871734756	1	1	GRAN, MARISSA PHD	4/22/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	964 5TH AVENUE	SUITE 535	SAN DIEGO	CA	92101	6102	37	06073	32.71539477	-117.1601872	San Diego County
33566	Fee-for-Service	1780245878	1780245878	1	1	GORBACH, OLENA	10/19/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
33590	Fee-for-Service	1407813322	1407813322	1	1	GONZALEZ, HECTOR A MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	50580	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
33634	Fee-for-Service	1881117489	1881117489	1	1	GANNON, JAMIE M PHD	10/10/2017	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
33640	Fee-for-Service	1649685074	1649685074	1	1	GUERRA, JACUELINE C MD	1/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151449	41	Internal Medicine	0	In state provider	None	122 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2091	42	06083	34.43800958	-119.8082259	Santa Barbara County
33682	Fee-for-Service	1205037199	1205037199	1	1	GEE, ANNA OD	2/3/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25965 S NORMANDIE	None	HARBOR CITY	CA	90710	3416	19	06037	33.78690131	-118.2975558	Los Angeles County
33684	Fee-for-Service	1750008124	1750008124	1	1	GHAZARYAN MD INC	8/1/2023	163WG0000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1100 E BROADWAY	205	GLENDALE	CA	91205	1384	19	06037	34.14622171	-118.2415193	Los Angeles County
33733	Fee-for-Service	1194032060	1194032060	1	1	GOSIENGFIAO, ZARAH L	5/23/2019	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
33746	Fee-for-Service	1124436142	1124436142	1	1	GOLDIN, AMANDA N MD	6/8/2021	390200000X	NA	Other	026	PHYSICIANS	137997	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
33761	Fee-for-Service	1043657430	1043657430	1	1	GREENFIELD, LISA M MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
33763	Fee-for-Service	1730115221	1730115221	1	2	GORENBERG, ALAN E MD	10/1/1998	207K00000X	NA	Other	026	PHYSICIANS	60876	03	Allergy	0	In state provider	None	12380 HESPERIA RD	STE 2	VICTORVILLE	CA	92395	5814	36	06071	34.47639649	-117.2913437	San Bernardino County
33798	Fee-for-Service	1982287181	1982287181	1	1	GLENBURB HOME HEALTH INC	7/18/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4910 SAN FERNANDO RD	UNIT A	GLENDALE	CA	91204	1414	19	06037	34.14101643	-118.2688187	Los Angeles County
33814	Fee-for-Service	1154896488	1154896488	1	1	GOLDEN TOUCH HOME HEALTH	9/30/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	17050 CHATSWORTH ST	STE 211	GRANADA HILLS	CA	91344	5975	19	06037	34.26477251	-118.5039945	Los Angeles County
33869	Fee-for-Service	1225326903	1225326903	1	1	GOTESMAN, MORAN MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127848	40	Pediatrics	0	In state provider	None	21840 S NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
33893	Fee-for-Service	1972009967	1972009967	2	1	GAKHAL, GURINDER PAL S MD	3/14/2023	208M00000X	NA	Other	026	PHYSICIANS	176700	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
33927	Fee-for-Service	1275801243	1275801243	1	1	GUZMAN LOPEZ AGUADO, MAYELI	2/18/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	E CNM	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
33928	Fee-for-Service	1235105610	1235105610	1	1	GREWAL, KARANBIR S MD	5/4/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53044	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
33938	Fee-for-Service	1326313008	1326313008	1	1	GRAVES, KENYETTA	11/9/2023	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
33942	Fee-for-Service	1801536867	1801536867	1	3	GALEN INPATIENT PHYSICIANS,	6/1/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	ONE MARCELA DRIVE	None	WILLITS	CA	95490	5769	23	06045	39.3901086	-123.339055	Mendocino County
33966	Fee-for-Service	1649262650	1649262650	1	1	GAGLIARDI, MARTIN P MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	51695	20	Orthopedic Surgery	0	In state provider	None	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
33967	Fee-for-Service	1871024877	1871024877	1	1	GUTIERREZ, ADAM C MD	9/9/2024	208600000X	NA	General Surgery	026	PHYSICIANS	161615	02	General Surgery	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
33978	Fee-for-Service	1801536867	1801536867	1	2	GALEN INPATIENT PHYSICIANS,	6/1/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	10 WOODLAND ROAD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
33994	Fee-for-Service	1689742702	1689742702	1	1	GIDOWSKI, ROSA M MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53575	08	Family Practice	0	In state provider	None	368 W BADILLO ST	None	COVINA	CA	91723	1827	19	06037	34.08627048	-117.8963055	Los Angeles County
34002	Fee-for-Service	1992742621	1992742621	1	1	GORADIA, DHAWAL A MD	3/24/2009	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	103612	30	Radiology	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
34012	Fee-for-Service	1982360269	1982360269	1	1	GASER, CHRISTINA OT	9/7/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3413 W PACIFIC AVE	100, 200	BURBANK	CA	91505	1555	19	06037	34.18839272	-118.3485967	Los Angeles County
34031	Fee-for-Service	1205975901	1205975901	1	1	GREENBERG, ERIC N	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58056	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
34044	Fee-for-Service	1689243214	1689243214	1	1	GARCIA, FIDEL G CRNA	8/23/2021	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
34057	Fee-for-Service	1245338730	1245338730	1	1	GARFIELD BEACH CVS LLC	12/12/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18872 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2008	30	06059	33.68830707	-117.9886523	Orange County
34096	Fee-for-Service	1104180504	1104180504	1	1	GARIBAY, REY ANTHONY G MD	3/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187812	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
34116	Fee-for-Service	1073561098	1073561098	1	1	GROSSMAN, GERALD R MD	12/16/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	22345	None	None	0	In state provider	None	4500 W 116TH ST	None	HAWTHORNE	CA	90250	2209	19	06037	33.92906042	-118.3548882	Los Angeles County
34159	Fee-for-Service	1225326903	1225326903	1	1	GOTESMAN, MORAN MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127848	78	Neoplastic Diseases/Oncology	0	In state provider	None	21840 S NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
34171	Fee-for-Service	1649215179	1649215179	2	1	GRACE HEALTHCARE SOLUTIONS I	12/15/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1330 W COVINA BLVD	STE 100	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
34186	Fee-for-Service	1487964417	1487964417	1	1	GENARO-RIVAS, JANA M PT	5/2/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
34214	Fee-for-Service	1386834992	1386834992	1	1	GEE, JULIUS W DO	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8375	02	General Surgery	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
34219	Fee-for-Service	1235105610	1235105610	1	1	GREWAL, KARANBIR S MD	5/4/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53044	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
34224	Fee-for-Service	1669550166	1669550166	1	1	GRAY, DANIEL C MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89732	40	Pediatrics	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
34249	Fee-for-Service	1780262576	1780262576	1	1	GREG MARTINS OJI, MD. INC.	4/5/2021	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	931 BUENA VISTA ST	302	DUARTE	CA	91010	1714	19	06037	34.141635	-117.9775755	Los Angeles County
34251	Fee-for-Service	1275536443	1275536443	1	1	GIULIANO, PETER D MD	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80977	30	Radiology	0	In state provider	None	301 NEWPORT BEACH BLVD	None	NEWPORT BEACH	CA	92663	0000	30	06059	33.6242782	-117.9284249	Orange County
34254	Fee-for-Service	1972041747	1972041747	1	1	GARFIELD BEACH CVS LLC	6/21/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1025 E ADAMS BLVD	None	LOS ANGELES	CA	90011	5522	19	06037	34.01901432	-118.255437	Los Angeles County
34266	Fee-for-Service	1083641708	1083641708	1	1	GUESS, RICHARD P. MD	8/31/1994	193400000X	NA	Other	026	PHYSICIANS	35031	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
34271	Fee-for-Service	1689742702	1689742702	1	1	GIDOWSKI, ROSA M MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53575	01	General Practice	0	In state provider	None	368 W BADILLO ST	None	COVINA	CA	91723	1827	19	06037	34.08627048	-117.8963055	Los Angeles County
34309	Fee-for-Service	1376080382	1376080382	1	1	GARCIA, DELLA LMFT	12/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
34332	Fee-for-Service	1336315902	1336315902	1	1	GUTIERREZ-GO, MARIA N	4/1/2001	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MD INC	80495 US HIGHWAY 111	None	INDIO	CA	92201	6534	33	06065	33.70724448	-116.260686	Riverside County
34376	Fee-for-Service	1376589432	1376589432	1	1	GARFIELD BEACH CVS, LLC	12/19/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21761 LAKE FOREST DRIVE	None	LAKE FOREST	CA	92630	2784	30	06059	33.64641384	-117.687286	Orange County
34400	Fee-for-Service	1851523955	1851523955	1	1	GRAYSON, LOURDES MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111804	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
34447	Fee-for-Service	1225326903	1225326903	1	1	GOTESMAN, MORAN MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127848	68	Hematology	0	In state provider	None	21840 S NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
34449	Fee-for-Service	1649215062	1649215062	1	1	GRIFFITH, PATRICK K MD	2/27/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	APC	401 I STREET	#A	MARYSVILLE	CA	95901	5626	58	06115	39.13882888	-121.5963884	Yuba County
34451	Fee-for-Service	1629025085	1629025085	1	1	GRAHAM, JENNIFER A MD	3/12/2008	204D00000X	NA	Other	026	PHYSICIANS	99131	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
34457	Fee-for-Service	1790284404	1790284404	1	1	GARFIELD BEACH CVS LLC	11/6/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29171 NEWPORT RD	None	MENIFEE	CA	92584	2200	33	06065	33.68496052	-117.1509795	Riverside County
34487	Fee-for-Service	1235656562	1235656562	1	1	GUARDIAN FLIGHT LLC	8/15/2021	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	2111 W HISTORIC HWY 66 H	None	GALLUP	NM	87301	6899	00	None	35.51613599	-108.7803173	McKinley County
34499	Fee-for-Service	1972953297	1972953297	1	1	GONZAGA, MICHAEL MD	10/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155527	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
34558	Fee-for-Service	1528585858	1528585858	1	1	GUARDIAN FLIGHT LLC	7/24/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	217 CRESTWOOD CT	None	GALLUP	NM	87301	7121	00	None	35.50530528	-108.7351972	McKinley County
34559	Fee-for-Service	1689742702	1689742702	1	1	GIDOWSKI, ROSA M MD	6/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53575	40	Pediatrics	0	In state provider	None	368 W BADILLO ST	None	COVINA	CA	91723	1827	19	06037	34.08627048	-117.8963055	Los Angeles County
34606	Fee-for-Service	1477698579	1477698579	1	1	GARDNER, DENNIS L MD	5/31/1991	207P00000X	NA	Other	026	PHYSICIANS	49707	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
34612	Fee-for-Service	1427022177	1427022177	1	1	GLOGOVER, PHILIP H MD	2/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141644	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
34631	Fee-for-Service	1992385785	1992385785	1	1	GERENZ, MATTHEW NP	4/25/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183126	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	30	06059	33.78785047	-117.8631495	Orange County
34635	Fee-for-Service	1003266701	1003266701	1	1	GIESE, ANGELA MD	11/13/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	189817	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
34658	Fee-for-Service	1629604673	1629604673	1	1	GEVORKIAN, NATALIE N MD	12/27/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	182857	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
34688	Fee-for-Service	1891730073	1891730073	1	1	GIRKIN, CHRISTOPHER A MD	7/16/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	65262	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
34699	Fee-for-Service	1861785313	1861785313	1	1	GILMAN, LAURA A MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134582	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 EAST CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
34709	Fee-for-Service	1023579505	1023579505	1	1	GERARDO, MELISSA D NP	5/13/2019	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2300 W SUNNYSIDE AVE	None	VISALIA	CA	93277	7287	54	06107	36.303597	-119.316294	Tulare County
34745	Fee-for-Service	1376529552	1376529552	1	1	GAFTER, LANA MDA MD	4/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92610	01	General Practice	0	In state provider	None	99 MENTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
34752	Fee-for-Service	1942448543	1942448543	1	1	GOSSCHALK, EDDY A	3/1/1999	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	8875 LA MESA BLVD	SUITE B	SAN DIEGO	CA	91941	5134	37	06073	32.77264657	-117.0058782	San Diego
34755	Fee-for-Service	1952387235	1952387235	1	1	GRAHAM, COLE B III MD	10/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	77 PRINGLE WAY	None	RENO	NV	89502	1474	00	None	39.52484706	-119.7951825	Washoe County
34798	Fee-for-Service	1992891972	1992891972	1	1	GOVINDARAJAN, GURUSHANKAR MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122887	41	Internal Medicine	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
34808	Fee-for-Service	1639245608	1639245608	1	1	GUTIERREZ, MATTHEW A MD	6/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	83812	41	Internal Medicine	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
34832	Fee-for-Service	1659741478	1659741478	1	1	GALDAMEZ, KATHERINE H LCSW	12/30/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
34838	Fee-for-Service	1912173725	1912173725	1	1	GRECO, PAUL T MD	3/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127349	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
34845	Fee-for-Service	1659445211	1659445211	1	1	GIOMBETTI, ROBERT J MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61748	13	Neurology (M.D. only)	0	In state provider	None	4560 ADMIRALTY WAY	STE 352	MARINA DEL REY	CA	90292	5448	19	06037	33.98364904	-118.4449069	Los Angeles County
34862	Fee-for-Service	1720372576	1720372576	1	1	GREENE, MAXWELL A MD	12/8/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	152405	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
34864	Fee-for-Service	1750598546	1750598546	2	1	GARFIELD BEACH CVS LLC	5/22/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	430 BLUE RAVINE RD	None	FOLSOM	CA	95630	3402	34	06067	38.671497	-121.1529825	Sacramento County
34903	Fee-for-Service	1245478494	1245478494	1	1	GARFIELD BEACH CVS LLC	8/18/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5180 E KING CANYON RD	None	FRESNO	CA	93727	3971	10	06019	36.73575816	-119.719104	Fresno County
34915	Fee-for-Service	1558505172	1558505172	1	1	GAUTAM K GANDHI	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
34920	Fee-for-Service	1992385785	1992385785	1	1	GERENZ, MATTHEW NP	4/25/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183126	36	Psychiatry	0	In state provider	None	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	30	06059	33.78785047	-117.8631495	Orange County
34941	Fee-for-Service	1134281934	1134281934	1	1	GREENWOOD, VANESSA R	12/26/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	86350	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
34947	Fee-for-Service	1104942887	1104942887	1	1	GARAYCOCHEA, CHRISTIAN I	11/14/2007	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	90223	05	Anesthesiology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
34997	Fee-for-Service	1750786323	1750786323	1	1	GUTIERREZ, VENESSA F MD	11/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129167	40	Pediatrics	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
35019	Fee-for-Service	1811402571	1811402571	1	1	GOOD HEART MEDICAL GROUP A P	11/30/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	ROFESSIONAL CORPORATION	1220 W HEMLOCK WAY	STE. 204	SANTA ANA	CA	92707	3650	30	06059	33.70975375	-117.8842792	Orange County
35034	Fee-for-Service	1568421949	1568421949	1	1	GALITZ, RICHARD F MD	12/16/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42289	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7345 MEDICAL CENTER DR	STE 500	CANOGA PARK	CA	91307	1964	19	06037	34.20369349	-118.629837	Los Angeles County
35083	Fee-for-Service	1336330786	1336330786	1	1	GUPTA, POOJA MD	11/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137156	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	611 SOUTH MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
35085	Fee-for-Service	1417026493	1417026493	1	1	GANDHI, RADHAKRISHAN MD	5/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53184	41	Internal Medicine	0	In state provider	RAY GANDHI MD	11100 WARNER AVE	STE 206	FOUNTAIN VALLEY	CA	92708	7511	30	06059	33.716291	-117.9355051	Orange County
35093	Fee-for-Service	1871577569	1871577569	1	1	GOODRICH, SUSAN J	12/1/2004	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
35110	Fee-for-Service	1770692725	1770692725	1	1	GUZMAN, JOSE L MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	64098	05	Anesthesiology	0	In state provider	None	995 BLANCO CIR	None	SALINAS	CA	93901	4447	27	06053	36.65488958	-121.6372749	Monterey County
35120	Fee-for-Service	1528243540	1528243540	1	1	GEORGE L MEE MEM HOSP	5/15/1999	261QR1300X	NA	Rural Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CLINIC	467 EL CAMINO REAL	None	GREENFIELD	CA	93927	4915	27	06053	36.32573265	-121.2475971	Monterey County
35140	Fee-for-Service	1609082668	1609082668	1	1	GUTIERREZ, MARIA C MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106711	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
35144	Fee-for-Service	1063575025	1063575025	1	1	GLOVER,DIANNA 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	747 BROADWAY	None	SEATTLE	WA	98122	4307	00	None	47.608326	-122.3207985	King County
35189	Fee-for-Service	1295992527	1295992527	1	1	GOODMAN, DARENIE MD	12/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102161	08	Family Practice	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
35237	Fee-for-Service	1437539533	1437539533	1	1	GHAFFARIEH, ALIREZA MD	12/18/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	153671	None	None	0	In state provider	None	44139 MONTEREY AVE	A	PALM DESERT	CA	92260	8700	33	06065	33.728004	-116.3912775	Riverside County
35277	Fee-for-Service	1457475303	1457475303	1	1	GUERAMI, AMIR H MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124952	18	Ophthalmology	0	In state provider	None	16500 VENTURA BLVD	SUITE 250	ENCINO	CA	91436	2018	19	06037	34.15756758	-118.4926374	Los Angeles County
35337	Fee-for-Service	1497723803	1497723803	1	1	GERONIMO, REDEMPTION MD	11/13/1990	207R00000X	NA	Other	026	PHYSICIANS	42821	41	Internal Medicine	0	In state provider	None	175 E BONITA AVE	None	POMONA	CA	91767	1942	19	06037	34.09629825	-117.747176	Los Angeles County
35348	Fee-for-Service	1316000649	1316000649	1	1	GOLTS, EUGENE M MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82530	33	Thoracic Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
35373	Fee-for-Service	1417026493	1417026493	1	1	GANDHI, RADHAKRISHAN MD	5/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53184	06	Cardiovascular Disease (M.D. only)	0	In state provider	RAY GANDHI MD	11100 WARNER AVE	STE 206	FOUNTAIN VALLEY	CA	92708	7511	30	06059	33.716291	-117.9355051	Orange County
35408	Fee-for-Service	1073189361	1073189361	1	1	GONZALEZ, JACQUELYN LMFT	4/5/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	525 VETERANS BLVD	None	REDWOOD CITY	CA	94063	1140	41	06081	37.4934708	-122.2329786	San Mateo County
35427	Fee-for-Service	1376100784	1376100784	1	1	GODANA, IVY DO	8/1/2024	204F00000X	NA	General Surgery	026	PHYSICIANS	22822	02	General Surgery	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
35477	Fee-for-Service	1205235496	1205235496	1	1	GONZALEZ, SARAH G MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126821	None	None	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
35478	Fee-for-Service	1295992527	1295992527	1	1	GOODMAN, DARENIE MD	12/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102161	01	General Practice	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
35531	Fee-for-Service	1164607289	1164607289	1	1	GODWIN ABODOH	3/11/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ABA MEDICAL TRANSPORTATI	1761 NORTH D STREET	None	SAN BERNARDINO	CA	92405	4417	36	06071	34.13091351	-117.2918413	San Bernardino County
35563	Fee-for-Service	1598751059	1598751059	1	1	GONG, ROGER J MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	69291	41	Internal Medicine	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
35572	Fee-for-Service	1457861023	1457861023	1	1	GUBERNICK, LINDSAY MD	8/6/2021	207L00000X	NA	Other	026	PHYSICIANS	160521	None	None	0	In state provider	None	12746 W JEFFERSON BLVD	FL 2-4	LOS ANGELES	CA	90094	2885	19	06037	33.97751255	-118.417598	Los Angeles County
35617	Fee-for-Service	1811987621	1811987621	1	1	GERSHENGORN, KENT N MD	10/7/1974	No Taxonomy Provided	NA	None	026	PHYSICIANS	20314	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	350 PARNASSUS AVE	STE 50	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
35623	Fee-for-Service	1376574327	1376574327	1	1	GANAL-IHORI,CHERYLE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SOUTH KING STREET	None	HONOLULU	HI	96813	3083	00	None	21.30218603	-157.8505732	Honolulu County
35635	Fee-for-Service	1316000649	1316000649	1	1	GOLTS, EUGENE M MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82530	30	Radiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
35674	Fee-for-Service	1730129214	1730129214	1	1	GURNICK, KEITH L DPM	6/30/1989	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	#204	2080 CENTURY PARK E	None	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
35681	Fee-for-Service	1013024868	1013024868	1	1	GUARNERI, ERMINIA M MD	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78641	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
35687	Fee-for-Service	1003117185	1003117185	1	1	GATLIN, BARBARA A LCSW	7/17/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	745 LONGHORN CT	None	PASO ROBLES	CA	93446	4653	40	06079	35.60577809	-120.6756612	San Luis Obispo County
35691	Fee-for-Service	1639338601	1639338601	1	1	GRAHAM, DAVID M MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34436	47	Miscellaneous	0	In state provider	None	305 E 8TH ST	None	NATIONAL CITY	CA	91950	2311	37	06073	32.67676952	-117.1036528	San Diego County
35696	Fee-for-Service	1245726488	1245726488	1	1	GUZMAN-WILEY, ANA I LCSW	11/8/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
35766	Fee-for-Service	1649781873	1649781873	1	1	GUARDIAN FLIGHT LLC	2/4/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	485 S ROCK BLVD	STE B	RENO	NV	89502	4171	00	None	39.50767523	-119.7636152	Washoe County
35771	Fee-for-Service	1841643160	1841643160	1	1	GAVER, CLINTON W LMFT	9/6/2023	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
35847	Fee-for-Service	1861570756	1861570756	1	1	GALICIA, LILIAN R MD	4/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	75173	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
35851	Fee-for-Service	1477250165	1477250165	1	1	GRAND OAKS CARE LLC	5/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	897 N M ST	None	TULARE	CA	93274	2017	54	06107	36.22096887	-119.3444384	Tulare County
35856	Fee-for-Service	1174020192	1174020192	1	1	GOMEZ, TERESITA MD	4/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173769	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
35889	Fee-for-Service	1386173805	1386173805	1	1	GLEICHMAN, JULIA S MD	8/5/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172704	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
35914	Fee-for-Service	1275535874	1275535874	1	1	GARNER, DARIN S MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77788	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
35929	Fee-for-Service	1366593188	1366593188	1	1	GAY VARECKA	11/29/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
35976	Fee-for-Service	1730267220	1730267220	1	1	GEBEH, ANSUMANA A MD	10/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80882	25	Physical Medicine and Rehabilitation	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
36088	Fee-for-Service	1407886369	1407886369	1	1	GUENIN, DANIEL MD	6/5/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65866	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
36120	Fee-for-Service	1831629682	1831629682	1	1	GODDARD, MEGAN M CNP	9/20/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
36127	Fee-for-Service	1568792422	1568792422	1	1	GIRGIS, GEORGE M MD	6/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110467	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	4122	30	06059	33.84718298	-117.933758	Orange County
36141	Fee-for-Service	1689619595	1689619595	1	1	GARFIELD BEACH CVS LLC	6/21/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 W FOOTHILL BLVD	None	UPLAND	CA	91786	3847	36	06071	34.10675254	-117.652653	San Bernardino County
36162	Fee-for-Service	1790844454	1790844454	1	1	GARABEDIAN, EMILY M MD	5/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77416	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
36168	Fee-for-Service	1831456870	1831456870	1	1	GORDON, LAURA E MD	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129716	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
36179	Fee-for-Service	1104973825	1104973825	1	1	GIESE, HERBERT A MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	35129	None	None	0	In state provider	None	1133 COLOMA WAY	#C	ROSEVILLE	CA	95661	4488	31	06061	38.73639952	-121.2734295	Placer County
36200	Fee-for-Service	1912175787	1912175787	1	1	GEBRESLASSIE, SELAMAWIT T NP	4/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
36215	Fee-for-Service	1366111650	1366111650	1	1	GLENDALE HOME INC	5/3/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1545 N VERDUGO RD	UNIT 206	GLENDALE	CA	91208	2804	19	06037	34.16921698	-118.2280083	Los Angeles County
36248	Fee-for-Service	1447677497	1447677497	1	1	GRANIERI, DANIELLE N MD	4/27/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16283	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
36308	Fee-for-Service	1548571623	1548571623	1	1	GRANDON, DEEPA MD	1/20/2025	207K00000X	NA	Other	026	PHYSICIANS	112797	03	Allergy	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
36310	Fee-for-Service	1598024960	1598024960	1	1	GILES, ELIZABETH L MD	10/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142708	01	General Practice	0	In state provider	None	2440 23RD ST	STE B	EUREKA	CA	95501	3203	12	06023	40.78685791	-124.1403825	Humboldt County
36313	Fee-for-Service	1063452555	1063452555	1	1	GOWDA, SHARADA H MD	12/1/2021	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
36334	Fee-for-Service	1689073587	1689073587	1	1	GARCIA-JIMENEZ, MARIA P LCSW	6/14/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
36349	Fee-for-Service	1457794505	1457794505	1	1	GEORGE-MATTAPPALLY, SAPNA M	8/12/2019	207P00000X	NA	Other	026	PHYSICIANS	163131	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
36368	Fee-for-Service	1043640824	1043640824	1	1	GOOD SAMARITAN SHELTER	7/29/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	403 B WEST MORRISON ST	None	SANTA MARIA	CA	93454	8669	42	06083	34.94319568	-120.4411316	Santa Barbara County
36382	Fee-for-Service	1528319183	1528319183	1	1	GAROFALO, SALVATORE A DPM IN	11/20/2013	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	122 S PATTERSON AVENUE	SUITE 101	SANTA BARBARA	CA	93111	4017	42	06083	34.43800958	-119.8082259	Santa Barbara County
36386	Fee-for-Service	1558822056	1558822056	1	1	GOEL, ALEXANDER N MD	6/29/2024	163WX0601X	NA	Other	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	2581 SAMARITAN DR	None	SAN JOSE	CA	95124	4112	43	06085	37.25305684	-121.9507351	Santa Clara County
36413	Fee-for-Service	1568792422	1568792422	1	1	GIRGIS, GEORGE M MD	6/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110467	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	4122	30	06059	33.84718298	-117.933758	Orange County
36475	Fee-for-Service	1174570154	1174570154	1	1	GONZALGO, MARK A MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53670	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
36482	Fee-for-Service	1649233768	1649233768	1	1	GABLE, DENNIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KIMBERLY J. WILLIAMS	621 N HALL ST	STE 100	DALLAS	TX	75226	1305	00	None	32.787963	-96.7821075	Dallas County
36495	Fee-for-Service	1730486903	1730486903	1	1	GAYMAN, JENNIFER LCSW	10/24/2022	101YA0400X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
36506	Fee-for-Service	1558697946	1558697946	1	1	GASPER, CYNTHIA A MD	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114754	22	Pathology (M.D. only)	0	In state provider	None	3301 C STREET	SUITE 200-E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
36512	Fee-for-Service	1679688899	1679688899	1	1	GRAY, GARY DO	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	6348	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
36527	Fee-for-Service	1356493571	1356493571	1	1	GIAP, BENTON T MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69428	25	Physical Medicine and Rehabilitation	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
36569	Fee-for-Service	1801536867	1801536867	1	5	GALEN INPATIENT PHYSICIANS,	6/1/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
36592	Fee-for-Service	1437715638	1437715638	1	1	GREGORY, CORY S MD	2/6/2023	208M00000X	NA	Other	026	PHYSICIANS	180735	None	None	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
36598	Fee-for-Service	1134311186	1134311186	1	1	GLASPY, KATHLEEN E MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106951	41	Internal Medicine	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92835	1041	30	06059	33.87434143	-117.8870903	Orange
36622	Fee-for-Service	1194170431	1194170431	1	1	GOKSENIN, ALEXANDRA Y MD	7/27/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154408	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
36680	Fee-for-Service	1225056419	1225056419	1	1	GALLO, DONALD P PHD	7/24/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	18040 SHERMAN WAY	None	RESEDA	CA	91335	4631	19	06037	34.20103048	-118.526787	Los Angeles County
36690	Fee-for-Service	1255067310	1255067310	1	1	GLORIOUS HOME CARE ASSISTANC	11/14/2023	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	111 N MARKET ST	STE 300	SAN JOSE	CA	95113	1116	43	06085	37.33791617	-121.8939388	Santa Clara County
36730	Fee-for-Service	1740733096	1740733096	1	1	GRIFFIN, JESSICA NP	2/6/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5735 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	7623	34	06067	38.670597	-121.2722235	Sacramento County
36741	Fee-for-Service	1881703882	1881703882	1	1	GHADIALLY, RUBY	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	48116	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	# 316	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
36742	Fee-for-Service	1982014015	1982014015	1	1	GARCIA, EDDIE C MD	4/27/2020	207P00000X	NA	Other	026	PHYSICIANS	153746	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
36757	Fee-for-Service	1578589941	1578589941	1	1	GREENBERG, ARNOLD MD	11/1/1997	2084N0400X	NA	Neurology	026	PHYSICIANS	53456	13	Neurology (M.D. only)	0	In state provider	None	2299 POST ST	STE 206	SAN FRANCISCO	CA	94115	3473	38	06075	37.78434298	-122.4392033	San Francisco County
36768	Fee-for-Service	1306959333	1306959333	1	1	GHIYA, DINESH C MD	9/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39512	01	General Practice	0	In state provider	None	15141 WHITTIER BLVD	STE 350	WHITTIER	CA	90603	2169	19	06037	33.94810044	-118.0039419	Los Angeles County
36769	Fee-for-Service	1891792255	1891792255	1	1	GUSDORFF, JONATHAN M DO	3/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10862	30	Radiology	0	In state provider	None	2800 L ST	STE 260	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
36783	Fee-for-Service	1831321561	1831321561	2	1	GARFIELD BEACH CVS LLC	3/23/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	298 W MC KINLEY AVE	None	SUNNYVALE	CA	94086	6193	43	06085	37.37444023	-122.0320798	Santa Clara County
36792	Fee-for-Service	1457490880	1457490880	1	1	GENGHIS K. N. RABAGO NAVARRO	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	4831 35TH AVE SW	None	SEATTLE	WA	98126	2709	00	None	47.5583618	-122.3762768	King County
36901	Fee-for-Service	1275849713	1275849713	1	1	GOOD NEIGHBOR TRANSPORT, INC	4/9/2012	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4217 VISTOSA ST	None	DAVIS	CA	95618	7120	57	06113	38.55751758	-121.7006065	Yolo County
36914	Fee-for-Service	1588279707	1588279707	1	1	GPM HEALTHCARE MANAGEMENT IN	5/31/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13021 HEWES AVENUE	None	SANTA ANA	CA	92705	2763	30	06059	33.77327127	-117.8054053	Orange County
36923	Fee-for-Service	1861596546	1861596546	1	1	GARFIELD BEACH CVS LLC	7/9/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	22361 ANTONIO PKWY	None	RANCHO SANTA MARG	CA	92688	2809	30	06059	33.63782485	-117.5898001	Orange County
36936	Fee-for-Service	1174284202	1174284202	1	1	GAITA, IRENE W NP	7/18/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1341 HISTORICAL PLAZA WA	None	MANTECA	CA	95336	5064	39	06077	37.79628766	-121.1964812	San Joaquin County
36945	Fee-for-Service	1700996923	1700996923	1	1	GEORGE DELGADO, MD, INC	6/30/2006	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66807	None	None	0	In state provider	HCARE	362 W MISSION AVE	STE 105	ESCONDIDO	CA	92025	1740	37	06073	33.12864781	-117.090862	San Diego County
36947	Fee-for-Service	1831263672	1831263672	1	2	GLOVER, SHERRY J LCSW	2/18/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1652 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1602957	Los Angeles County
36960	Fee-for-Service	1740388982	1740388982	1	1	GABRIELIAN, KARINE MD	9/15/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66613	18	Ophthalmology	0	In state provider	None	409 N CENTRAL AVE	None	GLENDALE	CA	91203	2001	19	06037	34.15248444	-118.2579448	Los Angeles County
36970	Fee-for-Service	1053574947	1053574947	1	1	GEORGIO II, PETER J	4/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104803	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
36977	Fee-for-Service	1063640738	1063640738	1	7	GOLDEN GATE UROLOGY INC	7/1/2010	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	139 TOWNSEND ST	SUITE 100	SAN FRANCISCO	CA	94107	1946	38	06075	37.77984026	-122.3914878	San Francisco County
37024	Fee-for-Service	1568449122	1568449122	1	1	GENETICS CONSULTING	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	39721	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PARTNERSHIP	403 W ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
37034	Fee-for-Service	1699091850	1699091850	1	1	GIN, GREG E MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136431	34	Urology and Urological Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
37036	Fee-for-Service	1841388451	1841388451	1	1	GARFIELD NURSING HOME	12/10/1980	283Q00000X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	494 BLOSSOM WAY	None	HAYWARD	CA	94541	1948	01	06001	37.67843796	-122.1037905	Alameda County
37058	Fee-for-Service	1306959333	1306959333	1	1	GHIYA, DINESH C MD	9/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39512	40	Pediatrics	0	In state provider	None	15141 WHITTIER BLVD	STE 350	WHITTIER	CA	90603	2169	19	06037	33.94810044	-118.0039419	Los Angeles County
37069	Fee-for-Service	1932235140	1932235140	1	1	GRECO, SARAH LMFT	11/4/2022	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
37080	Fee-for-Service	1992773253	1992773253	1	1	GHAZARIAN, ARBI MD	4/14/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81408	08	Family Practice	0	In state provider	None	2103 MONTROSE AVE	STE E	MONTROSE	CA	91020	1546	19	06037	34.206831	-118.224702	Los Angeles County
37086	Fee-for-Service	1568704013	1568704013	1	1	GIVENS BECKERMAN, ERICA L MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150307	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1701 CESAR CHAVEZ AVE	STE 200 / 225	LOS ANGELES	CA	90033	2497	19	06037	34.05112725	-118.2173921	Los Angeles County
37089	Fee-for-Service	1518015536	1518015536	1	1	GOOLSBY, CRAIG A MD	2/25/2008	207P00000X	NA	Other	026	PHYSICIANS	92921	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
37126	Fee-for-Service	1639192487	1639192487	1	1	GELBERG, LILLIAN MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	49277	08	Family 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
37137	Fee-for-Service	1821299710	1821299710	1	1	GIESE, MARK M CRNA	5/25/2011	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
37155	Fee-for-Service	1336114578	1336114578	1	1	GARCIA, JESUS A MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98994	24	Plastic Surgery	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
37168	Fee-for-Service	1124656137	1124656137	1	1	GUAN, YUXI DPM	9/19/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1820 MAIN STREET	None	WATSONVILLE	CA	95076	3092	44	06087	36.91804831	-121.7799502	Santa Cruz County
37181	Fee-for-Service	1366198566	1366198566	1	1	GRACE ZHANG MD OPHTHALMOLOGY	5/24/2023	261QS0132X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1140 SONOMA AVE BLDG 2A	None	SANTA ROSA	CA	95405	4817	49	06097	38.440683	-122.699628	Sonoma County
37192	Fee-for-Service	1467150482	1467150482	1	1	GARFIELD BEACH CVS, L.L.C.	11/29/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5401 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	2723	19	06037	34.16937939	-118.3773828	Los Angeles County
37268	Fee-for-Service	1871738344	1871738344	1	1	GUIANG, KAREN M DO	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10579	77	Infectious Disease	0	In state provider	None	1135 S SUNSET AVE	STE 208	WEST COVINA	CA	91790	3938	19	06037	34.06215064	-117.9453997	Los Angeles County
37283	Fee-for-Service	1215921044	1215921044	1	1	GIRSKY, MARC J MD	2/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83112	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1400 S GRAND AVE	STE 615	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
37468	Fee-for-Service	1265402150	1265402150	1	1	GANDHI, DIPESH K	8/31/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44920	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24384 SUNNYMEAD BLVD	None	MORENO VALLEY	CA	92553	3069	33	06065	33.93909285	-117.2375825	Riverside County
37476	Fee-for-Service	1225629058	1225629058	1	2	GREENLINE NON-EMERGENCY TRAN	9/24/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SPORTATION, LLC	360 N PACIFIC COAST HWY	2000	EL SEGUNDO	CA	90245	4532	19	06037	33.92064108	-118.3960735	Los Angeles County
37477	Fee-for-Service	1003987355	1003987355	1	1	GOODMAN, DANIEL M MD	5/31/1992	174400000X	NA	Other	026	PHYSICIANS	63650	01	General Practice	0	In state provider	None	446 26TH ST	None	SAN DIEGO	CA	92102	3026	37	06073	32.70981972	-117.1381594	San Diego County
37484	Fee-for-Service	1982815262	1982815262	1	1	GADDAM, SRINIVAS MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137300	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
37500	Fee-for-Service	1316972995	1316972995	1	1	GOLDSTONE, ADAM D OD	9/8/2022	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
37532	Fee-for-Service	1386324168	1386324168	1	1	GILTON, HOLLY LMFT	3/3/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	800 COFFEE RD	None	MODESTO	CA	95355	4233	50	06099	37.654308	-120.9755515	Stanislaus County
37551	Fee-for-Service	1356714877	1356714877	1	1	G AND Y ASSOCIATES INC	7/25/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	16724 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	3423	19	06037	33.87878358	-118.3523295	Los Angeles County
37572	Fee-for-Service	1336390475	1336390475	1	2	GAMINO, ROSE T LMFT	8/23/2024	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1616 W SHAW AVE	SUITE D1	FRESNO	CA	93711	3513	10	06019	36.8084467	-119.8224562	Fresno County
37576	Fee-for-Service	1023083086	1023083086	1	1	GIANOUKAKIS, ANDREW G MD	12/5/2007	207RE0101X	NA	Endocrinology	026	PHYSICIANS	79831	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
37602	Fee-for-Service	1376595926	1376595926	1	1	GIBBS, MICHAEL W MD	2/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73391	05	Anesthesiology	0	In state provider	None	250 PROSPECT PL	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
37630	Fee-for-Service	1265591192	1265591192	1	1	GATES, DORIS L LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
37661	Fee-for-Service	1164436291	1164436291	1	1	GOSMAN, AMANDA A MD	10/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96153	24	Plastic 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
37677	Fee-for-Service	1659919603	1659919603	1	1	GOLDEN GATE HOSPICE CARE	8/13/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6420 VAN NUYS BLVD	STE 201	VAN NUYS	CA	91401	1436	19	06037	34.187337	-118.448712	Los Angeles County
37684	Fee-for-Service	1447298013	1447298013	1	1	GHURABI, MICHELINE H MD	5/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79137	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
37711	Fee-for-Service	1336758796	1336758796	1	1	GENOA HEALTHCARE, LLC	10/23/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10201 MISSION GORGE RD	2ND FL STE N RM P2	SANTEE	CA	92071	3027	37	06073	32.83844552	-116.9759925	San Diego County
37757	Fee-for-Service	1265402150	1265402150	1	1	GANDHI, DIPESH K	8/31/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44920	41	Internal Medicine	0	In state provider	None	24384 SUNNYMEAD BLVD	None	MORENO VALLEY	CA	92553	3069	33	06065	33.93909285	-117.2375825	Riverside County
37771	Fee-for-Service	1982815262	1982815262	1	1	GADDAM, SRINIVAS MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137300	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
37824	Fee-for-Service	1407126055	1407126055	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	43950 PACIFIC COMMONS BL	None	FREMONT	CA	94538	3803	01	06001	37.50083077	-121.9691314	Alameda County
37826	Fee-for-Service	1982246575	1982246575	1	4	GOLDEN STATE HEART & VASCULA	4/19/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	ENTER, INC.	2490 HOSPITAL DRIVE	106	MOUNTAIN VIEW	CA	94040	4122	43	06085	37.369827	-122.0818185	Santa Clara County
37857	Fee-for-Service	1558308858	1558308858	1	1	GUY, THOMAS S MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87712	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
37881	Fee-for-Service	1659391134	1659391134	1	2	GANESAN, USHA V MD	7/1/2014	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	36 SCARLET MAPLE DRIVE	None	LADERA RANCH	CA	92694	0839	30	06059	33.54487826	-117.6323234	Orange County
37949	Fee-for-Service	1992772644	1992772644	1	1	GORDON, CARRIE A MD	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88549	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1735 CREEKSIDE DR	None	FOLSOM	CA	95630	3444	34	06067	38.672028	-121.140198	Sacramento County
37950	Fee-for-Service	1104146026	1104146026	1	1	GOYENECHEA, MARTIN R MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111722	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
37964	Fee-for-Service	1659919603	1659919603	1	1	GOLDEN GATE HOSPICE CARE	8/13/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6420 VAN NUYS BLVD	STE 201	VAN NUYS	CA	91401	1436	19	06037	34.187337	-118.448712	Los Angeles County
37967	Fee-for-Service	1386849958	1386849958	1	2	GOODARZI, HEIDI MD	5/29/2022	207NP0225X	NA	Dermatology	026	PHYSICIANS	107754	None	None	0	In state provider	None	1310 W. STEWART DR.	STE 507	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
38007	Fee-for-Service	1548232903	1548232903	1	1	GOLDTHWAITE, NOEL D MD	6/30/1985	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	45635	20	Orthopedic Surgery	0	In state provider	None	4141 GEARY BLVD	RM 223	SAN FRANCISCO	CA	94118	3110	38	06075	37.78096053	-122.4637512	San Francisco County
38036	Fee-for-Service	1780764035	1780764035	1	1	GOLDSTEIN, STUART	3/26/2024	2080P0210X	NA	Nephrology	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
38054	Fee-for-Service	1235569591	1235569591	1	1	GUTIERREZ, OSCAR LCSW	11/20/2018	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
38063	Fee-for-Service	1780140046	1780140046	1	1	GAYAGOY, ROMMEL B CNP	3/26/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6540 STOCKTON BLVD	STE 3A	SACRAMENTO	CA	95823	1635	34	06067	38.507094	-121.434858	Sacramento County
38074	Fee-for-Service	1033153424	1033153424	1	1	GOLDFARB, STUART MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	32899	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	CANOGA PARK	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
38136	Fee-for-Service	1619922291	1619922291	1	1	GUO, SYDNEY S MD	1/7/2010	174400000X	NA	Other	026	PHYSICIANS	68397	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
38143	Fee-for-Service	1679013726	1679013726	1	1	GOLDEN VALLEY HEALTH CENTERS	11/7/2018	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	250 NORTHGATE DRIVE	None	MANTECA	CA	95336	3161	39	06077	37.81869269	-121.2190817	San Joaquin County
38164	Fee-for-Service	1992315089	1992315089	1	1	GLOBAL HEALTH HOSPICE, INC	4/22/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18711 SHERMAN WAY	UNIT 101B	RESEDA	CA	91335	4086	19	06037	34.20120092	-118.5408066	Los Angeles County
38178	Fee-for-Service	1346637576	1346637576	1	1	GHAI, AJAY DPM	8/28/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
38218	Fee-for-Service	1427524974	1427524974	1	1	GOMEZ LEZAMA, JESSICA P LCSW	3/4/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
38240	Fee-for-Service	1386025468	1386025468	1	1	GUPTA, NIKHIL MD	2/7/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166994	36	Psychiatry	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
38284	Fee-for-Service	1568455053	1568455053	1	1	GREENVILLE RANCHERIA	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	TRIBAL HEALTH PROGRAM	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	4605	52	06103	40.157883	-122.2250685	Tehama County
38305	Fee-for-Service	1598142747	1598142747	1	1	GROVES, DAVID	11/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166784	08	Family Practice	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
38323	Fee-for-Service	1780764035	1780764035	1	1	GOLDSTEIN, STUART	3/26/2024	2080P0210X	NA	Nephrology	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
38341	Fee-for-Service	1679556633	1679556633	1	1	GOODMAN, MATTHEW MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	53769	07	Dermatology	0	In state provider	None	1125 E 17TH ST	STE W248	SANTA ANA	CA	92701	2205	30	06059	33.76004145	-117.854838	Orange County
38356	Fee-for-Service	1033153424	1033153424	1	1	GOLDFARB, STUART MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	32899	41	Internal Medicine	0	In state provider	None	7300 MEDICAL CENTER DR	None	CANOGA PARK	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
38368	Fee-for-Service	1538593447	1538593447	1	1	GAFFAR ENTERPRISES INC	9/4/2013	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1901 3RD AVE	None	OAKLAND	CA	94606	1853	01	06001	37.80017743	-122.2503118	Alameda County
38429	Fee-for-Service	1679013726	1679013726	1	1	GOLDEN VALLEY HEALTH CENTERS	10/2/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	250 NORTHGATE DRIVE	None	MANTECA	CA	95336	3161	39	06077	37.81869269	-121.2190817	San Joaquin County
38453	Fee-for-Service	1992315089	1992315089	1	1	GLOBAL HEALTH HOSPICE, INC	4/22/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18711 SHERMAN WAY	UNIT 101B	RESEDA	CA	91335	4086	19	06037	34.20120092	-118.5408066	Los Angeles County
38478	Fee-for-Service	1316601529	1316601529	1	1	GOOD SHEPHERD PHARMACY INC	10/3/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13701 BEACH BLVD	STE A2	WESTMINSTER	CA	92683	3201	30	06059	33.76324302	-117.9900533	Orange County
38489	Fee-for-Service	1912724477	1912724477	1	1	GURUSWAMY, VELUPANDIAN MD	11/1/2024	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
38534	Fee-for-Service	1124892633	1124892633	1	1	GRUEN, DERRICK J PT	11/21/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	331 N 11TH AVE	None	HANFORD	CA	93230	4511	16	06031	36.32682132	-119.6548811	Kings County
38557	Fee-for-Service	1063818417	1063818417	1	1	GABRIELLI, GINA AU	12/13/2017	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
38558	Fee-for-Service	1922647668	1922647668	1	1	GARNETT, OLIVE	3/2/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	771 WEST 21ST ST	APT 4	SAN PEDRO	CA	90731	7710	19	06037	33.72514951	-118.294038	Los Angeles County
38573	Fee-for-Service	1699247973	1699247973	1	1	GARROVILLO, EVA C CNP	2/16/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
38574	Fee-for-Service	1568455053	1568455053	1	1	GREENVILLE RANCHERIA	9/1/2002	193200000X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	TRIBAL HEALTH PROGRAM	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	4605	52	06103	40.157883	-122.2250685	Tehama County
38578	Fee-for-Service	1265626378	1265626378	1	1	GILL, KANWAR P S MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109884	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
38625	Fee-for-Service	1770505950	1770505950	1	1	GITTLER, MARK J MD	8/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35840	05	Anesthesiology	0	In state provider	None	24235 HAWTHORNE BLVD	None	TORRANCE	CA	90505	6504	19	06037	33.802578	-118.351229	Los Angeles County
38648	Fee-for-Service	1649589383	1649589383	2	1	GOSS, BRITTANY L DO INC	6/3/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3273 CLAREMONT WAY	STE 209	NAPA	CA	94558	3329	28	06055	38.32062499	-122.3012501	Napa County
38663	Fee-for-Service	1295362192	1295362192	1	1	GAY, STEPHANIE O MD	8/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
38671	Fee-for-Service	1659372365	1659372365	1	1	GRIFFITH, KAREN A	1/31/1989	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	320 PETALUMA BLVD S	None	PETALUMA	CA	94952	4245	49	06097	38.23160743	-122.6346971	Sonoma County
38698	Fee-for-Service	1457618977	1457618977	1	1	GREEN, AMANDA B MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136605	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
38702	Fee-for-Service	1013927441	1013927441	1	2	GREENBERG, GREG A MD	8/3/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	86727	-	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
38705	Fee-for-Service	1083972590	1083972590	1	1	GORDON, CARLA R MD	10/29/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
38717	Fee-for-Service	1679013726	1679013726	1	1	GOLDEN VALLEY HEALTH CENTERS	2/2/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	250 NORTHGATE DRIVE	None	MANTECA	CA	95336	3161	39	06077	37.81869269	-121.2190817	San Joaquin County
38767	Fee-for-Service	1922259191	1922259191	1	1	GONZALEZ, MICAEL PHD	12/22/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
38791	Fee-for-Service	1720089642	1720089642	1	1	GONZALEZ-BARRETO, VILMA	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86233	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4409 S MAIN ST	None	LOS ANGELES	CA	90037	2731	19	06037	34.003368	-118.2740375	Los Angeles County
38848	Fee-for-Service	1922647668	1922647668	1	1	GARNETT, OLIVE	3/2/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	771 WEST 21ST ST	APT 4	SAN PEDRO	CA	90731	7710	19	06037	33.72514951	-118.294038	Los Angeles County
38860	Fee-for-Service	1043445349	1043445349	1	1	GORDON, DAVID 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
38882	Fee-for-Service	1588826382	1588826382	1	1	GIRGIS, MARK D MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108704	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
38901	Fee-for-Service	1063621316	1063621316	1	1	GAA, LLC	12/4/2000	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	GLENDALE HILLS ADHC	550 N GLENDALE AVE	STE A	GLENDALE	CA	91206	3311	19	06037	34.15468249	-118.2429014	Los Angeles County
38914	Fee-for-Service	1780726745	1780726745	1	1	GAFFAR, SABA MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42829	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
38918	Fee-for-Service	1689449506	1689449506	1	1	GONZALEZ, CRISTOFINA LCSW	1/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7677 CENTER AVE	STE 214	HUNTINGTON BEACH	CA	92647	9102	30	06059	33.736257	-117.995535	Orange County
38919	Fee-for-Service	1235271354	1235271354	1	1	GARCIA, MANUEL G MD	1/31/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	64359	40	Pediatrics	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
38937	Fee-for-Service	1477567717	1477567717	1	1	GRUBBS, VANESSA MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72945	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
38938	Fee-for-Service	1669532404	1669532404	1	1	GOULD, JEFFREY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61295	47	Miscellaneous	0	In state provider	None	248 REDWOOD AVE	None	REDWOOD CITY	CA	94061	3074	41	06081	37.47466127	-122.2250368	San Mateo County
38991	Fee-for-Service	1629053525	1629053525	1	2	GIBSON, LORETTA M CRNA	1/17/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	5 HOLLAND	STE 101	IRVINE	CA	92618	2568	30	06059	33.64596897	-117.7198362	Orange County
39007	Fee-for-Service	1679013726	1679013726	1	1	GOLDEN VALLEY HEALTH CENTERS	2/2/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	250 NORTHGATE DRIVE	None	MANTECA	CA	95336	3161	39	06077	37.81869269	-121.2190817	San Joaquin County
39030	Fee-for-Service	1205254968	1205254968	1	1	GUTIERREZ, MARIO MD	12/18/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145700	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
39038	Fee-for-Service	1447506506	1447506506	1	1	GRACE HOSPICE AND PALLIATIVE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	6101 BOLLINGER CANYON RD	STE 390	SAN RAMON	CA	94583	5118	07	06013	37.759761	-121.9559535	Contra Costa County
39050	Fee-for-Service	1891938981	1891938981	1	1	GUGELMANN, HALLAM M MD	3/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124665	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
39065	Fee-for-Service	1679081913	1679081913	1	1	GONZALEZ, JESSICA Y CNM	10/18/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	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
39092	Fee-for-Service	1487704292	1487704292	1	1	GATTANI, MONIKA MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77099	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
39115	Fee-for-Service	1417274283	1417274283	1	1	GUTIERREZ, HANI K NP	3/8/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
39131	Fee-for-Service	1609823210	1609823210	1	1	GOLGERT, REBECCA D MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102609	04	Otology, Laryngology, Rhinology	0	In state provider	None	5333 HOLLISTER AVE	STE 231	SANTA BARBARA	CA	93111	3324	42	06083	34.43491982	-119.8105484	Santa Barbara County
39149	Fee-for-Service	1306877055	1306877055	1	1	GUANZON, TERESITA V MD	12/21/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	46671	41	Internal Medicine	0	In state provider	None	2395 MONTPELIER DR	STE 4	SAN JOSE	CA	95116	1619	43	06085	37.36538903	-121.8473325	Santa Clara County
39155	Fee-for-Service	1326084294	1326084294	1	1	GE, JEFF J MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72384	None	None	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
39166	Fee-for-Service	1881602290	1881602290	1	1	GEULA, ARSALAN MD	3/27/1995	193400000X	NA	Other	026	PHYSICIANS	32263	41	Internal Medicine	0	In state provider	None	315 N 3RD AVE	STE 207	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
39180	Fee-for-Service	1588826382	1588826382	1	1	GIRGIS, MARK D MD	6/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108704	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
39188	Fee-for-Service	1366636573	1366636573	1	1	GUTKIN, GARY I MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99379	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
39190	Fee-for-Service	1194717512	1194717512	2	1	GAW, JOHNNY C H MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	38464	41	Internal Medicine	0	In state provider	None	931 BUENA VISTA STREET	SUITE 106	DUARTE	CA	91010	1780	19	06037	34.141635	-117.9775755	Los Angeles County
39271	Fee-for-Service	1942807193	1942807193	1	1	GUR, ALINA PT	12/17/2020	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
39286	Fee-for-Service	1831318765	1831318765	1	1	GLIEDERER, FRANZ MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51795	41	Internal Medicine	0	In state provider	None	9601 S SEPULVEDA BLVD	None	LOS ANGELES	CA	90045	5203	19	06037	33.948297	-118.3963665	Los Angeles County
39291	Fee-for-Service	1700302361	1700302361	1	1	GARFIELD BEACH CVS LLC	2/12/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1414 UNIVERSITY AVE	None	BERKELEY	CA	94702	1548	01	06001	37.87007785	-122.2839638	Alameda County
39293	Fee-for-Service	1942352075	1942352075	1	1	GROSSMAN, MARGARET L MD	1/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55960	08	Family Practice	0	In state provider	None	2504 HARRISON AVE	STE A	EUREKA	CA	95501	3221	12	06023	40.785408	-124.139668	Humboldt County
39313	Fee-for-Service	1912438532	1912438532	1	1	GORNES, CHRIS E MD	9/21/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159148	08	Family Practice	0	In state provider	None	2780 SKYPARK DRIVE	125	TORRANCE	CA	90505	7528	19	06037	33.80456075	-118.3357569	Los Angeles County
39328	Fee-for-Service	1447506506	1447506506	1	1	GRACE HOSPICE AND PALLIATIVE	4/16/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	6101 BOLLINGER CANYON RD	STE 390	SAN RAMON	CA	94583	5118	07	06013	37.759761	-121.9559535	Contra Costa County
39338	Fee-for-Service	1639298516	1639298516	1	1	GAO, XIN MD	3/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55691	22	Pathology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
39349	Fee-for-Service	1831574243	1831574243	1	1	GLENHAVEN HEALTHCARE LLC	8/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	212 W CHEVY CHASE DR	None	GLENDALE	CA	91204	2138	19	06037	34.13348452	-118.256994	Los Angeles County
39357	Fee-for-Service	1487683868	1487683868	1	1	GALLUP, JARIL F LCSW	4/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 PARKSHORE DR	100	FOLSOM	CA	95630	4726	34	06067	38.656962	-121.1866875	Sacramento County
39421	Fee-for-Service	1467940106	1467940106	1	1	GONZALEZ, DIANA N NP	11/10/2021	363LP2300X	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
39441	Fee-for-Service	1437260684	1437260684	1	1	GROSSMAN, KARUN F MD	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88413	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
39446	Fee-for-Service	1700982790	1700982790	1	1	GOSSETT, THOMAS MD	1/1/1985	207ZP0105X	NA	Other	026	PHYSICIANS	22767	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
39454	Fee-for-Service	1538375217	1538375217	1	1	GUO, JIN MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107121	90	Pathology-Forensic	0	In state provider	None	309 WEST BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
39460	Fee-for-Service	1245502400	1245502400	1	1	GACHPAZ, BABAK MD	8/1/2019	207R00000X	NA	Other	026	PHYSICIANS	137760	41	Internal Medicine	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
39463	Fee-for-Service	1538872155	1538872155	1	1	GLIMMER HEALTHCARE INC	2/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11900 RAMONA BLVD	None	EL MONTE	CA	91732	2314	19	06037	34.07490166	-118.0157548	Los Angeles County
39515	Fee-for-Service	1962247015	1962247015	1	1	GALLAGHER, CLAIRE BIRTH DOU	8/13/2024	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	49	06097	0	0	None
39542	Fee-for-Service	1629614029	1629614029	1	1	GUARDIAN ANGEL HOME CARE OF	8/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SAN LUIS OBISPO LLC	1428 PHILLIPS LN	SUITE B-2	SAN LUIS OBISPO	CA	93401	2571	40	06079	35.28794905	-120.6574321	San Luis Obispo County
39549	Fee-for-Service	1710360938	1710360938	1	1	GUSTAFSON, KEVIN R CRNA	10/23/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3440 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.852105	-117.8444835	Orange County
39574	Fee-for-Service	1831318765	1831318765	1	1	GLIEDERER, FRANZ MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51795	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9601 S SEPULVEDA BLVD	None	LOS ANGELES	CA	90045	5203	19	06037	33.948297	-118.3963665	Los Angeles County
39657	Fee-for-Service	1265097927	1265097927	1	1	GARCIA, NEYRA LMFT	11/5/2024	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
39673	Fee-for-Service	1326514597	1326514597	1	1	GYI, ADAM PT	4/5/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
39674	Fee-for-Service	1891186623	1891186623	1	1	GILLOGLY, MARK L LCSW	12/19/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
39722	Fee-for-Service	1871676189	1871676189	2	1	GARFIELD BEACH CVS LLC	6/15/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11051 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3719	19	06037	34.188669	-118.371276	Los Angeles County
39742	Fee-for-Service	1538375217	1538375217	1	1	GUO, JIN MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107121	22	Pathology (M.D. only)	0	In state provider	None	309 WEST BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
39771	Fee-for-Service	1174601983	1174601983	1	1	GABORKO, JEFFREY L MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64586	40	Pediatrics	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
39787	Fee-for-Service	1700119914	1700119914	1	1	GUIRGUIS, RONNIE S	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
39793	Fee-for-Service	1508062654	1508062654	1	1	GHASSEMI, KEVIN A MD	12/29/2009	207R00000X	NA	Other	026	PHYSICIANS	92568	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
39794	Fee-for-Service	1932566346	1932566346	1	1	GARCIA, VANESSA LCSW	3/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
39801	Fee-for-Service	1912370065	1912370065	1	1	GAONA, YADIRA LMFT	9/13/2024	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
39816	Fee-for-Service	1013941772	1013941772	1	1	GOLDFARB, ILONA T MD	10/24/2024	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87480	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
39862	Fee-for-Service	1831318765	1831318765	1	1	GLIEDERER, FRANZ MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51795	25	Physical Medicine and Rehabilitation	0	In state provider	None	9601 S SEPULVEDA BLVD	None	LOS ANGELES	CA	90045	5203	19	06037	33.948297	-118.3963665	Los Angeles County
39908	Fee-for-Service	1881899367	1881899367	1	1	GOMEZ, CARLA L LCSW	1/14/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2850 COMMERCIAL CROSSING	None	SANTA CRUZ	CA	95065	1816	44	06087	36.98796413	-121.9825327	Santa Cruz County
39910	Fee-for-Service	1588722771	1588722771	2	1	GRACE HOSPICE INC	1/15/2010	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1711 W TEMPLE ST	STE 3614	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
39955	Fee-for-Service	1144821356	1144821356	1	1	GOLDEN OAK FAMILY COUNSELING	11/25/2020	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ES	43460 RIDGE PARK DR	STE 245	TEMECULA	CA	92590	3619	33	06065	33.49676946	-117.1608841	Riverside County
40039	Fee-for-Service	1518347343	1518347343	1	1	GILLIAM, MARY LYNN A LCSW	9/6/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10601 CHURCH ST.	SUITE # 124	RANCHO CUCAMONGA	CA	91730	6840	36	06071	34.11301097	-117.5717343	San Bernardino County
40042	Fee-for-Service	1063640738	1063640738	1	8	GOLDEN GATE UROLOGY INC	11/16/2010	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	929 CLAY STREET	SUITE 505	SAN FRANCISCO	CA	94108	1500	38	06075	37.79398652	-122.4083496	San Francisco County
40046	Fee-for-Service	1285864942	1285864942	1	1	GEFT, ATARA MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117516	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
40063	Fee-for-Service	1184102717	1184102717	1	1	GARFIELD BEACH CVS LLC	2/15/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2650 GATEWAY RD	None	CARLSBAD	CA	92009	1773	37	06073	33.129387	-117.2536965	San Diego County
40079	Fee-for-Service	1508062654	1508062654	1	1	GHASSEMI, KEVIN A MD	12/29/2009	207R00000X	NA	Other	026	PHYSICIANS	92568	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
40132	Fee-for-Service	1407295942	1407295942	1	1	GREENE, PETER MD	8/1/2018	390200000X	NA	Other	026	PHYSICIANS	152750	34	Urology and Urological Surgery	0	In state provider	None	11180 WARNER AVE	SUITE 167	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.71632048	-117.9334575	Orange County
40196	Fee-for-Service	1588722771	1588722771	2	1	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	1711 W TEMPLE ST	STE 3614	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
40212	Fee-for-Service	1801538350	1801538350	1	1	GROSS, SARAH B CCC-SLP	2/20/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	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
40261	Fee-for-Service	1194316588	1194316588	1	1	GRAHAM, KAMERON NP	4/2/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
40267	Fee-for-Service	1992970586	1992970586	1	1	GARCIA, SANDRA L LMFT	3/3/2023	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
40278	Fee-for-Service	1083023790	1083023790	1	1	GARCIA, DINAH A DO	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13508	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
40284	Fee-for-Service	1912248618	1912248618	1	1	GLICKLICH, LORI A NP	5/18/2017	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
40289	Fee-for-Service	1770697492	1770697492	1	1	GRACE, ANA M MD	6/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75372	78	Neoplastic Diseases/Oncology	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
40296	Fee-for-Service	1174806905	1174806905	1	1	GWENDOLYN P JONES	8/1/2011	163W00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	23846 MATADOR WAY	None	MURRIETA	CA	92562	4696	33	06065	33.58914604	-117.2076896	Riverside County
40301	Fee-for-Service	1588696637	1588696637	1	1	GONG, YIN-JIA MD	2/20/2011	204D00000X	NA	Other	026	PHYSICIANS	56519	01	General Practice	0	In state provider	None	112 N RIVERSIDE AVE	None	RIALTO	CA	92376	5922	36	06071	34.10124678	-117.3705407	San Bernardino County
40303	Fee-for-Service	1417216763	1417216763	1	1	GOO, LORRAINE E MD	5/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126706	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
40307	Fee-for-Service	1740569235	1740569235	1	1	G & C SWAN INC	6/24/2019	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	MENT CENTER	650 INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5444	19	06037	34.10020135	-117.7201918	Los Angeles County
40320	Fee-for-Service	1619538543	1619538543	1	1	GILL, MANRAJAN S MD	10/12/2022	207R00000X	NA	Other	026	PHYSICIANS	181352	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
40329	Fee-for-Service	1679907869	1679907869	1	1	GLENDALE ADVENTIST EMERGENCY	4/20/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS INCORPORATED	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
40354	Fee-for-Service	1922133594	1922133594	1	1	GUERRERO, MARISSA D	7/24/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96653	-	NOT APPLICABLE	0	In state provider	None	401 S. STREET	None	SACRAMENTO	CA	95811	6919	34	06067	38.572677	-121.5050805	Sacramento County
40363	Fee-for-Service	1528479458	1528479458	1	1	GENTRY, PRESTON MD	4/29/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158082	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
40443	Fee-for-Service	1366464992	1366464992	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1750 STORY RD	None	SAN JOSE	CA	95122	1921	43	06085	37.34102907	-121.8412912	Santa Clara County
40458	Fee-for-Service	1063562775	1063562775	1	1	GLASSBERG, ANDREA E MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74882	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
40483	Fee-for-Service	1104994177	1104994177	1	1	GREENBERG, MARA B MD	10/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86053	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	350 30TH ST	STE 205	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
40499	Fee-for-Service	1770112781	1770112781	1	1	GRACE-ABRAHAM, NADINE MD	8/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182930	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
40505	Fee-for-Service	1578171898	1578171898	1	1	GALLARDO, JANELLE R OD	8/4/2020	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
40511	Fee-for-Service	1144472127	1144472127	1	1	GARDES, JONATHAN H MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122421	05	Anesthesiology	0	In state provider	None	275 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
40520	Fee-for-Service	1023159738	1023159738	1	1	GOODMAN, ELIZABETH H LMFT	6/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	517 THIRD STREET	SUITE 39	EUREKA	CA	95501	1165	12	06023	40.80367671	-124.166036	Humboldt County
40542	Fee-for-Service	1497969166	1497969166	1	1	GOLDEN VALLEY HEALTH CTR	3/1/1997	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	PATTERSON MEDICAL CTR	200 C ST	None	PATTERSON	CA	95363	2701	50	06099	37.46733509	-121.1258615	Stanislaus County
40546	Fee-for-Service	1063457869	1063457869	2	1	GARFIELD BEACH CVS LLC	8/3/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
40554	Fee-for-Service	1730120643	1730120643	1	1	GARFIELD BEACH CVS, LLC	3/20/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2530 GLENDALE BLVD	None	LOS ANGELES	CA	90039	3220	19	06037	34.10317638	-118.2591943	Los Angeles County
40576	Fee-for-Service	1770697492	1770697492	1	1	GRACE, ANA M MD	6/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75372	30	Radiology	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
40584	Fee-for-Service	1174806905	1174806905	1	1	GWENDOLYN P JONES	8/1/2011	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	23846 MATADOR WAY	None	MURRIETA	CA	92562	4696	33	06065	33.58914604	-117.2076896	Riverside County
40591	Fee-for-Service	1588696637	1588696637	1	1	GONG, YIN-JIA MD	2/20/2011	204D00000X	NA	Other	026	PHYSICIANS	56519	25	Physical Medicine and Rehabilitation	0	In state provider	None	112 N RIVERSIDE AVE	None	RIALTO	CA	92376	5922	36	06071	34.10124678	-117.3705407	San Bernardino County
40592	Fee-for-Service	1104871631	1104871631	1	1	GASTROENTEROL0GY MEDICAL	12/9/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	CLINIC	1006 MARSHALL WAY	None	PLACERVILLE	CA	95667	5706	09	06017	38.7261417	-120.7925328	El Dorado County
40605	Fee-for-Service	1548721558	1548721558	1	1	GRANT, KYLE DO	7/14/2023	208M00000X	NA	Other	026	PHYSICIANS	20382	None	None	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
40624	Fee-for-Service	1225553605	1225553605	1	1	GONZALES, TASHA J NP	4/12/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
40662	Fee-for-Service	1487710463	1487710463	1	1	GONZALEZ VELEZ, JUAN M MD	8/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121943	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
40665	Fee-for-Service	1306880653	1306880653	1	1	GARFIELD BEACH CVS LLC	6/29/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	313 WASHINGTON ST	None	SAN DIEGO	CA	92103	2109	37	06073	32.74979492	-117.1624902	San Diego County
40710	Fee-for-Service	1770748030	1770748030	1	1	GREWAL, PRABHJOT K MD	11/22/2010	2086S0129X	NA	General Surgery	026	PHYSICIANS	89940	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
40789	Fee-for-Service	1710297064	1710297064	1	1	GALACGAC, KEVIN L	6/27/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
40790	Fee-for-Service	1326574005	1326574005	1	1	GEROLA, RUTH P MD	10/18/2022	208600000X	NA	General Surgery	026	PHYSICIANS	175998	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
40811	Fee-for-Service	1417095183	1417095183	1	1	GRIFFIN, WILLIAM M MD	1/1/1989	174400000X	NA	Other	026	PHYSICIANS	65062	30	Radiology	0	In state provider	None	108 COURT ST	None	JACKSON	CA	95642	2308	03	06005	38.34952818	-120.773123	Amador County
40815	Fee-for-Service	1356486906	1356486906	1	1	GARFIELD BEACH CVS,LLC	3/27/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8859 ALONDRA BLVD	None	PARAMOUNT	CA	90723	4603	19	06037	33.88935254	-118.1432255	Los Angeles County
40817	Fee-for-Service	1023009107	1023009107	1	1	GELERA, MARYANN S RN	5/9/2006	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2385 CARTER LN	None	CASTRO VALLEY	CA	94546	5216	01	06001	37.69493678	-122.0943043	Alameda County
40844	Fee-for-Service	1316953219	1316953219	1	1	GELB, MICHAEL E MD	8/29/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	69863	36	Psychiatry	0	In state provider	None	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
40883	Fee-for-Service	1699064147	1699064147	1	1	GLENN, SAMMY B LCSW	9/12/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	37491 ENTERPRISE DRIVE	None	BURNEY	CA	96013	4379	45	06089	40.88784451	-121.6526265	Shasta County
40919	Fee-for-Service	1063493435	1063493435	1	1	GIFFORD, CLARK L MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	47524	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
40927	Fee-for-Service	1043873235	1043873235	1	1	GOWD, ANIRUDH K MD	7/29/2024	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
40944	Fee-for-Service	1801879804	1801879804	1	1	GOLDFARB RX ENTERPRISES	9/9/1992	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CENTRAL PHARMACY	2008 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5608	19	06037	34.03159104	-118.4828518	Los Angeles County
40983	Fee-for-Service	1740501006	1740501006	1	1	GOFFSTEIN, CHAD D MD	10/24/2014	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
41039	Fee-for-Service	1043742588	1043742588	1	1	GERWER, JOHANNA MD	9/6/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	169752	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
41056	Fee-for-Service	1376884072	1376884072	1	2	GUSTAVO ALVA MD, A PROFESSIO	9/11/2020	261QM0801X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	NAL CORP.	3151 AIRWAY AVE	SUITE T-3	COSTA MESA	CA	92626	4627	30	06059	33.67783408	-117.8720921	Orange County
41072	Fee-for-Service	1265408249	1265408249	1	1	GOLDFINGER, NEIL MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29719	40	Pediatrics	0	In state provider	None	16870 W BERNARDO DR	None	SAN DIEGO	CA	92127	1677	37	06073	33.01956754	-117.0809122	San Diego County
41103	Fee-for-Service	1245970722	1245970722	1	1	GOLUBJATNIKOV, MATTHEW K MD	1/1/2025	207P00000X	NA	Other	026	PHYSICIANS	188136	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
41130	Fee-for-Service	1316953219	1316953219	1	1	GELB, MICHAEL E MD	8/29/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	69863	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
41156	Fee-for-Service	1538717384	1538717384	1	1	GIFFORD, NANCY LCSW	10/15/2024	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
41169	Fee-for-Service	1154409779	1154409779	1	1	GIBBONEY, JAMES J MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	83436	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
41170	Fee-for-Service	1649315508	1649315508	1	1	GLENN, CASPER T MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48007	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
41190	Fee-for-Service	1316036239	1316036239	1	1	GARCIA, ANA M LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4760 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
41236	Fee-for-Service	1134521479	1134521479	1	1	GREENE, TESSA C CNM	6/29/2015	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
41244	Fee-for-Service	1114284767	1114284767	1	1	GUNNARSSON, BJORN E	7/1/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	855 N LARK ELLEN AVENUE	SUITE J	WEST COVINA	CA	91791	1099	19	06037	34.087707	-117.9166385	Los Angeles County
41279	Fee-for-Service	1952318727	1952318727	1	1	GUILLORY, CHARLETA MD	11/1/2020	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
41315	Fee-for-Service	1023462025	1023462025	1	1	GOLDEN KEY HOSPICE INC	5/7/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13083 VAN NUYS BLVD	SUITE 4	PACOIMA	CA	91311	1308	19	06037	34.26899632	-118.4181797	Los Angeles County
41321	Fee-for-Service	1306974886	1306974886	1	1	GRALIA, MAIYA LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	12290 PALMER RD	None	NEVADA CITY	CA	95959	9240	29	06057	39.3157805	-120.972885	Nevada County
41324	Fee-for-Service	1477667418	1477667418	1	1	GUBERMAN DE ANDRADE,	3/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	88171	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CRISTIANE MD	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
41342	Fee-for-Service	1306130919	1306130919	1	1	GEHRKE, STEFANIE M CRNA	12/27/2011	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
41379	Fee-for-Service	1952348617	1952348617	1	1	GONSER, WILLIAM N MD	1/22/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73301	30	Radiology	0	In state provider	None	1617 N CALIFORNIA ST	STE 1A	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
41388	Fee-for-Service	1043219967	1043219967	1	1	GREENBERG, MARK 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	525 N 18TH ST	STE 302	PHOENIX	AZ	85006	3734	00	None	33.454755	-112.042674	Maricopa County
41434	Fee-for-Service	1134268519	1134268519	1	1	GREGORIA, MARIA E LMFT	9/14/2018	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
41435	Fee-for-Service	1659792828	1659792828	1	1	GARCIA, BEATRIZ	8/2/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
41484	Fee-for-Service	1922708684	1922708684	1	1	GOLDEN ROSE PHARMACY INC.	10/26/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4070 BASELINE RD	STE 110	ROSEVILLE	CA	95747	6489	31	06061	38.75183291	-121.355422	Placer County
41494	Fee-for-Service	1801478540	1801478540	1	1	GAU, ALEXANDER J DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	20667	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
41537	Fee-for-Service	1437212636	1437212636	1	1	GOKLANEY, RAVI K MD	12/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	44584	-	NOT APPLICABLE	0	In state provider	None	1124 BAKER ST	None	BAKERSFIELD	CA	93305	4322	15	06029	35.38059062	-118.9915812	Kern County
41564	Fee-for-Service	1619082096	1619082096	1	1	GOODWIN, JANE D OD	2/23/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
41586	Fee-for-Service	1376691196	1376691196	1	1	GROCHOWSKI, YVONNE L MD	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54594	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
41592	Fee-for-Service	1154378859	1154378859	1	1	GRAYS HARBOR COMM HOSP	8/1/1999	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	915 ANDERSON DR	None	ABERDEEN	WA	98520	1006	00	None	46.979334	-123.8464165	Grays Harbor County
41604	Fee-for-Service	1225118581	1225118581	1	1	GRIFFIN, IAN J MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53337	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
41605	Fee-for-Service	1487912499	1487912499	1	1	GIBB, DAVID R MD	7/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155012	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
41606	Fee-for-Service	1023462025	1023462025	1	1	GOLDEN KEY HOSPICE INC	5/7/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13083 VAN NUYS BLVD	SUITE 4	PACOIMA	CA	91311	1308	19	06037	34.26899632	-118.4181797	Los Angeles County
41621	Fee-for-Service	1336338805	1336338805	1	1	GROSSMONT HOSPTIAL CORP	11/28/2006	282NW0100X	NA	Hospitals	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3077	37	06073	32.781483	-117.007182	San Diego County
41624	Fee-for-Service	1356007819	1356007819	1	1	GRANDVIEW MEDICAL GROUP, INC	6/7/2024	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	.	605 E. BADILLO STREET	100	COVINA	CA	91723	2846	19	06037	34.08628747	-117.87903	Los Angeles County
41640	Fee-for-Service	1518357821	1518357821	1	1	GARCIA, JAVIER E LCSW	10/4/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	35287 AVENUE B	None	YUCAIPA	CA	92501	4444	36	06071	34.03170851	-117.034722	San Bernardino County
41692	Fee-for-Service	1124139233	1124139233	1	1	GRANGER, DAVID A MD	9/5/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	160416	40	Pediatrics	0	In state provider	None	1120 W LA VETA AVE	STE 125	ORANGE	CA	92868	4235	30	06059	33.78029455	-117.864369	Orange County
41710	Fee-for-Service	1073566931	1073566931	1	1	GHURABI, WALID DO	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	4366	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
41749	Fee-for-Service	1871851980	1871851980	1	1	GARCES, NICOLE M LMFT	7/4/2020	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
41777	Fee-for-Service	1427359637	1427359637	1	1	GONZALES, ANTHONY M M D INC	5/16/2011	207L00000X	NA	Other	026	PHYSICIANS	60280	None	None	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
41854	Fee-for-Service	1770642670	1770642670	1	1	GAO, HONG LAC	12/30/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	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
41880	Fee-for-Service	1154378859	1154378859	1	1	GRAYS HARBOR COMM HOSP	8/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	915 ANDERSON DR	None	ABERDEEN	WA	98520	1006	00	None	46.979334	-123.8464165	Grays Harbor County
41899	Fee-for-Service	1043208218	1043208218	1	1	GONZALEZ, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	777 HOSPITAL WAY	BLDG A	POCATELLO	ID	83201	5162	00	None	42.87385929	-112.4189402	Bannock County
41915	Fee-for-Service	1356007819	1356007819	1	1	GRANDVIEW MEDICAL GROUP, INC	6/7/2024	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	.	605 E. BADILLO STREET	100	COVINA	CA	91723	2846	19	06037	34.08628747	-117.87903	Los Angeles County
41922	Fee-for-Service	1538178553	1538178553	1	1	GOUGOV, PETER D MD	4/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89759	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
41931	Fee-for-Service	1861551517	1861551517	1	1	GRECIA-LABARO, MARIAN M	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44378	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
41934	Fee-for-Service	1851301295	1851301295	1	1	GIORDANO-BRENGHAUSE, KAREN M	4/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	1555 RIVER PARK DRIVE	STE 206P	SACRAMENTO	CA	95815	4604	34	06067	38.600019	-121.434687	Sacramento County
41947	Fee-for-Service	1942707385	1942707385	1	1	GIANG, SOPHIA MD	6/20/2024	2080P0210X	NA	Nephrology	026	PHYSICIANS	163692	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
41950	Fee-for-Service	1811997737	1811997737	1	1	GREENSON, NIKOLAS W MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79764	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
41960	Fee-for-Service	1053334664	1053334664	1	1	GORDHAN, DHARMESH I PT	12/28/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	957 FAULKNERROAD	105	SANTA PAULA	CA	93060	9129	56	06111	34.33481551	-119.0867489	Ventura County
41976	Fee-for-Service	1265402648	1265402648	1	1	GUTIERREZ, MIGUEL A MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55844	None	None	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
41987	Fee-for-Service	1689274755	1689274755	1	1	GENESIS HCP OF ORANGE COUNTY	3/19/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	, INC	11552 KNOTT	C11	GARDEN GROVE	CA	92841	1824	30	06059	33.794199	-118.0110805	Orange County
42017	Fee-for-Service	1922452606	1922452606	1	1	GARISPE, ASHLEY DO	11/4/2019	207P00000X	NA	Other	026	PHYSICIANS	16685	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
42139	Fee-for-Service	1639104250	1639104250	1	1	GLASPY, JOHN A MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42778	41	Internal Medicine	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
42146	Fee-for-Service	1528306529	1528306529	1	1	GLOBAL HOSPICE AND	2/5/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1200 G STREET	SUITE B	MODESTO	CA	95354	2450	50	06099	37.63916311	-120.9947497	Stanislaus County
42158	Fee-for-Service	1396731352	1396731352	1	1	GOODMAN, WARREN G	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 AINSWORTH DR	STE 115	PRESCOTT	AZ	86305	3413	00	None	34.560126	-112.483638	Yavapai County
42160	Fee-for-Service	1811392475	1811392475	1	1	GRINDLER, JENNIFER	2/28/2025	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
42192	Fee-for-Service	1295834844	1295834844	1	1	GUTZMAN, JAMES D PA	11/23/2022	363A00000X	NA	Physician Assistant	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	6425 LYNCH CANYON DR	None	LAKE ISABELLA	CA	93240	9726	15	06029	35.63676438	-118.4054121	Kern County
42210	Fee-for-Service	1649857046	1649857046	1	1	GAIA HOSPICE, INC	6/23/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18401 BURBANK BLVD	STE 218	TARZANA	CA	91356	6618	19	06037	34.17187827	-118.5339035	Los Angeles County
42211	Fee-for-Service	1902250236	1902250236	2	1	GONZALES, NOVIE O MD	4/27/2023	207R00000X	NA	Other	026	PHYSICIANS	161119	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
42220	Fee-for-Service	1881744696	1881744696	1	1	GOYAL, ASHU MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91375	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
42224	Fee-for-Service	1528425543	1528425543	1	1	GARFIELD TERRACE LLC	1/10/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1435 N GARFIELD AVE	None	PASADENA	CA	91104	2106	19	06037	34.170615	-118.1439395	Los Angeles County
42229	Fee-for-Service	1336139773	1336139773	1	1	GLAUSER, TODD A MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80983	22	Pathology (M.D. only)	0	In state provider	None	2111 E DAKOTA AVE	None	FRESNO	CA	93726	4805	10	06019	36.78683711	-119.785712	Fresno County
42251	Fee-for-Service	1326245754	1326245754	1	1	GHADERI, VANESSA S MD	12/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96591	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
42255	Fee-for-Service	1639672918	1639672918	1	1	GREENWOOD, MICHELE R S CRNA	4/19/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
42300	Fee-for-Service	1548898810	1548898810	1	1	GOORHUIS, JONATHAN K MD	2/21/2024	207P00000X	NA	Other	026	PHYSICIANS	182856	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
42307	Fee-for-Service	1073742854	1073742854	1	1	GEHRICKE, JEAN PHD	8/2/2012	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
42317	Fee-for-Service	1780983221	1780983221	1	1	GOLDBERG, COREY T MD	4/14/2020	207P00000X	NA	Other	026	PHYSICIANS	159656	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
42373	Fee-for-Service	1902226822	1902226822	1	1	GARLAND BECERRA, ALEJANDRA	11/5/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	149526	13	Neurology (M.D. only)	0	In state provider	MD	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
42417	Fee-for-Service	1326631813	1326631813	1	1	GARFIELD BEACH CVS LLC	10/15/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1401 BERRYESSA RD	None	SAN JOSE	CA	95133	1014	43	06085	37.36865005	-121.8801857	Santa Clara County
42436	Fee-for-Service	1528306529	1528306529	1	1	GLOBAL HOSPICE AND	2/5/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	1200 G STREET	SUITE B	MODESTO	CA	95354	2450	50	06099	37.63916311	-120.9947497	Stanislaus County
42498	Fee-for-Service	1851751853	1851751853	1	1	GOVIL, VISHAL DO	10/25/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15718	08	Family Practice	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
42500	Fee-for-Service	1649857046	1649857046	1	1	GAIA HOSPICE, INC	6/23/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18401 BURBANK BLVD	STE 218	TARZANA	CA	91356	6618	19	06037	34.17187827	-118.5339035	Los Angeles County
42506	Fee-for-Service	1245326883	1245326883	1	2	GLASSMAN, JERROLD MD INC	3/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	34309	None	None	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2138	37	06073	32.75053781	-117.1627168	San Diego County
42541	Fee-for-Service	1104004365	1104004365	1	1	GIBSON, LEENA C MD	4/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101342	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
42570	Fee-for-Service	1215016969	1215016969	1	1	GHASSEMI, KOUROSH F MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64588	41	Internal Medicine	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
42602	Fee-for-Service	1922027630	1922027630	1	1	GIRON, ANDRES E MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42914	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	555 MARIN ST	STE 110	THOUSAND OAKS	CA	91360	4102	56	06111	34.18377743	-118.8801886	Ventura County
42606	Fee-for-Service	1780983221	1780983221	1	1	GOLDBERG, COREY T MD	4/14/2020	207P00000X	NA	Other	026	PHYSICIANS	159656	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
42628	Fee-for-Service	1659390995	1659390995	1	1	GUNDZIK, JOHN M MD	3/31/1993	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	51755	30	Radiology	0	In state provider	None	2301 BAHAMAS DR	None	BAKERSFIELD	CA	93309	0663	15	06029	35.37447628	-119.0453594	Kern County
42629	Fee-for-Service	1891971156	1891971156	1	1	GANDOTRA, BHAVANA MD	8/3/2020	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	164672	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
42658	Fee-for-Service	1649289315	1649289315	1	1	GUPTA, RENU MD	6/6/2020	207R00000X	NA	Other	026	PHYSICIANS	158884	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
42689	Fee-for-Service	1790700995	1790700995	1	1	GOLDSMITH, JEFFREY S MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62681	41	Internal Medicine	0	In state provider	None	1131 WILSHIRE BLVD	# 100200	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
42734	Fee-for-Service	1275046385	1275046385	1	2	GANDARA, BRENDA L PHD	9/30/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15615 ALTON PARKWAY	230	IRVINE	CA	92618	3341	30	06059	33.6555222	-117.7537825	Orange County
42755	Fee-for-Service	1942255757	1942255757	1	1	GARRISON, MARTHA H MD	5/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87977	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
42767	Fee-for-Service	1639614100	1639614100	1	1	GERONIMO, CHRISTINE ANNE P N	3/13/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
42784	Fee-for-Service	1861423709	1861423709	1	1	GUTIN, MARC S MD INC	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48699	41	Internal Medicine	0	In state provider	None	210 S GRAND AVE	STE 224	GLENDORA	CA	91741	4205	19	06037	34.133859	-117.872523	Los Angeles County
42792	Fee-for-Service	1912014663	1912014663	1	1	GERBERDING, JULIE L MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39646	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
42807	Fee-for-Service	1952715955	1952715955	1	1	GEORGE, PORSCHE LMFT	2/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1060 E FOOTHILL BLVD	204	UPLAND	CA	91786	4070	36	06071	34.1070235	-117.6371235	San Bernardino County
42829	Fee-for-Service	1104004365	1104004365	1	1	GIBSON, LEENA C MD	4/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101342	16	Obstetrics-Gynecology (M.D. Only) Neonatal	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
42831	Fee-for-Service	1528555026	1528555026	1	1	GUILLEN, NICOLE R MD	1/21/2021	390200000X	NA	Other	026	PHYSICIANS	166122	None	None	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
42840	Fee-for-Service	1164628343	1164628343	1	1	GRAY, EMILY K MD	4/15/2020	2084P0804X	NA	Psychiatry	026	PHYSICIANS	107531	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
42851	Fee-for-Service	1326579962	1326579962	1	1	GALVEZ, KENDALL NP	6/21/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
42852	Fee-for-Service	1942973029	1942973029	1	1	GENERATIONS OF ANAHEIM ASSIS	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	TED LIVING FACILITY INC	1941 E CENTER ST	None	ANAHEIM	CA	92805	3409	30	06059	33.84108345	-117.8897042	Orange County
42864	Fee-for-Service	1053741330	1053741330	1	1	GRANALI, ALLISON G	10/14/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 BROADWAY ST	None	REDWOOD CITY	CA	94063	2086	41	06081	37.48674011	-122.2238575	San Mateo County
42888	Fee-for-Service	1922027630	1922027630	1	1	GIRON, ANDRES E MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	42914	41	Internal Medicine	0	In state provider	None	555 MARIN ST	STE 110	THOUSAND OAKS	CA	91360	4102	56	06111	34.18377743	-118.8801886	Ventura County
42900	Fee-for-Service	1033522842	1033522842	1	1	GLAMORE, MICHAEL J MD	9/9/2019	208800000X	NA	Other	026	PHYSICIANS	161424	34	Urology and Urological Surgery	0	In state provider	None	905 EAST WASHINGTON ST	None	PETALUMA	CA	94952	3385	49	06097	38.24451673	-122.6303052	Sonoma County
42992	Fee-for-Service	1891296422	1891296422	1	1	GUARDIAN ANGELS ADULT DAY	7/13/2018	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE LLC	4837 E MCKINLEY AVE	None	FRESNO	CA	93703	1342	10	06019	36.76523123	-119.734833	Fresno County
42995	Fee-for-Service	1609535558	1609535558	1	1	GEORGE, CERENE C CNP	3/2/2022	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
43012	Fee-for-Service	1730123191	1730123191	1	1	GIOVANNETTI, MARK J MD	9/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53478	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
43013	Fee-for-Service	1457989709	1457989709	1	1	GENERAL CARE GROUP INC	10/18/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6005 VINELAND AVE	STE 202	NORTH HOLLYWOOD	CA	91606	4984	19	06037	34.179921	-118.3703275	Los Angeles County
43043	Fee-for-Service	1326391004	1326391004	1	1	GARCIA, CRISTINA I MD	7/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123276	01	General Practice	0	In state provider	None	901 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4737	19	06037	34.01042334	-118.1099428	Los Angeles County
43049	Fee-for-Service	1255580973	1255580973	1	1	GIAMMATTEI, SHAWN PHD	4/16/2024	103TF0000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	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
43074	Fee-for-Service	1831125624	1831125624	1	1	GUPTA, INDU MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92758	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
43075	Fee-for-Service	1861423709	1861423709	1	1	GUTIN, MARC S MD INC	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48699	67	Endocrinology	0	In state provider	None	210 S GRAND AVE	STE 224	GLENDORA	CA	91741	4205	19	06037	34.133859	-117.872523	Los Angeles County
43081	Fee-for-Service	1912907833	1912907833	1	1	GIBLY,RAQUEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	0000	00	None	32.227209	-110.8556595	Pima County
43083	Fee-for-Service	1356879845	1356879845	1	1	GONZALEZ-VEGA, OMAR MD	9/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
43094	Fee-for-Service	1063693000	1063693000	1	1	GROSSMAN, GLENN M MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74125	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	23633 BLYTHE ST	None	WEST HILLS	CA	91304	5802	19	06037	34.21415114	-118.641899	Los Angeles County
43130	Fee-for-Service	1700808599	1700808599	2	1	GARFIELD BEACH CVS LLC	3/29/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 BELL RD	None	AUBURN	CA	95603	2508	31	06061	38.94234605	-121.0950552	Placer County
43136	Fee-for-Service	1457397515	1457397515	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16 3RD AVE EXT	None	CHULA VISTA	CA	91910	1039	37	06073	32.65065157	-117.0873467	San Diego County
43156	Fee-for-Service	1609892959	1609892959	1	1	GRUBE, GERALD MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	22946	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
43206	Fee-for-Service	1144546672	1144546672	1	1	GONZALEZ, LIANA MD	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130565	41	Internal Medicine	0	In state provider	None	215 PESETAS LANE	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
43245	Fee-for-Service	1861807851	1861807851	1	1	GUERRERO, ERNESTO LCSW	10/9/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
43266	Fee-for-Service	1477621431	1477621431	1	1	GOMEZ-GARCIA, MARCO MD	5/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84263	41	Internal Medicine	0	In state provider	INC	1510 S CENTRAL AVENUE	STE 340	GLENDALE	CA	91204	2577	19	06037	34.12709764	-118.2577911	Los Angeles County
43279	Fee-for-Service	1245498682	1245498682	1	1	GAFFNEY, CHRISTOPHER E MD	4/22/2021	2085P0229X	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
43299	Fee-for-Service	1457989709	1457989709	1	1	GENERAL CARE GROUP INC	10/18/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6005 VINELAND AVE	STE 202	NORTH HOLLYWOOD	CA	91606	4984	19	06037	34.179921	-118.3703275	Los Angeles County
43324	Fee-for-Service	1881777167	1881777167	1	1	GUTHRIE, ANDREA C LMFT	12/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	163 2ND STREET	None	WOODLAND	CA	95695	0000	57	06113	38.68060768	-121.7718082	Yolo County
43327	Fee-for-Service	1184646788	1184646788	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5769 LONE TREE WAY	None	ANTIOCH	CA	94531	8587	07	06013	37.964511	-121.7379645	Contra Costa County
43381	Fee-for-Service	1508047648	1508047648	1	1	GILLOTTI, THERESA A LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
43388	Fee-for-Service	1497726574	1497726574	1	1	GUSTAFSON, JILL E MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72927	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
43389	Fee-for-Service	1154161529	1154161529	1	1	GILL, SHARAN CNP	7/11/2024	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
43412	Fee-for-Service	1982649885	1982649885	1	1	GARFIELD BEACH CVS LLC	4/20/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 E COMPTON BLVD	None	COMPTON	CA	90220	2413	19	06037	33.89595042	-118.2216755	Los Angeles County
43430	Fee-for-Service	1255396594	1255396594	1	1	GOETZL, EDWARD J MD	11/30/1982	207K00000X	NA	Other	026	PHYSICIANS	47295	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
43439	Fee-for-Service	1619912417	1619912417	1	1	GARFIELD BEACH CVS LLC	1/17/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2427 E VALLEY PKWY	None	ESCONDIDO	CA	92027	2932	37	06073	33.14171487	-117.0426662	San Diego County
43449	Fee-for-Service	1891840039	1891840039	1	1	GOLD CASTLE INC	5/20/1997	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5230 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90027	4909	19	06037	34.10172584	-118.3040556	Los Angeles County
43457	Fee-for-Service	1083981252	1083981252	1	1	GILL, AKASHDEEP MD	3/26/2025	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	123279	-	NOT APPLICABLE	0	In state provider	None	8330 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	1615	19	06037	34.2217725	-118.3873405	Los Angeles County
43475	Fee-for-Service	1831198514	1831198514	1	1	GORDON F GREENMAN MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	PLAZA ONE 202 N DIVISION	None	AUBURN	WA	98002	0000	00	None	47.3066897	-122.2117967	King County
43477	Fee-for-Service	1952080061	1952080061	1	1	GUERRERO, DIANA	5/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR	SUITE #230	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
43478	Fee-for-Service	1053775684	1053775684	1	1	GEYER, ALEXANDER J MD	8/3/2020	390200000X	NA	Other	026	PHYSICIANS	154572	08	Family Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
43487	Fee-for-Service	1306547757	1306547757	1	1	GEORGETTI, DIANNE G NP	10/15/2024	363LG0600X	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
43496	Fee-for-Service	1497814156	1497814156	1	1	GARCIA, DAVID MD	6/29/1989	207R00000X	NA	Other	026	PHYSICIANS	38767	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
43508	Fee-for-Service	1629118153	1629118153	1	1	GHAEMIAN, SHADAN MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55902	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
43528	Fee-for-Service	1477880102	1477880102	1	1	GARIMELLA, PRANAV S MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143549	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
43540	Fee-for-Service	1427081678	1427081678	1	1	GHALY, CHRISTINA R MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87045	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
43588	Fee-for-Service	1194784322	1194784322	1	1	GUINTO-MIRANDA, LILIBETH	12/31/1983	207ZC0500X	NA	Other	026	PHYSICIANS	31602	22	Pathology (M.D. only)	0	In state provider	None	2828 H ST	STE D	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
43643	Fee-for-Service	1881602175	1881602175	1	1	GABBITA, GEETHA V MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43392	01	General Practice	0	In state provider	None	14568 WHITTIER BLVD	None	WHITTIER	CA	90605	2129	19	06037	33.95246351	-118.0138614	Los Angeles County
43650	Fee-for-Service	1184867806	1184867806	1	1	GOPENG, JENNIFER S MD	8/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105644	08	Family Practice	0	In state provider	None	290 N WAYTE LN	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
43674	Fee-for-Service	1083099428	1083099428	1	1	GARRICK, SARAH J LMFT	7/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
43740	Fee-for-Service	1356896849	1356896849	1	1	GEORGES, NANCY K LMFT	9/8/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ONS	2062 JOHN JONES RD	240	DAVIS	CA	95616	9709	57	06113	38.5636139	-121.769196	Yolo County
43806	Fee-for-Service	1558993527	1558993527	1	1	GARFIELD BEACH CVS LLC	6/3/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5500 WEST SUNSET BOULEVA	None	LOS ANGELES	CA	90028	8522	19	06037	34.09807154	-118.310157	Los Angeles County
43838	Fee-for-Service	1346352473	1346352473	1	1	GUNAWAN, BASUKI K MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78609	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
43853	Fee-for-Service	1215382080	1215382080	1	1	GANDHI, KRISH M MD	7/11/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	177903	None	None	0	In state provider	None	1662 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1816	44	06087	36.99033079	-121.9816507	Santa Cruz County
43877	Fee-for-Service	1194784322	1194784322	1	1	GUINTO-MIRANDA, LILIBETH	12/31/1983	207ZC0500X	NA	Other	026	PHYSICIANS	31602	01	General Practice	0	In state provider	None	2828 H ST	STE D	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
43884	Fee-for-Service	1184698391	1184698391	1	1	GRIMWOOD, JOHN L MD	10/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54557	07	Dermatology	0	In state provider	None	7592 METROPOLITAN DRIVE	STE 405	SAN DIEGO	CA	92108	4428	37	06073	32.77772014	-117.1575637	San Diego County
43886	Fee-for-Service	1528264926	1528264926	1	1	GILLENSON, RONI J LMFT	6/6/2023	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
43920	Fee-for-Service	1417945999	1417945999	1	1	GELDERS, ALBERT H MD	5/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55384	None	None	0	In state provider	None	1425 W H ST	STE #200	OAKDALE	CA	95361	3588	50	06099	37.75771796	-120.8627767	Stanislaus County
43931	Fee-for-Service	1881602175	1881602175	1	1	GABBITA, GEETHA V MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43392	08	Family Practice	0	In state provider	None	14568 WHITTIER BLVD	None	WHITTIER	CA	90605	2129	19	06037	33.95246351	-118.0138614	Los Angeles County
43949	Fee-for-Service	1063576080	1063576080	1	1	GERSBACH, ANNE M CRNA	3/17/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
43978	Fee-for-Service	1346380631	1346380631	1	1	GLENDALE ADULT DAY	5/25/2006	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE CENTER	6900 SAN FERNANDO RD	None	GLENDALE	CA	91201	1609	19	06037	34.17310455	-118.2980681	Los Angeles County
43980	Fee-for-Service	1073775623	1073775623	1	1	GOPALAN, ANJALI MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138697	41	Internal Medicine	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
43988	Fee-for-Service	1851626881	1851626881	1	1	GRAHAM, STACI J LP	9/19/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	41760 IVY STREET	SUITE 204	MURRIETA	CA	92562	0000	33	06065	33.55331844	-117.2081759	Riverside County
44026	Fee-for-Service	1972542264	1972542264	1	1	GENESIS HEALTH SYSTEM	11/19/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1227 E RUSHOLME ST	None	DAVENPORT	IA	52803	2459	00	None	41.54280563	-90.55710413	Scott County
44027	Fee-for-Service	1083993877	1083993877	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	43525 10TH ST W	None	LANCASTER	CA	93534	6091	19	06037	34.673139	-118.147909	Los Angeles County
44030	Fee-for-Service	1962425868	1962425868	1	1	GRAHAM, DAVID M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	BILLINGS CLINIC	2800 10TH AVE NORTH	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
44059	Fee-for-Service	1972790897	1972790897	1	1	GRATITUDE HEALTH CARE INC	11/23/2009	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	21800 OXNARD STREET	SUITE 910	WOODLAND HILLS	CA	91467	3639	19	06037	34.17914151	-118.6028325	Los Angeles County
44068	Fee-for-Service	1497791552	1497791552	1	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8985 VENICE BLVD	None	LOS ANGELES	CA	90034	3344	19	06037	34.02720362	-118.392374	Los Angeles County
44081	Fee-for-Service	1730111469	1730111469	1	1	GREGORIO, RENEE DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7301 GIRARD AVE	STE 202	LA JOLLA	CA	92037	5151	37	06073	32.83764565	-117.2715586	San Diego County
44091	Fee-for-Service	1194316018	1194316018	1	1	GRESSEL, SYDNEY NP	2/4/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44105	Fee-for-Service	1952310054	1952310054	1	1	GORTY, SRI G MD	8/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73742	30	Radiology	0	In state provider	None	1910 ROYALTY DR	None	POMONA	CA	91767	3021	19	06037	34.07871356	-117.7454184	Los Angeles County
44127	Fee-for-Service	1346352473	1346352473	1	1	GUNAWAN, BASUKI K MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78609	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
44140	Fee-for-Service	1568478436	1568478436	1	1	GAMBLE, BRIAN K MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76121	None	None	0	In state provider	None	10701 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2384	19	06037	34.15226651	-118.36386	Los Angeles County
44174	Fee-for-Service	1184698391	1184698391	1	1	GRIMWOOD, JOHN L MD	10/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54557	22	Pathology (M.D. only)	0	In state provider	None	7592 METROPOLITAN DRIVE	STE 405	SAN DIEGO	CA	92108	4428	37	06073	32.77772014	-117.1575637	San Diego County
44190	Fee-for-Service	1114703006	1114703006	1	1	GALEN INPATIENT PHYSICIANS P	10/5/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
44195	Fee-for-Service	1063704641	1063704641	1	1	GIBBS, MICHAEL G MD	11/14/2017	2084N0600X	NA	Neurology	026	PHYSICIANS	136594	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
44198	Fee-for-Service	1629450721	1629450721	1	1	GOLCHIAN, DAVID MD DO	7/6/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18024	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
44211	Fee-for-Service	1396775300	1396775300	1	1	GATES, BENNETT E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38585	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
44234	Fee-for-Service	1306070271	1306070271	1	1	GULATI, VIKANT MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121551	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
44272	Fee-for-Service	1699834465	1699834465	1	1	GONG, ROBERT L MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41145	08	Family Practice	0	In state provider	None	2150 MAIN ST	STE 3	CAMBRIA	CA	93428	3022	40	06079	35.5637421	-121.0835084	San Luis Obispo County
44287	Fee-for-Service	1225353568	1225353568	1	1	GORDON, JUSTIN S MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118547	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
44309	Fee-for-Service	1659378990	1659378990	1	1	GILBERT, JULIE R MD	1/1/2022	2086S0105X	NA	General Surgery	026	PHYSICIANS	70670	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
44315	Fee-for-Service	1972542264	1972542264	1	1	GENESIS HEALTH SYSTEM	11/19/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1227 E RUSHOLME ST	None	DAVENPORT	IA	52803	2459	00	None	41.54280563	-90.55710413	Scott County
44340	Fee-for-Service	1497120679	1497120679	1	1	GARFIELD BEACH CVS LLC	8/19/2016	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3627 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90063	2216	19	06037	34.04054652	-118.186227	Los Angeles County
44355	Fee-for-Service	1518554120	1518554120	1	1	GUILLEN, ADRIANA LMFT	4/22/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
44358	Fee-for-Service	1770631657	1770631657	1	1	GRIMALDI, JAY F MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23936	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
44368	Fee-for-Service	1366500571	1366500571	1	1	GROSSMONT ANESTHESIA	3/1/1994	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SERIVES MED GROUP INC	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
44388	Fee-for-Service	1811314941	1811314941	1	1	GANDHI, PRATIK J MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150060	01	General Practice	0	In state provider	None	500 S ANAHEIM HILLS	STE 206	ANAHEIM	CA	92807	4759	30	06059	33.8427954	-117.7772895	Orange County
44390	Fee-for-Service	1801274576	1801274576	1	1	GOPALAN, ANANTH MD	12/1/2023	207R00000X	NA	Other	026	PHYSICIANS	186126	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
44401	Fee-for-Service	1144678848	1144678848	1	1	GRIER, DEMETRICE NP	5/7/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
44423	Fee-for-Service	1104899368	1104899368	1	1	GHAI, VINOD KUMAR MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	41422	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
44465	Fee-for-Service	1487698734	1487698734	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4440 ALAMO ST	None	SIMI VALLEY	CA	93063	1733	56	06111	34.28630476	-118.7083421	Ventura County
44466	Fee-for-Service	1598010399	1598010399	1	1	GREEN, JACK MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136598	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
44513	Fee-for-Service	1295717288	1295717288	1	1	GREEN, ELAINE M NP	2/27/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
44531	Fee-for-Service	1639216468	1639216468	2	1	GOLBARI, ABRAHAM MD	7/11/2012	207R00000X	NA	Other	026	PHYSICIANS	55387	41	Internal Medicine	0	In state provider	None	14030 CRENSHAW BLVD	None	GARDENA	CA	90249	2715	19	06037	33.9043434	-118.3264901	Los Angeles County
44543	Fee-for-Service	1265089841	1265089841	1	1	GAMMA HOSPICE INC	10/16/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11100 VALLEY BLVD	SUITE 106	EL MONTE	CA	91731	2533	19	06037	34.07383477	-118.0332998	Los Angeles County
44675	Fee-for-Service	1669421202	1669421202	1	1	GAVIN HAMILTON, IVAN D	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104632	None	None	0	In state provider	MD	2340 CLAY STREET	3RD FL	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
44696	Fee-for-Service	1972571982	1972571982	1	1	GELBERMAN, SARA C MD	10/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	86990	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
44699	Fee-for-Service	1952655631	1952655631	1	1	GALLEGOS, KAY E PHD	5/4/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4901 MORENA BLVD	STE 109	SAN DIEGO	CA	92117	3370	37	06073	32.82669128	-117.2303448	San Diego County
44818	Fee-for-Service	1255427928	1255427928	1	1	GRAY, THOMAS J PT	5/18/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
44829	Fee-for-Service	1265089841	1265089841	1	1	GAMMA HOSPICE INC	10/16/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11100 VALLEY BLVD	SUITE 106	EL MONTE	CA	91731	2533	19	06037	34.07383477	-118.0332998	Los Angeles County
44834	Fee-for-Service	1457900433	1457900433	1	1	GERALDO, JENNIFER S PT	2/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
44892	Fee-for-Service	1881677961	1881677961	1	1	GREIDANUS, THOMAS G 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 CTR	400 W 16TH STREET	None	PUEBLO	CO	81003	0000	00	None	38.28171999	-104.6119963	Pueblo County
44907	Fee-for-Service	1609077197	1609077197	1	1	GUPTA, MANJUSHA MD	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102011	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
44915	Fee-for-Service	1841233590	1841233590	1	1	GILKISON, RICHARD A OD	11/1/2002	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EYECARE	9589 FOOTHILL BLVD	STE 102	RANCHO CUCAMONGA	CA	91730	3506	36	06071	34.10649714	-117.5959289	San Bernardino County
44937	Fee-for-Service	1932690393	1932690393	1	1	GOLDEN STAR HOME CARE LLC	4/19/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	320 E 18TH ST	STE A	ANTIOCH	CA	94509	2451	07	06013	38.00488236	-121.7987162	Contra Costa County
44942	Fee-for-Service	1891385449	1891385449	1	1	GOLD COUNTRY HOME HEALTH	4/16/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1024 IRON POINT RD	STE 1056	FOLSOM	CA	95630	8013	34	06067	38.643246	-121.1794245	Sacramento County
44956	Fee-for-Service	1477534378	1477534378	1	2	GOLDEN GATE PHARMACY SERVICE	4/12/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	S INC	8 DIGITAL DR	200	NOVATO	CA	94949	8705	21	06041	38.07023457	-122.5339008	Marin County
44962	Fee-for-Service	1851377584	1851377584	1	1	GUTMANN, DANIEL LEE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CAREPOINT, PC	2550 S PARKER RD, #206	None	AURORA	CO	80014	0000	00	None	39.670515	-104.8642785	Arapahoe County
44967	Fee-for-Service	1255309803	1255309803	1	1	GREATER SACRAMENTO	4/1/1990	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGERY CENTER LP	2288 AUBURN BLVD	STE 201	SACRAMENTO	CA	95821	1620	34	06067	38.625345	-121.4114985	Sacramento County
44968	Fee-for-Service	1356007819	1356007819	1	2	GRANDVIEW MEDICAL GROUP, INC	6/7/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	.	625 E BADILLO ST	None	COVINA	CA	91723	2800	19	06037	34.08629558	-117.8783846	Los Angeles County
44978	Fee-for-Service	1962679829	1962679829	1	1	GOYAL, VISHAL MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105207	41	Internal Medicine	0	In state provider	None	1201 ALHAMBRA BLVD	#230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
44984	Fee-for-Service	1164473807	1164473807	1	1	GANZHORN, FRANK M MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	62533	41	Internal Medicine	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
44986	Fee-for-Service	1154392637	1154392637	1	1	GALLAND, DAVID B MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40814	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
44997	Fee-for-Service	1790768638	1790768638	1	1	GROSSMAN, STEVEN R MD	3/9/2021	207RX0202X	NA	Oncology	026	PHYSICIANS	171199	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
45001	Fee-for-Service	1467899187	1467899187	1	1	GESCH, JULIE D MD	2/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136207	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
45005	Fee-for-Service	1427186212	1427186212	1	1	GASPER, WARREN J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89802	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
45040	Fee-for-Service	1598078545	1598078545	1	1	GUPTA, RUCHI MD	4/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119612	40	Pediatrics	0	In state provider	None	900 SCENIC DRIVE	None	MODESTO	CA	95350	6133	50	06099	37.64720549	-120.981654	Stanislaus County
45055	Fee-for-Service	1437771664	1437771664	1	1	GONZALES, GLORIA Y LMFT	10/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2895 LOMA VISTA	STE B	VENTURA	CA	93003	1572	56	06111	34.27543868	-119.2574459	Ventura County
45078	Fee-for-Service	1366079485	1366079485	1	1	GONZALEZ OSEGUERA, JENNIFER	10/19/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20646	None	None	0	In state provider	A DO	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
45090	Fee-for-Service	1578530218	1578530218	1	1	GRABOWSKY, KARI MD	6/6/2024	207R00000X	NA	Other	026	PHYSICIANS	64748	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
45091	Fee-for-Service	1376295626	1376295626	1	1	GARCIA, DIANA LCSW	3/12/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 S FARRELL DR	STE B210	PALM SPRINGS	CA	92262	7933	33	06065	33.81787498	-116.5180068	Riverside County
45146	Fee-for-Service	1932313160	1932313160	1	1	GOLDEN VALLEY HEALTH CTR	7/31/1991	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PATTERSON MEDICAL CTR	200 C ST	None	PATTERSON	CA	95363	2701	50	06099	37.46733509	-121.1258615	Stanislaus County
45147	Fee-for-Service	1083182398	1083182398	1	1	GABRIELYAN, ZARINE OD	11/13/2020	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
45165	Fee-for-Service	1720669963	1720669963	1	1	GERULA, HAYLEY M NP	10/21/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2801 K STREET	SUITE 200	SACRAMENTO	CA	95816	9582	34	06067	38.572947	-121.46904	Sacramento County
45180	Fee-for-Service	1265422695	1265422695	1	2	GUZZETTA, RICHARD V MD	4/15/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	40600	-	NOT APPLICABLE	0	In state provider	None	515 SOUTH CEDAR AVENUE	None	FRESNO	CA	93702	2908	10	06019	36.73744912	-119.7543742	Fresno County
45187	Fee-for-Service	1760518245	1760518245	1	1	GODIKSEN, MARK V MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43850	41	Internal Medicine	0	In state provider	STE #106	688 MEDICAL CENTER DR E	None	CLOVIS	CA	93611	6807	10	06019	36.840645	-119.658746	Fresno County
45188	Fee-for-Service	1376570309	1376570309	1	1	GARCIA, STEPHANE H MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	51084	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
45253	Fee-for-Service	1356007819	1356007819	1	2	GRANDVIEW MEDICAL GROUP, INC	6/7/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	.	625 E BADILLO ST	None	COVINA	CA	91723	2800	19	06037	34.08629558	-117.8783846	Los Angeles County
45264	Fee-for-Service	1346607520	1346607520	1	1	GIANITSIS, JOHN A CRNA	5/19/2017	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
45279	Fee-for-Service	1396081212	1396081212	1	1	GHC OF LOMPOC LLC	8/1/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1428 W NORTH AVENUE	None	LOMPOC	CA	93436	3961	42	06083	34.65348456	-120.4735457	Santa Barbara County
45283	Fee-for-Service	1710237821	1710237821	1	1	GARCHA, GAGAN P MD	6/10/2020	207R00000X	NA	Other	026	PHYSICIANS	163190	41	Internal Medicine	0	In state provider	None	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
45300	Fee-for-Service	1588946107	1588946107	1	1	GOODMAN, STEPHANIE NP	9/3/2024	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
45304	Fee-for-Service	1457856924	1457856924	1	1	GLOSS, REBECCA	3/12/2025	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
45332	Fee-for-Service	1285670851	1285670851	1	1	GOLDEN OAK HOLDINGS, LLC	9/11/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	VASONA CREEK HEALTHCARE	16412 LOS GATOS BLVD	None	LOS GATOS	CA	95032	5525	43	06085	37.23046706	-121.9654506	Santa Clara County
45378	Fee-for-Service	1720152663	1720152663	1	1	GARREN, RONALD MD	2/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	19297	41	Internal Medicine	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
45401	Fee-for-Service	1437175460	1437175460	1	1	GOICOECHEA, MARTA J MD	1/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81954	41	Internal Medicine	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
45405	Fee-for-Service	1245890854	1245890854	1	1	GAO, YINGLIN DO	10/3/2022	207R00000X	NA	Other	026	PHYSICIANS	20286	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
45427	Fee-for-Service	1730868480	1730868480	1	1	GIROT, CHLOE O	7/12/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
45433	Fee-for-Service	1932313160	1932313160	1	1	GOLDEN VALLEY HEALTH CTR	7/31/1991	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PATTERSON MEDICAL CTR	200 C ST	None	PATTERSON	CA	95363	2701	50	06099	37.46733509	-121.1258615	Stanislaus County
45444	Fee-for-Service	1366803397	1366803397	1	1	GONZALEZ, BELEN LCSW	11/29/2024	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
45463	Fee-for-Service	1134517782	1134517782	1	1	GRAY-DORSETT, TANYA LMFT	12/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
45485	Fee-for-Service	1033185442	1033185442	1	1	GIAP, HUAN B MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54883	78	Neoplastic Diseases/Oncology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
45544	Fee-for-Service	1760594725	1760594725	1	1	GLENN K GUZMAN MD	8/25/2013	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
45585	Fee-for-Service	1275618803	1275618803	1	1	GUPTA, PIYUSH	12/18/2020	207R00000X	NA	Other	026	PHYSICIANS	53824	None	None	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
45609	Fee-for-Service	1104285816	1104285816	1	1	GUARDADO, LINDSAY R LCSW	11/9/2023	103TC0700X	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
45612	Fee-for-Service	1790170850	1790170850	1	1	GUSLITS, ELYSSA MD	8/20/2021	2080P0203X	NA	Other	026	PHYSICIANS	146812	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
45676	Fee-for-Service	1841476546	1841476546	1	1	GONZALES, FRANCIS B MD	8/23/2010	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	112963	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
45702	Fee-for-Service	1467890624	1467890624	1	1	GULLETT, JONATHAN C MD	12/17/2018	207ZC0006X	NA	Other	026	PHYSICIANS	149262	22	Pathology (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
45718	Fee-for-Service	1710248745	1710248745	1	1	GROVE, INGRID G DO	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12235	08	Family Practice	0	In state provider	None	6555 COYLE AVENUE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
45773	Fee-for-Service	1033185442	1033185442	1	1	GIAP, HUAN B MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54883	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
45796	Fee-for-Service	1851725527	1851725527	1	1	GUTIERREZ, KAREN A LMFT	4/27/2020	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
45837	Fee-for-Service	1891174116	1891174116	1	1	GLEDHILL, TODD MD	12/8/2018	207P00000X	NA	Other	026	PHYSICIANS	154302	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
45863	Fee-for-Service	1093916918	1093916918	1	1	GLOVER, ANDREA G LCSW	5/6/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
45867	Fee-for-Service	1548659592	1548659592	1	1	GOSNEY, CARY E CRNA	8/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
45898	Fee-for-Service	1528353521	1528353521	1	1	GUIDO-ESTRADA, NATALIE M MD	7/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140052	None	None	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
45900	Fee-for-Service	1487861720	1487861720	1	1	GUPTA, ATUL K MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56162	30	Radiology	0	In state provider	None	6121 N THESTA ST	STE 207	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
45909	Fee-for-Service	1811408198	1811408198	1	1	GLENDENNING, KENDRA C PT	12/25/2020	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
45934	Fee-for-Service	1124007430	1124007430	1	3	GREENE, GILBERT E DO	12/9/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1307 N COMMERCE ST	None	STOCKTON	CA	95202	1012	39	06077	37.96535383	-121.2959608	San Joaquin County
45938	Fee-for-Service	1932162724	1932162724	1	1	GRADE, BRIAN MD	2/28/1995	207P00000X	NA	Other	026	PHYSICIANS	55504	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1516 E COLLINS AVE	None	ORANGE	CA	92867	5934	30	06059	33.80227852	-117.837333	Orange County
45973	Fee-for-Service	1225141393	1225141393	1	1	GREEN, STEVEN A MD	1/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	58182	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
45974	Fee-for-Service	1588951768	1588951768	1	1	GUERRA, LESLEY K OD	5/16/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	162 W D STREET	None	LEMOORE	CA	93245	2938	16	06031	36.302089	-119.7831008	Kings County
46009	Fee-for-Service	1356892616	1356892616	1	1	GARFIELD BEACH CVS LLC	5/9/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6720 N FRESNO ST	None	FRESNO	CA	93710	3743	10	06019	36.83632547	-119.7811185	Fresno County
46114	Fee-for-Service	1134578115	1134578115	1	1	GAMMON, BEN MD	5/22/2021	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
46130	Fee-for-Service	1356429013	1356429013	1	1	GYETVAI, ERNO J MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79217	42	Nuclear Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
46132	Fee-for-Service	1649834060	1649834060	1	1	GRUHONJIC, IMRAN DO	8/1/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	22681	20	Orthopedic Surgery	0	In state provider	None	6719 ALVARADO ROAD	SUITE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
46160	Fee-for-Service	1679025308	1679025308	1	1	GREEN, SYREETA LMFT	7/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14393 PARK AVE	STE 200	VICTORVILLE	CA	92392	3302	36	06071	34.5123	-117.3248825	San Bernardino County
46161	Fee-for-Service	1043267446	1043267446	1	1	GOLDEN, JEFFREY A MD	7/30/1981	207RP1001X	NA	Pulmonology	026	PHYSICIANS	27108	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
46203	Fee-for-Service	1861482143	1861482143	1	1	GRITCHEN, CATHERINE D MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79436	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
46208	Fee-for-Service	1104087808	1104087808	1	1	GAN, TERENCE M MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106013	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
46250	Fee-for-Service	1871742718	1871742718	1	1	GUNTON, ROBERT R	7/16/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8421 AUBURN BLVD	STE 110	SACRAMENTO	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento
46279	Fee-for-Service	1861657082	1861657082	1	1	GANSTER, ANNA C MD	11/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121733	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
46336	Fee-for-Service	1619234523	1619234523	1	1	GANDHI, PRATIK J DO	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15756	25	Physical Medicine and Rehabilitation	0	In state provider	None	2488 N CALIFORNIA ST	None	STOCKTON	CA	95204	5508	39	06077	37.97587328	-121.2911856	San Joaquin County
46360	Fee-for-Service	1225043938	1225043938	1	1	GALANT, MICHELLE H MD	3/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129767	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46379	Fee-for-Service	1124381595	1124381595	1	1	GLENN, IAN C MD	6/22/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	170930	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
46411	Fee-for-Service	1861547887	1861547887	1	1	GIARRITTA, MICHAEL A LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
46419	Fee-for-Service	1356429013	1356429013	1	1	GYETVAI, ERNO J MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79217	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
46427	Fee-for-Service	1164670428	1164670428	1	1	GOLDBERG, RACHEL LMFT	7/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11712 MOORPARK STREET	111	STUDIO CITY	CA	91604	2154	19	06037	34.1503315	-118.38825	Los Angeles County
46436	Fee-for-Service	1558337840	1558337840	1	1	GREGORY JERARD OZARK, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2160 S 1ST AVE	None	MAYWOOD	IL	60153	3328	00	None	41.86025379	-87.83381752	Cook County
46451	Fee-for-Service	1659348050	1659348050	1	1	GREWAL, NAVRAJ S MD	6/1/1999	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	65442	30	Radiology	0	In state provider	None	1001 E LATHAM AVE	STE X	HEMET	CA	92543	4435	33	06065	33.74937254	-116.961804	Riverside County
46455	Fee-for-Service	1467537134	1467537134	1	1	GAUT, CHRISTOPHER C MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61587	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
46456	Fee-for-Service	1003967522	1003967522	1	2	GUSTINE UNIFIED SD	7/1/2019	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1500 MEREDITH AVE	None	GUSTINE	CA	95322	1701	24	06047	37.24930699	-121.0111954	Merced County
46461	Fee-for-Service	1205004652	1205004652	1	1	GROSSMAN, IRWIN MD	1/28/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19219	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
46467	Fee-for-Service	1942833660	1942833660	1	2	GRACE SPEECH THERAPY CORP	2/1/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22672 LAMBERT ST	611	LAKE FOREST	CA	92630	1613	30	06059	33.63324401	-117.7136718	Orange County
46489	Fee-for-Service	1730220765	1730220765	1	1	GLENDALE ANESTHESIA SPEC	9/23/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1530 E CHEVY CHASE DR	STE 205A	GLENDALE	CA	91206	4168	19	06037	34.150689	-118.2303855	Los Angeles County
46492	Fee-for-Service	1699718833	1699718833	1	1	GASPAR, KATHY G MD	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93100	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
46497	Fee-for-Service	1306868187	1306868187	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3750 BARRANCA PKWY	None	IRVINE	CA	92606	8200	30	06059	33.68656124	-117.8130325	Orange County
46525	Fee-for-Service	1164493888	1164493888	1	1	GIMBEL, EVANGELINE A MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50667	40	Pediatrics	0	In state provider	None	7950 CHERRY AVE	STE 105	FONTANA	CA	92336	4023	36	06071	34.109892	-117.4887375	San Bernardino County
46533	Fee-for-Service	1760689921	1760689921	1	1	GUERRERO, MALORA K	7/18/2011	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
46576	Fee-for-Service	1346866589	1346866589	1	1	GUERRERO, NERY MD	9/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185299	08	Family Practice	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
46578	Fee-for-Service	1518046275	1518046275	2	1	GILL, EDWARD A MD	9/1/2018	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
46605	Fee-for-Service	1326466848	1326466848	1	1	GRANNIS, KIMBERLY A MD	8/1/2019	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	138068	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
46646	Fee-for-Service	1639138852	1639138852	1	1	GUGIG, ROBERTO MD	2/24/2010	261QR1300X	NA	Rural Health Center	026	PHYSICIANS	69432	40	Pediatrics	0	In state provider	None	1014 SAN JUAN AVENUE	None	EXETER	CA	93221	1312	54	06107	36.29887348	-119.1316702	Tulare County
46655	Fee-for-Service	1932666575	1932666575	1	1	GOLD COUNTRY HEALTH INITIATI	11/25/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	VE, LLC	820/830 STATE HIGHWAY 88	None	JACKSON	CA	95642	2134	03	06005	38.35226951	-120.7658983	Amador County
46675	Fee-for-Service	1992786487	1992786487	1	1	GONZALEZ, GEORGE C MD	8/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55847	08	Family Practice	0	In state provider	None	110 N VALERIA ST	STE 206	FRESNO	CA	93701	2167	10	06019	36.74388938	-119.7847725	Fresno County
46680	Fee-for-Service	1952366692	1952366692	1	1	GARNER, ANGELA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2310 HOLMES ST	STE 800	KANSAS CITY	MO	64108	2602	00	None	39.08432765	-94.57585309	Jackson County
46695	Fee-for-Service	1942353602	1942353602	1	1	GURLEY, GIA N LMFT	5/16/2020	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
46698	Fee-for-Service	1184789539	1184789539	1	1	GARDNER, KAM C	11/7/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
46714	Fee-for-Service	1104973825	1104973825	1	2	GIESE, HERBERT A MD	10/6/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	35129	-	NOT APPLICABLE	0	In state provider	None	590 RIO LINDA AVE	None	CHICO	CA	95926	1817	04	06007	39.75427022	-121.8482553	Butte County
46720	Fee-for-Service	1326011297	1326011297	1	1	GONZALEZ, RICARDO J MD	11/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1240 E 9TH ST	None	RENO	NV	89512	2964	00	None	39.53846574	-119.7974202	Washoe County
46727	Fee-for-Service	1063680023	1063680023	1	1	GUO, YUJIAN MD	7/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97549	13	Neurology (M.D. only)	0	In state provider	None	7000 BOULDER AVENUE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
46729	Fee-for-Service	1316167265	1316167265	1	1	GERMAN, CRAIG A MD	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91512	13	Neurology (M.D. only)	0	In state provider	None	11600 MISSION HILL RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.28150754	-118.4621165	Los Angeles County
46743	Fee-for-Service	1922532167	1922532167	1	1	GREEN ACUPUNCTURE PROF CORP	6/19/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	13788 ROSWELL AVE	STE 138	CHINO	CA	91710	1409	36	06071	34.00313001	-117.721863	San Bernardino County
46745	Fee-for-Service	1629194121	1629194121	1	1	GUISARD, MARSHA J MD	1/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106091	25	Physical Medicine and Rehabilitation	0	In state provider	None	222 W 39TH STREET	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
46753	Fee-for-Service	1831238310	1831238310	1	1	GHANI, FATEMA M PT	10/4/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	631 S HAM LN	STE B	LODI	CA	95242	3532	39	06077	38.12696729	-121.2882893	San Joaquin County
46819	Fee-for-Service	1164289203	1164289203	1	1	GARCIA, DANIELA LMFT	5/20/2024	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
46824	Fee-for-Service	1033475108	1033475108	1	1	GUSTAFSON, LOLETA M LMFT	8/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	34455 YUCAIPA BLVD	SUITE 206	YUCAIPA	CA	92399	2476	36	06071	34.0338117	-117.0525613	San Bernardino County
46833	Fee-for-Service	1750663951	1750663951	1	2	GET WELL HOME HEALTH INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	28436 CONSTELLATION RD	SUITE 200	VALENCIA	CA	91355	5081	19	06037	34.45366635	-118.5775631	Los Angeles County
46857	Fee-for-Service	1659451706	1659451706	1	1	GIMENEZ, KIMBERLY M MD	2/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78912	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
46863	Fee-for-Service	1992741862	1992741862	1	1	GESLANI, BEVAN A MD	2/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	42353	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
46866	Fee-for-Service	1154773406	1154773406	1	1	GHC OF SAC-RCFE LLC	4/11/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2200 GRAMERCY DRIVE	None	SACRAMENTO	CA	95825	0308	34	06067	38.60631	-121.3975755	Sacramento County
46870	Fee-for-Service	1740501196	1740501196	1	1	GRAHAM, GARY C MD INC	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	13700	18	Ophthalmology	0	In state provider	None	517 W 23RD STREET	None	MERCED	CA	95340	3724	24	06047	37.30761572	-120.4803848	Merced County
46896	Fee-for-Service	1538108097	1538108097	1	1	GONZALEZ, ALEJANDRO L DO	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6453	41	Internal Medicine	0	In state provider	None	850 S ATLANTIC BLVD	STE 101	MONTEREY PARK	CA	91754	4727	19	06037	34.05097684	-118.1379979	Los Angeles County
46911	Fee-for-Service	1841812575	1841812575	1	1	GOLDSTEIN, ANDREW MD	10/15/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	910 E STOWELL RD	None	SANTA MARIA	CA	93454	7001	42	06083	34.93834649	-120.422502	Santa Barbara County
46935	Fee-for-Service	1639138852	1639138852	1	1	GUGIG, ROBERTO MD	2/24/2010	261QR1300X	NA	Rural Health Center	026	PHYSICIANS	69432	10	Gastroenterology (M.D. only)	0	In state provider	None	1014 SAN JUAN AVENUE	None	EXETER	CA	93221	1312	54	06107	36.29887348	-119.1316702	Tulare County
46947	Fee-for-Service	1326127580	1326127580	2	1	GODOY, IGNACIO P MD	7/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	48799	40	Pediatrics	0	In state provider	None	16660 PARAMOUNT BLVD	STE 206	PARAMOUNT	CA	90723	5458	19	06037	33.882723	-118.1599535	Los Angeles County
46971	Fee-for-Service	1811032634	1811032634	1	1	GIBSON, CHRIS S	11/1/1995	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2906 DARWIN ST	None	SACRAMENTO	CA	95821	4510	34	06067	38.618253	-121.4173125	Sacramento County
46973	Fee-for-Service	1790933794	1790933794	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1363 W HENDERSON AVE	None	PORTERVILLE	CA	93257	1456	54	06107	36.07812	-119.047239	Tulare County
47003	Fee-for-Service	1881761807	1881761807	1	1	GANJU, AMEETA MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77881	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
47071	Fee-for-Service	1235321621	1235321621	1	1	GRIFFIN JR, STEVEN R MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102423	40	Pediatrics	0	In state provider	None	27555 YNEZ RD	#370	TEMECULA	CA	92591	4678	33	06065	33.50370608	-117.1492569	Riverside County
47077	Fee-for-Service	1043605751	1043605751	1	1	GARCIA, DANIEL MD	11/5/2019	207L00000X	NA	Other	026	PHYSICIANS	162536	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
47105	Fee-for-Service	1700049459	1700049459	1	1	GONZALEZ, KASEIN G MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117390	None	None	0	In state provider	None	710 N EUCLID ST	STE 101	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
47108	Fee-for-Service	1033820469	1033820469	1	1	GONZALES, DIONNE	1/31/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
47110	Fee-for-Service	1679616981	1679616981	1	1	GRAY, ROBERT M PHD	6/20/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
47139	Fee-for-Service	1841427556	1841427556	1	1	GRAY, BENJAMIN L MD	11/1/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	172644	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
47185	Fee-for-Service	1538108097	1538108097	1	1	GONZALEZ, ALEJANDRO L DO	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6453	01	General Practice	0	In state provider	None	850 S ATLANTIC BLVD	STE 101	MONTEREY PARK	CA	91754	4727	19	06037	34.05097684	-118.1379979	Los Angeles County
47188	Fee-for-Service	1447241609	1447241609	1	1	GRIMSRUD, CHRISTOPHER MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79045	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
47215	Fee-for-Service	1215230164	1215230164	1	1	GODWIN, TINA DO	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11528	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
47238	Fee-for-Service	1366631962	1366631962	1	1	GREWAL, NAVROSE S MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	95109	33	Thoracic Surgery	0	In state provider	None	2650 ELM AVE	STE 318	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
47257	Fee-for-Service	1396427977	1396427977	1	1	GARCES, MARLOU RUSSEL S PT	8/23/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	312 W J ST	None	LOS BANOS	CA	93635	4069	24	06047	37.06221105	-120.8570564	Merced County
47263	Fee-for-Service	1124318746	1124318746	1	1	GHALCHI, DANIEL D MD	12/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126365	01	General Practice	0	In state provider	None	8510 BALBOA BLVD	STE 150	NORTHRIDGE	CA	91325	5810	19	06037	34.224507	-118.5026015	Los Angeles County
47274	Fee-for-Service	1164049664	1164049664	1	1	GARDEN OF LIFE HOME HEALTH	4/8/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	6117 RESEDA BLVD	UNIT 207	TARZANA	CA	91335	7361	19	06037	34.181208	-118.536059	Los Angeles County
47304	Fee-for-Service	1962692384	1962692384	1	1	GEORGE L MEE MEM HOSP	7/13/2000	282N00000X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
47337	Fee-for-Service	1588800080	1588800080	1	1	GILANI, HUSSAIN A MD	7/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120187	None	None	0	In state provider	None	3300 WEBSTER ST	SUITE 304	OAKLAND	CA	94609	3118	01	06001	37.82132826	-122.2621843	Alameda County
47342	Fee-for-Service	1972210755	1972210755	1	1	GUEVARA, KRISTINA NP	8/13/2024	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
47346	Fee-for-Service	1083719926	1083719926	1	1	GETTLER, LAWRENCE H MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	36986	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13855 E 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
47375	Fee-for-Service	1114564648	1114564648	1	1	GROSS, JENNIFER LMFT	6/3/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 BOARDWALK AVENUE	SUITE 210	THOUSAND OAKS	CA	91360	5766	56	06111	34.18007258	-118.8728752	Ventura County
47403	Fee-for-Service	1902269434	1902269434	1	1	GUAN, XIN MD	8/20/2020	390200000X	NA	Other	026	PHYSICIANS	167401	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
47437	Fee-for-Service	1558918680	1558918680	1	1	GREENO, JENNIFER LCSW	8/23/2022	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
47521	Fee-for-Service	1174658330	1174658330	1	1	GARFIELD BEACH CVS, LLC	10/31/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3361 MARKET ST.	None	RIVERSIDE	CA	92501	2828	33	06065	33.98666386	-117.3729679	Riverside County
47528	Fee-for-Service	1942220249	1942220249	1	1	GOLD, CLAUDIA R MD	11/30/1988	207P00000X	NA	Other	026	PHYSICIANS	60971	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
47545	Fee-for-Service	1063695658	1063695658	1	1	GOYAL, RAJAN MD	6/21/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	139406	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5531 BUSINESS PARK S	101	BAKERSFIELD	CA	93309	1668	15	06029	35.35738668	-119.0601246	Kern County
47561	Fee-for-Service	1902841802	1902841802	1	1	GARFIELD BEACH CVS, LLC	4/23/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	602 N EL CAMINO REAL	None	SAN CLEMENTE	CA	92672	4720	30	06059	33.43010576	-117.6177175	Orange County
47565	Fee-for-Service	1356318240	1356318240	1	1	GRECO, THERESA L MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104899	67	Endocrinology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
47579	Fee-for-Service	1598777559	1598777559	1	1	GUSTAVESON, STEVEN MD	11/30/1994	207R00000X	NA	Other	026	PHYSICIANS	49993	41	Internal Medicine	0	In state provider	EKG DEPARTMENT	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
47600	Fee-for-Service	1295806107	1295806107	1	1	GORDON, LOUISE S MD	2/3/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42459	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
47709	Fee-for-Service	1851896575	1851896575	1	1	GOPINATHAN NAIR, GEETHU G MD	8/30/2021	208M00000X	NA	Other	026	PHYSICIANS	173452	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
47713	Fee-for-Service	1477567345	1477567345	1	2	GRADY, SHAUN P MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70152	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	147 W SIERRA MADRE BLVD	None	SIERRA MADRE	CA	91024	2492	19	06037	34.16191714	-118.0557211	Los Angeles County
47730	Fee-for-Service	1679201016	1679201016	1	1	GRANT SERENITY HOMES OF	10/6/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	SIERRA MADRE INC	425 N SIERRA MADRE BLVD	None	PASADENA	CA	91107	2859	19	06037	34.153748	-118.0943198	Los Angeles County
47746	Fee-for-Service	1922194869	1922194869	1	1	GOLDMAN ERIC S MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	40271	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
47763	Fee-for-Service	1487820577	1487820577	1	1	GEULA, NAVID DO	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10333	None	None	0	In state provider	None	710 N EUCLID STREET	STE 107	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
47815	Fee-for-Service	1356792022	1356792022	1	1	GOSWAMY, VINAY P	10/13/2022	207K00000X	NA	Other	026	PHYSICIANS	167886	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
47838	Fee-for-Service	1770990202	1770990202	1	1	GAMEZ, MICAH A LCSW	1/11/2024	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
47845	Fee-for-Service	1174818470	1174818470	1	1	GENERATIONAL CHANGES, INC	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3333 N BOND AVE	ROOMS 101-207	FRESNO	CA	93726	5712	10	06019	36.78078434	-119.7679443	Fresno County
47855	Fee-for-Service	1356318240	1356318240	1	1	GRECO, THERESA L MD	10/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104899	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
47869	Fee-for-Service	1407537004	1407537004	1	1	GONZALEZ, MARISOL LMFT	8/4/2023	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
47955	Fee-for-Service	1326784588	1326784588	1	1	GOMEZ, JAVIER E	9/20/2022	225X00000X	NA	Other	019	OCCUPATIONAL 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
47999	Fee-for-Service	1114304920	1114304920	1	1	GRAVES, KENNETH LMFT	1/29/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	4000 BIRCH ST	SUITE 112A	NEWPORT BEACH	CA	92660	2211	30	06059	33.66463772	-117.8698289	Orange County
48005	Fee-for-Service	1992977888	1992977888	2	1	GOLIK, LISA A MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113952	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6121 N THESTA ST	SUITE 303	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
48028	Fee-for-Service	1275558330	1275558330	1	1	GHAZAL, JOSEPH S MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53712	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1510 S CENTRAL AVE	STE 150	GLENDALE	CA	91204	2541	19	06037	34.12709764	-118.2577911	Los Angeles County
48098	Fee-for-Service	1225241110	1225241110	1	1	GARCIA, BARBARA D MD	1/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94487	07	Dermatology	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
48117	Fee-for-Service	1699872945	1699872945	1	1	GARFIELD BEACH CVS, LLC	10/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3943 SAN FERNANDO RD.	None	GLENDALE	CA	91204	2721	19	06037	34.12807423	-118.2590585	Los Angeles County
48128	Fee-for-Service	1780299636	1780299636	1	1	GONZALES, CATHY LYNN L	10/14/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	556 N 1ST ST	SUITE 201	SAN JOSE	CA	95112	5300	43	06085	37.34591974	-121.8977166	Santa Clara County
48170	Fee-for-Service	1457402430	1457402430	1	1	GONZALEZ-MENDEZ, GUSTAVO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44064	08	Family Practice	0	In state provider	None	751 LOMBARDI CT	STE B	SANTA ROSA	CA	95407	6793	49	06097	38.427804	-122.7493035	Sonoma County
48171	Fee-for-Service	1447320262	1447320262	1	1	GOTTFRIED, SARA E MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60268	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
48203	Fee-for-Service	1629053525	1629053525	1	1	GIBSON, LORETTA M CRNA	3/1/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
48220	Fee-for-Service	1629518337	1629518337	1	1	GONZALES, GRACE M LMFT	8/4/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4344 LATHAM	110	RIVERSIDE	CA	92501	0400	33	06065	34.00198519	-117.3739252	Riverside County
48231	Fee-for-Service	1063640738	1063640738	1	1	GOLDEN GATE UROLOGY INC	12/1/2009	208800000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1850 SULLIVAN AVENUE	SUITE 300	DALY CITY	CA	94015	2204	41	06081	37.68085904	-122.4728842	San Mateo County
48235	Fee-for-Service	1790886174	1790886174	1	1	GUNTUPALLI, NAGESWARA MD	10/31/1994	174400000X	NA	Other	026	PHYSICIANS	54955	36	Psychiatry	0	In state provider	INC	500 WEST BADILLO STREET	None	COVINA	CA	91722	3762	19	06037	34.0862325	-117.899253	Los Angeles County
48284	Fee-for-Service	1568129260	1568129260	1	1	GREY, KATHERINE C LMFT	10/24/2023	101YM0800X	NA	Other	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
48300	Fee-for-Service	1144744400	1144744400	1	1	GREKSOUK, ELIZABETH A NP	11/6/2019	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
48303	Fee-for-Service	1609213420	1609213420	1	1	GOTLIBOYM, KARINA MD	8/9/2019	207P00000X	NA	Other	026	PHYSICIANS	16581	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
48320	Fee-for-Service	1679613012	1679613012	1	1	GRIFFITHS, PATRICK D LMFT	1/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14075 HESPERIA RD	#105	VICTORVILLE	CA	92395	0000	36	06071	34.50679185	-117.296399	San Bernardino County
48321	Fee-for-Service	1669935185	1669935185	1	1	GUPTA, DIVYA 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
48380	Fee-for-Service	1467404566	1467404566	2	1	GARFIELD BEACH CVS, L.L.C.	1/30/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 COURT ST	STE A	REDDING	CA	96001	1805	45	06089	40.57812322	-122.3935669	Shasta County
48381	Fee-for-Service	1053392639	1053392639	1	1	GERI-CARE INC	4/15/1976	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	21521 S VERMONT AVE	None	TORRANCE	CA	90502	1939	19	06037	33.832629	-118.2903095	Los Angeles County
48394	Fee-for-Service	1275068884	1275068884	1	1	GORRELL, SASHA C PHD	1/11/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
48447	Fee-for-Service	1457373151	1457373151	2	1	GARFIELD BEACH CVS LLC	12/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10451 FAIRWAY DR	None	ROSEVILLE	CA	95678	1987	31	06061	38.79184414	-121.2897328	Placer County
48458	Fee-for-Service	1457402430	1457402430	1	1	GONZALEZ-MENDEZ, GUSTAVO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44064	01	General Practice	0	In state provider	None	751 LOMBARDI CT	STE B	SANTA ROSA	CA	95407	6793	49	06097	38.427804	-122.7493035	Sonoma County
48460	Fee-for-Service	1265527592	1265527592	1	1	GARCIA, DONALD P MD	8/31/1983	208600000X	NA	General Surgery	026	PHYSICIANS	46236	20	Orthopedic Surgery	0	In state provider	None	221 TUXEDO CT	STE 6	STOCKTON	CA	95204	5261	39	06077	37.97154914	-121.3012172	San Joaquin County
48518	Fee-for-Service	1063640738	1063640738	1	1	GOLDEN GATE UROLOGY INC	12/1/2009	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	1850 SULLIVAN AVENUE	SUITE 300	DALY CITY	CA	94015	2204	41	06081	37.68085904	-122.4728842	San Mateo County
48537	Fee-for-Service	1285656892	1285656892	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2485 EL CAMINO REAL	None	REDWOOD CITY	CA	94063	2849	41	06081	37.475649	-122.217111	San Mateo County
48549	Fee-for-Service	1467699413	1467699413	1	1	GENDZWILL, LISA K LCSW	12/16/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
48555	Fee-for-Service	1689713380	1689713380	1	1	GOLDEN, KRAIG L MD	7/1/1998	207R00000X	NA	Other	026	PHYSICIANS	60099	41	Internal Medicine	0	In state provider	None	1500 W WEST COVINA PKWY	STE 203	WEST COVINA	CA	91790	2708	19	06037	34.06953243	-117.9391587	Los Angeles County
48590	Fee-for-Service	1033475108	1033475108	1	2	GUSTAFSON, LOLETA M LMFT	5/17/2021	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ES	34455 YUCAIPA BLVD	206	YUCAIPA	CA	92399	0000	36	06071	34.0338117	-117.0525613	San Bernardino County
48632	Fee-for-Service	1821225020	1821225020	1	1	GAUSEWITZ, KATHRYN R MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116319	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
48664	Fee-for-Service	1487951430	1487951430	1	1	GILL, RUQAYYA DO	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11575	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
48705	Fee-for-Service	1407869142	1407869142	1	1	GAO, BIQI MD	5/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89212	08	Family Practice	0	In state provider	None	2790 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
48706	Fee-for-Service	1730612029	1730612029	1	1	GRANATA, ROBERT T MD	2/1/2020	207P00000X	NA	Other	026	PHYSICIANS	160839	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
48731	Fee-for-Service	1649621426	1649621426	1	1	GOERTZ, AARON DO	9/9/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	19884	None	None	0	In state provider	None	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
48736	Fee-for-Service	1821253626	1821253626	1	1	GHIMIRE, ANIL K MD	6/5/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	162434	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 260	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
48739	Fee-for-Service	1750551503	1750551503	1	1	GADE, RAJESH L MD	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96205	77	Infectious Disease	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
48747	Fee-for-Service	1265527592	1265527592	1	1	GARCIA, DONALD P MD	8/31/1983	208600000X	NA	General Surgery	026	PHYSICIANS	46236	01	General Practice	0	In state provider	None	221 TUXEDO CT	STE 6	STOCKTON	CA	95204	5261	39	06077	37.97154914	-121.3012172	San Joaquin County
48817	Fee-for-Service	1629399498	1629399498	1	1	GARFIELD BEACH CVS LLC	9/27/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3401 KATELLA AVE	None	LOS ALAMITOS	CA	90720	2353	30	06059	33.80320561	-118.0728226	Orange County
48825	Fee-for-Service	1013922467	1013922467	1	1	GEALY, W JAMES JR MD	5/18/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43671	18	Ophthalmology	0	In state provider	None	234 HEATHER CT	STE 1	TEMPLETON	CA	93465	8765	40	06079	35.55398686	-120.7176543	San Luis Obispo County
48877	Fee-for-Service	1033475108	1033475108	1	2	GUSTAFSON, LOLETA M LMFT	5/17/2021	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ES	34455 YUCAIPA BLVD	206	YUCAIPA	CA	92399	0000	36	06071	34.0338117	-117.0525613	San Bernardino County
48880	Fee-for-Service	1811107410	1811107410	1	1	GARDENA HOSP, LP	9/1/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	MEMORIAL HOSP OF GARDENA	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
48921	Fee-for-Service	1043288731	1043288731	1	1	GARCIA-KENNEDY, RICHARD	1/1/1988	207ZP0105X	NA	Other	026	PHYSICIANS	54556	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
48925	Fee-for-Service	1245224708	1245224708	1	1	GOVER, DAVID D MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87242	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
48929	Fee-for-Service	1861938557	1861938557	1	1	GUERRERO, SHIZATIZ LCSW	3/6/2025	No Taxonomy Provided	NA	None	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
48982	Fee-for-Service	1497919765	1497919765	1	1	GOMES, ALEX R OD	6/25/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12737 GLENOAKS BLVD	STE 3	SYLMAR	CA	91342	4724	19	06037	34.30181336	-118.4422626	Los Angeles County
49026	Fee-for-Service	1750551503	1750551503	1	1	GADE, RAJESH L MD	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96205	41	Internal Medicine	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
49032	Fee-for-Service	1497326169	1497326169	1	1	GIAN HERNANDEZ D O, INC.	6/20/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	23838 VALENCIA BLVD	STE 220	VALENCIA	CA	91355	5609	19	06037	34.41337791	-118.5520369	Los Angeles County
49060	Fee-for-Service	1699748301	1699748301	1	2	GUIAMELON, RITA P MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	84265	01	General Practice	0	In state provider	None	1543 E PALMDALE BLVD	STE C AND F	LOS ANGELES	CA	93550	2000	19	06037	34.57966352	-118.101582	Los Angeles
49072	Fee-for-Service	1023385283	1023385283	1	1	GOLIVE, ANJANI D MD	10/11/2023	207R00000X	NA	Other	026	PHYSICIANS	186814	None	None	0	In state provider	None	227 WEST JANSS ROAD	SUITE 340	THOUSAND OAKS	CA	91360	1879	56	06111	34.20611691	-118.883861	Ventura County
49145	Fee-for-Service	1437656923	1437656923	1	1	GENERALES, NICHOLAS P DO	10/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19090	None	None	0	In state provider	None	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	19	06037	34.148637	-118.4312035	Los Angeles County
49250	Fee-for-Service	1336776111	1336776111	1	1	GUPTA, SHIKHA MD	11/20/2023	208M00000X	NA	Other	026	PHYSICIANS	184267	None	None	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
49268	Fee-for-Service	1093004988	1093004988	1	1	GHAFFAR, SAMIA A MD	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122660	20	Orthopedic Surgery	0	In state provider	None	290 NORTH WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
49270	Fee-for-Service	1356360879	1356360879	1	1	GRATTON, RODOLFO L MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82532	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA STE 42	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
49329	Fee-for-Service	1922144849	1922144849	1	1	GOLDBERG, BETH C MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62353	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
49346	Fee-for-Service	1093878514	1093878514	1	1	GLAVIN, SARAH H MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53786	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
49392	Fee-for-Service	1891187969	1891187969	1	1	GOLDWATER SAG HOLDINGS LLC	9/21/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	607 WEST DUARTE ROAD	None	ARCADIA	CA	91007	7332	19	06037	34.12659214	-118.0516153	Los Angeles County
49457	Fee-for-Service	1255480075	1255480075	1	1	GU, HELEN H MD	12/5/2007	207R00000X	NA	Other	026	PHYSICIANS	91007	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
49468	Fee-for-Service	1841282423	1841282423	1	1	GREENBERG, HARVEY MD	10/31/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	67540	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
49476	Fee-for-Service	1275616187	1275616187	1	1	GIANCHANDANI, ROMA Y MD	12/5/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	49461	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
49480	Fee-for-Service	1609336692	1609336692	1	1	GALAMGAM, JAYDEN M MD	7/1/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	179216	07	Dermatology	0	In state provider	None	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
49515	Fee-for-Service	1811919608	1811919608	2	1	GARFIELD BEACH CVS LLC	12/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	41040 CALIFORNIA OAKS RD	None	MURRIETA	CA	92562	5749	33	06065	33.565752	-117.2031435	Riverside County
49522	Fee-for-Service	1942533617	1942533617	1	1	GARFIELD BEACH CVS LLC	3/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3100 GEER RD	None	TURLOCK	CA	95382	1119	50	06099	37.521387	-120.848793	Stanislaus County
49531	Fee-for-Service	1831517937	1831517937	1	1	GORRINDO, PHILLIP C MD	1/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163684	09	Gynecology (D.O. only)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
49560	Fee-for-Service	1891104139	1891104139	1	1	GREAT LIFE HOSPICE	4/27/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	SUITE 213	VAN NUYS	CA	91411	4197	19	06037	34.18663255	-118.452402	Los Angeles County
49588	Fee-for-Service	1396770178	1396770178	1	1	GILMORE, BENJAMIN N MD	1/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88735	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
49614	Fee-for-Service	1912322546	1912322546	1	1	GARCIA, ANGELA S LMFT	12/18/2024	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
49624	Fee-for-Service	1053311332	1053311332	1	2	GOLD WELLNESS, INC	5/23/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6221 WILSHIRE BLVD	#616	LOS ANGELES	CA	90048	5201	19	06037	34.06329534	-118.3640031	Los Angeles County
49626	Fee-for-Service	1104068444	1104068444	1	1	GHOUSSAINI, KRISTEN T NP	9/25/2019	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
49657	Fee-for-Service	1497536874	1497536874	1	1	GABRIYELYAN, ASTGEK NP	3/21/2024	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
49684	Fee-for-Service	1093797151	1093797151	1	1	GREENWALD, GARY I MD	4/30/1986	174400000X	NA	Other	026	PHYSICIANS	49421	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	42362 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	4469	33	06065	33.739038	-116.4080635	Riverside County
49712	Fee-for-Service	1619256757	1619256757	1	1	GOOZEE, SARAH S PHD	12/7/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD RD	STE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
49713	Fee-for-Service	1336435239	1336435239	1	1	GAGE, LIZA L PT	5/23/2019	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
49735	Fee-for-Service	1073522504	1073522504	1	1	GAVINI HEMANTH	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY MEDICAL CENTE	1501 N CAMPBELL	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
49736	Fee-for-Service	1114357555	1114357555	1	1	GRAY, JENNIFER NP	9/12/2022	364SA2100X	NA	Other	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
49740	Fee-for-Service	1578795464	1578795464	1	1	GANGWAR, DIVYA MD	4/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	123793	41	Internal Medicine	0	In state provider	None	637 MERCED STREET	None	NEUMAN	CA	95360	1070	50	06099	37.31481158	-121.0162228	Stanislaus County
49745	Fee-for-Service	1295810950	1295810950	1	1	GELIEBTER, MARK MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34307	01	General Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
49756	Fee-for-Service	1144651233	1144651233	1	1	GILILLAND, JENNIFER M	12/16/2013	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	800 N TUSTIN AVENUE	SUITE I	SANTA ANA	CA	92705	3605	30	06059	33.752241	-117.8342255	Orange County
49762	Fee-for-Service	1265214480	1265214480	1	1	GROOT, DANIELLE	1/18/2024	363LN0005X	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
49765	Fee-for-Service	1952346009	1952346009	1	1	GUERRA, LISA E MD	8/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95743	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
49773	Fee-for-Service	1265700975	1265700975	1	1	GARG, AMBICA MD	1/9/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	117019	None	None	0	In state provider	None	801 N TUSTIN AVE	#201	SANTA ANA	CA	92705	3600	30	06059	33.752286	-117.8341735	Orange County
49819	Fee-for-Service	1831517937	1831517937	1	1	GORRINDO, PHILLIP C MD	1/28/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163684	15	Obstetrics (D.O. only)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
49847	Fee-for-Service	1891104139	1891104139	1	1	GREAT LIFE HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	SUITE 213	VAN NUYS	CA	91411	4197	19	06037	34.18663255	-118.452402	Los Angeles County
49903	Fee-for-Service	1992773550	1992773550	1	1	GATES, JOHN MD	8/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92079	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
49904	Fee-for-Service	1164546404	1164546404	1	1	GARBER, LISA R CNM	2/8/2015	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	54	06107	36.05128153	-119.0422344	Tulare County
49942	Fee-for-Service	1043846256	1043846256	1	1	GITAU, LUCY W	4/10/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	336 OAKWOOD COURT	None	CORONA	CA	92879	8070	33	06065	33.89377028	-117.5040936	Riverside County
49944	Fee-for-Service	1235431388	1235431388	1	1	GOMEZ, ADRIAN Q DO	4/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
49959	Fee-for-Service	1376595777	1376595777	1	1	GOOD SAMARITAN HOSP, LP	2/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3985	43	06085	37.25111017	-121.9465891	Santa Clara County
49974	Fee-for-Service	1346390481	1346390481	1	1	GUILAK, HALEH	1/16/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	32225 TMECULA PKWY	None	TEMECULA	CA	92592	6811	33	06065	33.480135	-117.094554	Riverside County
49976	Fee-for-Service	1730861097	1730861097	1	1	GARDENA HEARING INC	1/16/2024	237700000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 155TH ST	STE 107	GARDENA	CA	90247	4048	19	06037	33.89049013	-118.2982407	Los Angeles County
49985	Fee-for-Service	1417068941	1417068941	1	1	GALLINA, CLAUDIO F MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76651	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
49998	Fee-for-Service	1184010365	1184010365	1	1	GEORGE, KEVIN MD	7/22/2019	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
50006	Fee-for-Service	1871171249	1871171249	1	1	GALITZER, HAYLEY A MD	3/19/2024	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
50020	Fee-for-Service	1285196881	1285196881	1	1	GERMANOS, MARINA C MD	8/17/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181503	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
50022	Fee-for-Service	1033519574	1033519574	1	1	GILKERSON, RACHEL G	7/11/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
50034	Fee-for-Service	1972945913	1972945913	1	1	GRATTAN, ANNE OD	9/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6109 W RAMSEY STREET	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
50064	Fee-for-Service	1952885139	1952885139	1	1	G & C SWAN INC	3/27/2024	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	MENT CENTER	373 SAN JOSE AVE	None	CLAREMONT	CA	91711	5210	19	06037	34.08323533	-117.7098649	Los Angeles County
50103	Fee-for-Service	1760594014	1760594014	1	1	GENTLE CARE, INC	1/11/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13101 W WASHINGTON BLVD	STE 142	LOS ANGELES	CA	90066	8122	19	06037	33.99397583	-118.440813	Los Angeles County
50172	Fee-for-Service	1043615180	1043615180	1	1	GALLIVAN, WILLIAM R JR MD	8/4/2016	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	73901	20	Orthopedic Surgery	0	In state provider	INC	320 W JUNIPERO ST	None	SANTA BARBARA	CA	93105	4305	42	06083	34.43067675	-119.7240654	Santa Barbara County
50230	Fee-for-Service	1043846256	1043846256	1	1	GITAU, LUCY W	4/10/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	336 OAKWOOD COURT	None	CORONA	CA	92879	8070	33	06065	33.89377028	-117.5040936	Riverside County
50255	Fee-for-Service	1891715835	1891715835	1	1	GUERRERO, RICHARD A JR MD	1/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79327	02	General Surgery	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
50264	Fee-for-Service	1730861097	1730861097	1	1	GARDENA HEARING INC	1/16/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1300 155TH ST	STE 107	GARDENA	CA	90247	4048	19	06037	33.89049013	-118.2982407	Los Angeles County
50271	Fee-for-Service	1457431058	1457431058	1	1	GALT, DENISE H LCSW	7/23/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7 FOURTH ST	STE 49	PETALUMA	CA	94952	3072	49	06097	38.23300765	-122.640298	Sonoma County
50284	Fee-for-Service	1821278714	1821278714	1	1	GARCIA, KELLI G OD	8/11/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10 BRYSON DR	None	SUTTER CREEK	CA	95685	4118	03	06005	38.38296339	-120.8055258	Amador County
50285	Fee-for-Service	1235269184	1235269184	1	1	GRITNEY, KAWANNA	4/23/2024	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
50313	Fee-for-Service	1215012752	1215012752	1	1	GARNER, RACHEL S MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125032	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5151 F STREET	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
50324	Fee-for-Service	1609857275	1609857275	1	1	GERI-CARE IV, LLC	12/1/1999	311500000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ANTELOPE VALLEY NURSING	44567 15TH ST W	None	LANCASTER	CA	93534	2803	19	06037	34.6923888	-118.1569099	Los Angeles County
50325	Fee-for-Service	1982058152	1982058152	1	1	GUPTA, NIKHIL MD	5/23/2022	390200000X	NA	Other	026	PHYSICIANS	151035	None	None	0	In state provider	None	12595 HESPERIA RD	STE 101	VICTORVILLE	CA	92395	8318	36	06071	34.47992741	-117.2908165	San Bernardino County
50326	Fee-for-Service	1710148077	1710148077	2	1	GARFIELD BEACH CVS LLC	5/24/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1405 W PACHECO BLVD	None	LOS BANOS	CA	93635	7806	24	06047	37.054071	-120.8760435	Merced County
50414	Fee-for-Service	1356723761	1356723761	1	1	GREGORY, NICHOLAS S MD	8/25/2020	207L00000X	NA	Other	026	PHYSICIANS	162535	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
50458	Fee-for-Service	1255301537	1255301537	1	1	GORDON, LEONARD MD	11/2/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	26770	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
50483	Fee-for-Service	1407015696	1407015696	1	1	GARY B. WRIGHT CHIROPRACTIC	7/21/2020	261Q00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	50 S. ANAHEIM BLVD.	250	ANAHEIM	CA	92805	2931	30	06059	33.83588032	-117.9138111	Orange County
50517	Fee-for-Service	1891758892	1891758892	1	1	GONZALES, CHARLOTTE V MD	12/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	86661	41	Internal Medicine	0	In state provider	None	1313 LAUREL ST	STE 106	SAN CARLOS	CA	94070	5013	41	06081	37.49782611	-122.2507762	San Mateo County
50541	Fee-for-Service	1568781235	1568781235	1	1	GEE, LESLIE MD	12/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98200	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
50560	Fee-for-Service	1730107293	1730107293	1	1	GANATA JR, JOSE R MD	10/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35837	01	General Practice	0	In state provider	None	625 W COLLEGE ST	STE 105	LOS ANGELES	CA	90012	1650	19	06037	34.06520183	-118.240809	Los Angeles County
50584	Fee-for-Service	1376747709	1376747709	1	1	GRANITE WELLNESS CENTERS	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1530 3RD STREET	STE 106	LINCOLN	CA	95648	2500	31	06061	38.88922046	-121.303647	Placer County
50601	Fee-for-Service	1215012752	1215012752	1	1	GARNER, RACHEL S MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125032	40	Pediatrics	0	In state provider	None	5151 F STREET	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
50612	Fee-for-Service	1124215348	1124215348	1	1	GREGORY G SMITH M D A PROFES	5/29/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SIONAL CORPORATION	7600 HOSPITAL DR	STE G	SACRAMENTO	CA	95823	5406	34	06067	38.463876	-121.414698	Sacramento County
50657	Fee-for-Service	1063640738	1063640738	1	10	GOLDEN GATE UROLOGY INC	3/22/2011	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	728 PACIFIC AVE	STE 608	SAN FRANCISCO	CA	94133	4449	38	06075	37.79687859	-122.4074282	San Francisco County
50691	Fee-for-Service	1730352287	1730352287	1	1	GERTSCH, JEFFREY H MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88828	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
50694	Fee-for-Service	1275923773	1275923773	1	1	GUAVA HOLDINGS LLC	12/16/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1220 PLUMAS ST	None	YUBA CITY	CA	95991	3411	51	06101	39.14626814	-121.6176162	Sutter County
50747	Fee-for-Service	1366622409	1366622409	1	1	GENTLECARE TRANSPORT INC	11/7/2008	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3539 CASITAS AVE	None	LOS ANGELES	CA	90039	1903	19	06037	34.12053658	-118.2570929	Los Angeles County
50767	Fee-for-Service	1730691916	1730691916	1	1	GETZ, ASHLEY E NP	6/28/2018	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
50815	Fee-for-Service	1578173753	1578173753	1	1	GRAENING, TOMMI C LMFT	1/29/2024	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
50823	Fee-for-Service	1609101914	1609101914	1	1	GOFORTH SERVICES INC	3/13/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	901 H STREET	None	MARYSVILLE	CA	95901	5125	58	06115	39.14449039	-121.5957244	Yuba County
50827	Fee-for-Service	1619478062	1619478062	1	1	GILBERT, NICOLE LMFT	5/13/2024	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
50840	Fee-for-Service	1801234414	1801234414	1	1	GOLI, HARINI MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138013	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
50879	Fee-for-Service	1275699530	1275699530	1	1	GOLDEN STATE AIR CHARTER	2/7/2007	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	1535 BOUGHTON DR	None	BAKERSFIELD	CA	93308	1621	15	06029	35.4340587	-119.0460437	Kern County
50919	Fee-for-Service	1831257773	1831257773	1	1	GREENWOOD, TREVOR C PT	5/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
50934	Fee-for-Service	1265201990	1265201990	1	1	GALEN INPATIENT PHYSICIANS P	3/5/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3660	15	06029	35.76144847	-119.238912	Kern County
50935	Fee-for-Service	1972831790	1972831790	1	1	GURM, HARMEET S MD	6/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123671	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
50943	Fee-for-Service	1447203120	1447203120	1	1	GAIL A MCCRACKEN	2/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
50960	Fee-for-Service	1477698389	1477698389	1	1	GALANG-FEATHER, NERISSA	1/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	44676	None	None	0	In state provider	V MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
50982	Fee-for-Service	1659681997	1659681997	1	1	GROSSERODE, STEPHEN M	1/28/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT STREET	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
51005	Fee-for-Service	1326432873	1326432873	1	1	GREENFIELD, ISABEL Q MD	1/10/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	144104	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
51006	Fee-for-Service	1922000942	1922000942	1	1	GREENE, HUNTER S MD	5/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84651	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51023	Fee-for-Service	1285653394	1285653394	1	1	GANDHI, ARTEE MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90669	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
51040	Fee-for-Service	1821018086	1821018086	1	1	GITLIN, MICHAEL J MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	32712	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
51054	Fee-for-Service	1578833604	1578833604	1	1	GEE, JONATHAN P MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115418	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
51065	Fee-for-Service	1689032815	1689032815	1	1	GHOTRA, JAGMOHAN K	6/12/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
51117	Fee-for-Service	1932167582	1932167582	1	1	GARCIA, MARTHA P MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53023	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
51186	Fee-for-Service	1376780015	1376780015	1	1	GONZALES, ERIC A CRNA	1/31/2025	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
51195	Fee-for-Service	1740299833	1740299833	2	1	GARVEY HEALTHY FAMILY	12/14/2015	207R00000X	NA	Other	026	PHYSICIANS	54127	40	Pediatrics	0	In state provider	MEDICAL CLINIC INC	705 E GARVEY AVE	None	MONTEREY PARK	CA	91755	3024	19	06037	34.0626543	-118.1127966	Los Angeles County
51211	Fee-for-Service	1629594197	1629594197	1	1	GILLIAM, GERREKA LMFT	6/24/2024	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
51221	Fee-for-Service	1265201990	1265201990	1	1	GALEN INPATIENT PHYSICIANS P	3/5/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3660	15	06029	35.76144847	-119.238912	Kern County
51222	Fee-for-Service	1972831790	1972831790	1	1	GURM, HARMEET S MD	6/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123671	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
51295	Fee-for-Service	1922000942	1922000942	1	1	GREENE, HUNTER S MD	5/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84651	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
51306	Fee-for-Service	1821039736	1821039736	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	861 NORTH VINE ST	None	HOLLYWOOD	CA	90038	3715	19	06037	34.086816	-118.326647	Los Angeles County
51336	Fee-for-Service	1184670317	1184670317	1	1	GREGORY BERMAN, M.D	4/4/2012	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
51359	Fee-for-Service	1902906555	1902906555	1	1	GENATO, SHARON F MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51792	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
51368	Fee-for-Service	1013927441	1013927441	1	1	GREENBERG, GREG A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86727	08	Family Practice	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
51389	Fee-for-Service	1174609689	1174609689	1	1	GORDON, CALVIN O MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	37360	40	Pediatrics	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
51468	Fee-for-Service	1023117553	1023117553	1	1	GEORGE C. IN.M.D.INC	10/20/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	500 S VIRGIL AVE	501	LOS ANGELES	CA	90020	1450	19	06037	34.064964	-118.2870335	Los Angeles County
51475	Fee-for-Service	1720443526	1720443526	2	1	GRADS, INC.	5/11/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	A	250 S G ST	None	SAN BERNARDINO	CA	92410	3320	36	06071	34.09693522	-117.2986838	San Bernardino County
51481	Fee-for-Service	1295869782	1295869782	1	1	GUZMAN, YELENA PSY	7/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24136	-	NOT APPLICABLE	0	In state provider	PSY	3580 WILSHIRE BLVD	STE 2000	LOS ANGELES	CA	90010	2521	19	06037	34.06170677	-118.302787	Los Angeles County
51483	Fee-for-Service	1740299833	1740299833	2	1	GARVEY HEALTHY FAMILY	12/14/2015	207R00000X	NA	Other	026	PHYSICIANS	54127	01	General Practice	0	In state provider	MEDICAL CLINIC INC	705 E GARVEY AVE	None	MONTEREY PARK	CA	91755	3024	19	06037	34.0626543	-118.1127966	Los Angeles County
51484	Fee-for-Service	1952934424	1952934424	1	1	GIBSON, SARAH L LCSW	11/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
51582	Fee-for-Service	1871234138	1871234138	1	1	GONZALEZ, EDDIE HERNANDEZ N	6/20/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	18092 WIKA ROAD	SUITE 220	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
51583	Fee-for-Service	1285735001	1285735001	1	1	GRIFFIN, CHARLES MD	1/31/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50626	30	Radiology	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
51603	Fee-for-Service	1427163930	1427163930	2	1	GALLAGHER, JAMES J MD	2/18/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52929	08	Family Practice	0	In state provider	None	268 GREEN VALLEY RD	None	FREEDOM	CA	95019	3139	44	06087	36.93810448	-121.7709537	Santa Cruz County
51605	Fee-for-Service	1144294927	1144294927	1	1	GILLILAND, DIANE MD	4/8/2024	207P00000X	NA	Other	026	PHYSICIANS	52865	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
51608	Fee-for-Service	1699826255	1699826255	1	1	GUILE, MATTHEW W MD	8/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108104	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1201 ALHAMBRA BLVD	STE 320	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
51645	Fee-for-Service	1720314487	1720314487	1	1	GHOTB, ALIREZA MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112887	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
51661	Fee-for-Service	1407884315	1407884315	1	1	GRIFFITH, JACK W DO	10/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9405	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
51666	Fee-for-Service	1083908396	1083908396	1	1	GHETMIRI, EHSAN MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127383	None	None	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
51675	Fee-for-Service	1386804508	1386804508	1	1	GHALY, RAMEZ A MD	10/20/2008	207L00000X	NA	Other	026	PHYSICIANS	96592	None	None	0	In state provider	None	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2653	19	06037	33.93112671	-118.2035532	Los Angeles County
51684	Fee-for-Service	1558383158	1558383158	2	1	GARFIELD BEACH CVS LLC	11/29/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2615 TUSCANY ST	None	CORONA	CA	92881	4631	33	06065	33.826887	-117.516447	Riverside County
51696	Fee-for-Service	1346552320	1346552320	1	1	GILPIN, MELANIE A PSYD	7/20/2023	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
51711	Fee-for-Service	1407177488	1407177488	1	1	GOUD, ASHA R MD	10/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104682	30	Radiology	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
51724	Fee-for-Service	1104860469	1104860469	1	1	GARFIELD BEACH CVS LLC	4/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1706 OCEANSIDE BLVD	None	OCEANSIDE	CA	92054	3454	37	06073	33.19180128	-117.3599108	San Diego County
51725	Fee-for-Service	1124028345	1124028345	1	1	GUIV, NILOUFAR MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73949	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
51726	Fee-for-Service	1114614013	1114614013	1	1	GOMEZ PADUA, MAYRA A PHD	4/26/2023	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
51749	Fee-for-Service	1174558407	1174558407	1	1	GOODMAN, MICHAEL P MD	4/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	31721	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1340 E COVELL BLVD	STE 102	DAVIS	CA	95616	1365	57	06113	38.5613113	-121.7344809	Yolo County
51777	Fee-for-Service	1679597827	1679597827	1	1	GO, SERGIO Y JR MD	10/4/2013	207L00000X	NA	Other	026	PHYSICIANS	50373	05	Anesthesiology	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
51786	Fee-for-Service	1972670891	1972670891	1	1	GARRIS, RICHARD F MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32171	01	General Practice	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
51790	Fee-for-Service	1073163119	1073163119	1	1	GENTLE HEART DAYCARE CENTER	3/5/2025	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1275 E HOLT AVENUE	None	POMONA	CA	91767	5817	19	06037	34.06304843	-117.7246195	Los Angeles County
51841	Fee-for-Service	1003933235	1003933235	1	1	GONG, SARAH H MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104681	13	Neurology (M.D. only)	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
51854	Fee-for-Service	1619302601	1619302601	1	1	GARFIELD BEACH CVS LLC	1/28/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2636 MARCONI AVE	None	SACRAMENTO	CA	95821	5106	34	06067	38.617254	-121.400541	Sacramento County
51855	Fee-for-Service	1871939447	1871939447	1	1	GRAHAM, MAYA S MD	2/10/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51858	Fee-for-Service	1639260292	1639260292	1	1	GILL, TIRATH S MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51319	36	Psychiatry	0	In state provider	None	8448 E ADAMS	None	FOWLER	CA	93625	9777	10	06019	36.63439504	-119.6378291	Fresno County
51861	Fee-for-Service	1255409512	1255409512	1	1	GORDON, DOUGLAS M DC	8/27/2018	111NS0005X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	20700 VENTURA BLVD	STE 130	WOODLAND HILLS	CA	91364	6277	19	06037	34.16687239	-118.5840442	Los Angeles County
51900	Fee-for-Service	1649697137	1649697137	1	1	GRANT, ANIKA J LMFT	8/11/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
51903	Fee-for-Service	1386647709	1386647709	1	1	GROSS, JERRY J MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	4868	41	Internal Medicine	0	In state provider	None	870 SHASTA ST	STE 300	YUBA CITY	CA	95991	4152	51	06101	39.14204	-121.6161711	Sutter County
51934	Fee-for-Service	1639128242	1639128242	1	1	GARRIS, JOEL B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29713	30	Radiology	0	In state provider	None	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	19	06037	34.01597577	-118.1003516	Los Angeles County
51944	Fee-for-Service	1700870912	1700870912	1	1	GLASSER, JUDD L MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73820	None	None	0	In state provider	None	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
51954	Fee-for-Service	1780771584	1780771584	1	1	GOEDERT, STEVEN L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1225 EUREKA WAY	STE A	REDDING	CA	96001	0815	45	06089	40.58819524	-122.3900343	Shasta County
51972	Fee-for-Service	1851061295	1851061295	1	1	GILLIAM, ALICIA S LCSW	9/29/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
51973	Fee-for-Service	1720047590	1720047590	1	1	GAUR, RAJAN MD	12/6/2007	207R00000X	NA	Other	026	PHYSICIANS	100938	38	Geriatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
51997	Fee-for-Service	1821176322	1821176322	1	1	GHOSH, ARADHANA MD	1/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96102	78	Neoplastic Diseases/Oncology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
52002	Fee-for-Service	1740202373	1740202373	2	1	GARFIELD BEACH CVS LLC	5/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2800 NAGLEE RD	None	TRACY	CA	95304	7307	39	06077	37.757484	-121.457916	San Joaquin County
52013	Fee-for-Service	1134288871	1134288871	1	1	GREWAL, RICKINDER S MD	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95224	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
52015	Fee-for-Service	1821029687	1821029687	1	1	GRASSELL, JAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63050	08	Family Practice	0	In state provider	None	414 G ST	STE 210	MARYSVILLE	CA	95901	5669	58	06115	39.13913942	-121.5934649	Yuba County
52035	Fee-for-Service	1710326806	1710326806	1	1	GAUTHIER, JUSTIN R PHD	3/2/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
52050	Fee-for-Service	1790715522	1790715522	1	1	GREGORY MASSOUD D.O.	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
52102	Fee-for-Service	1508861782	1508861782	1	1	GRAY, WADE J MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	72573	08	Family Practice	0	In state provider	None	480 MAIN STREET	None	MENDOCINO	CA	95460	0000	23	06045	39.30508226	-123.7986577	Mendocino County
52141	Fee-for-Service	1316171390	1316171390	1	1	GLOMB, NICOLAUS W MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142978	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
52197	Fee-for-Service	1073016853	1073016853	1	1	GUZMAN-URIZA, COLLEENA R MD	10/7/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	19441	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
52199	Fee-for-Service	1467263947	1467263947	1	1	GARCIA-HALLMAN, JESSICA E CD	2/25/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	1	Border provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	00	None	0	0	None
52206	Fee-for-Service	1518181866	1518181866	1	1	GRIMES, PETER F MD	8/31/1992	207P00000X	NA	Other	026	PHYSICIANS	75633	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
52220	Fee-for-Service	1184186314	1184186314	1	1	GIRALDO, ANDRES DO	8/1/2023	390200000X	NA	Other	026	PHYSICIANS	20893	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
52230	Fee-for-Service	1619029675	1619029675	1	1	GONG, HUI RONG	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3408 BALBOA ST	None	SAN FRANCISCO	CA	94121	2702	38	06075	37.77584268	-122.495397	San Francisco County
52250	Fee-for-Service	1295050243	1295050243	1	1	GROBMAN, YEVGENIY M MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136416	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
52260	Fee-for-Service	1720047590	1720047590	1	1	GAUR, RAJAN MD	12/6/2007	207R00000X	NA	Other	026	PHYSICIANS	100938	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
52267	Fee-for-Service	1720048507	1720048507	1	1	GONZALES, MICHELE M NP	5/18/2015	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
52300	Fee-for-Service	1538287289	1538287289	1	1	GRISEZ, KATHLEEN M LMFT	6/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
52304	Fee-for-Service	1457562688	1457562688	1	1	GARCIA, ELIZABETH LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	115 LOCUST ST	None	SANTA CRUZ	CA	95060	3907	44	06087	36.97519309	-122.027024	Santa Cruz County
52341	Fee-for-Service	1043470818	1043470818	1	1	GUPTA, REENA MD	7/21/2009	207R00000X	NA	Other	026	PHYSICIANS	104187	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
52375	Fee-for-Service	1194988451	1194988451	1	1	GRIAZUDE, RIMA K MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141845	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
52392	Fee-for-Service	1295901213	1295901213	1	1	GU, MELINDA M MD	5/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121060	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
52402	Fee-for-Service	1700014529	1700014529	1	1	GHURABI, RAFFI DO	11/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12210	None	None	0	In state provider	None	520 N PROSPECT AVE	SUITE 103	REDONDO BEACH	CA	90277	3033	19	06037	33.8529819	-118.3802954	Los Angeles County
52429	Fee-for-Service	1316171390	1316171390	1	1	GLOMB, NICOLAUS W MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142978	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
52500	Fee-for-Service	1538470562	1538470562	1	1	GAJJAR, ASHISH MD	1/22/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	145577	13	Neurology (M.D. only)	0	In state provider	None	3838 SAN DIMAS ST	SUITE A250	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
52541	Fee-for-Service	1518365998	1518365998	1	1	GORMAN, JODI NP	10/16/2020	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
52556	Fee-for-Service	1881784049	1881784049	1	1	GUTIERREZ, HUMBERTO A DO	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7232	08	Family Practice	0	In state provider	None	1111 W 6TH ST	FL 2	LOS ANGELES	CA	90017	1800	19	06037	34.05416748	-118.2622848	Los Angeles County
52576	Fee-for-Service	1124392113	1124392113	1	1	GREENE, DANIEL J MD	7/3/2018	208800000X	NA	Other	026	PHYSICIANS	154075	34	Urology and Urological Surgery	0	In state provider	None	1667 DOMINICAN WAY	STE 234	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
52654	Fee-for-Service	1225028913	1225028913	1	1	GRIJALVA, CINDY A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54556	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2100 WEBSTER ST	STE 319	SAN FRANCISCO	CA	94115	2377	38	06075	37.7904826	-122.4324477	San Francisco County
52673	Fee-for-Service	1659387595	1659387595	1	1	GUERRERO, MIGUEL L OD	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
52675	Fee-for-Service	1174940027	1174940027	1	1	GRADY, DEREK W MD	2/9/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182798	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
52681	Fee-for-Service	1407260672	1407260672	1	1	GASTON, JEFFREY D MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139663	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
52692	Fee-for-Service	1235240458	1235240458	1	1	GAO, MAHER MD	7/27/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166987	40	Pediatrics	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
52703	Fee-for-Service	1255147963	1255147963	1	1	GARVIN, PEIGHTON OT	1/3/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1251 E DYER RD	SUITE 150	SANTA ANA	CA	92705	5662	30	06059	33.70870351	-117.8551005	Orange County
52710	Fee-for-Service	1033577697	1033577697	1	1	GREEN-KROGMANN, ERIN R PHD	11/17/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
52718	Fee-for-Service	1235851965	1235851965	1	1	GEO REENTRY SERVICES, LLC	3/15/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1415 COURT ST	None	REDDING	CA	96001	1634	45	06089	40.58383071	-122.3959841	Shasta County
52740	Fee-for-Service	1477180420	1477180420	1	1	GREENBERG, DANIELLE C MD	8/8/2024	390200000X	NA	Other	026	PHYSICIANS	186947	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
52765	Fee-for-Service	1861437501	1861437501	1	1	GROSSMONT EMERGENCY MED	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
52799	Fee-for-Service	1013470384	1013470384	1	1	GLEBER, RYAN MD	4/22/2024	207P00000X	NA	Other	026	PHYSICIANS	181277	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3330 LOMITA	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
52813	Fee-for-Service	1477788131	1477788131	1	1	GARDUNO, MARIA	5/29/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11105 KNOTT AVE	STE B	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
52835	Fee-for-Service	1932581295	1932581295	1	1	GHAYOUMI, POURIYA MD	5/20/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	148106	None	None	0	In state provider	None	1901 W LUGONIA AVE	STE 120	REDLANDS	CA	92374	9704	36	06071	34.07027851	-117.218421	San Bernardino County
52891	Fee-for-Service	1982667572	1982667572	1	1	GOYAL, MADHU MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	34653 US HIGHWAY 19 N	None	PALM HARBOR	FL	34684	2152	00	None	28.08695904	-82.73928993	Pinellas County
52909	Fee-for-Service	1497920938	1497920938	1	1	GEHLING, DANIEL J MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10359	20	Orthopedic Surgery	0	In state provider	None	2826 HARRIS ST	None	EUREKA	CA	95503	4809	12	06023	40.78047614	-124.1355056	Humboldt County
52944	Fee-for-Service	1588184055	1588184055	1	1	GOMEZ RINCON, MARIANELA MD	7/14/2023	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	169505	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
52956	Fee-for-Service	1609167139	1609167139	1	1	GRIMALDO, FELIPE H JR MD	12/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138202	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
52959	Fee-for-Service	1992974737	1992974737	1	1	GARCIA, KIARA M 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
52964	Fee-for-Service	1437655024	1437655024	1	1	GILL, EVANPAUL MD	7/29/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	173438	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2335 E KASHIAN LANE	SUITE 260	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
52977	Fee-for-Service	1467779637	1467779637	1	1	GUPTA, JITESH PT	2/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
52992	Fee-for-Service	1679779060	1679779060	1	1	GLEN, CLARISSE J MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149746	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
52995	Fee-for-Service	1609885714	1609885714	1	1	GIORGI, LOUIS JR MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	65765	34	Urology and Urological Surgery	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
53062	Fee-for-Service	1114458114	1114458114	1	1	GRASSINI, MOLLY C MD	9/8/2021	207P00000X	NA	Other	026	PHYSICIANS	157859	None	None	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	0000	19	06037	34.158213	-118.328112	Los Angeles County
53073	Fee-for-Service	1114168879	1114168879	1	1	GHASAN M TABEL MD INC	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88852	41	Internal Medicine	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
53109	Fee-for-Service	1912963364	1912963364	1	1	GLENDALE INT MED & CARD	1/1/1979	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MED GRP INC	500 NORTH CENTRAL AVENUE	SUITE 800	GLENDALE	CA	91203	3345	19	06037	34.15321627	-118.2578985	Los Angeles County
53134	Fee-for-Service	1104921840	1104921840	1	1	GREENSIDES, ROBERT D MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (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
53151	Fee-for-Service	1841368305	1841368305	1	1	GROSU, SIMONA OD	4/18/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND BLVD	SUITE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
53154	Fee-for-Service	1316585847	1316585847	1	1	GUARDIAN ANGEL HOME CARE OF	4/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SANTA ANA LLC	2030 E 4TH STREET	SUITE 132	SANTA ANA	CA	92705	3940	30	06059	33.74808045	-117.8378273	Orange County
53171	Fee-for-Service	1699098145	1699098145	1	1	GOLETZ, JEFFREY T MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130058	30	Radiology	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
53172	Fee-for-Service	1659456887	1659456887	1	1	GERHARDT, ANN L MD	7/16/2007	207R00000X	NA	Other	026	PHYSICIANS	56285	10	Gastroenterology (M.D. only)	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
53214	Fee-for-Service	1790915759	1790915759	1	1	GOMEZ, JUANITA PHD	7/5/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
53246	Fee-for-Service	1831277557	1831277557	1	1	GASSNER, HEIDI L MD	4/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73065	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
53253	Fee-for-Service	1437655024	1437655024	1	1	GILL, EVANPAUL MD	7/29/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	173438	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 260	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
53267	Fee-for-Service	1477539252	1477539252	1	1	GRAY, SHARMANE M MD	8/12/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	132774	None	None	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
53284	Fee-for-Service	1407679194	1407679194	1	1	GALEN INPATIENT PHYSICIANS P	12/18/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	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
53408	Fee-for-Service	1912192014	1912192014	1	1	GHASEMLOEI, HOMA MD	4/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101315	08	Family Practice	0	In state provider	None	6830 RESEDA BLVD	None	RESEDA	CA	91335	4204	19	06037	34.19499052	-118.5360141	Los Angeles County
53409	Fee-for-Service	1720114093	1720114093	1	1	GADDIPATI, KISHORE V MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111638	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
53413	Fee-for-Service	1710065594	1710065594	1	1	GUTIERREZ, JORGE A JR MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68605	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
53479	Fee-for-Service	1659412757	1659412757	1	1	GABAYAN, AFSHIN ELI MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55613	None	None	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
53507	Fee-for-Service	1982246575	1982246575	1	6	GOLDEN STATE HEART & VASCULA	8/27/2024	174400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	R ASSOCIATES	1174 CASTRO ST	SUITE 200	MOUNTAIN VIEW	CA	94040	2568	43	06085	37.3822628	-122.0861276	Santa Clara County
53521	Fee-for-Service	1780188631	1780188631	1	1	GONZALEZ, HECTOR D OD APC	5/22/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2524 S FIGUEROA ST	None	LOS ANGELES	CA	90007	2549	19	06037	34.02828035	-118.2748681	Los Angeles County
53525	Fee-for-Service	1487124715	1487124715	1	1	GORCZYNSKI, SARA R PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
53533	Fee-for-Service	1326417536	1326417536	1	1	GEORGE, CLARA M NP	11/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
53572	Fee-for-Service	1407679194	1407679194	1	1	GALEN INPATIENT PHYSICIANS P	12/18/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
53596	Fee-for-Service	1124062013	1124062013	1	1	GRAY, MARY O MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64546	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
53637	Fee-for-Service	1982344651	1982344651	1	1	GURU, AMREEN CNP	5/12/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8101 GREENBACK LN	None	FAIR OAKS	CA	95628	2502	34	06067	38.679237	-121.261662	Sacramento County
53639	Fee-for-Service	1770886251	1770886251	1	1	GRACE WANJIRU	3/14/2011	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3378 NIMES LANE	None	RIVERSIDE	CA	92503	8906	33	06065	33.92170338	-117.4273151	Riverside County
53650	Fee-for-Service	1982246575	1982246575	1	1	GOLDEN STATE HEART & VASCULA	6/19/2020	2471C1101X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	ENTER, INC.	2 LOWER RAGSDALE	160	MONTEREY	CA	93940	5748	27	06053	36.5766066	-121.8193801	Monterey County
53653	Fee-for-Service	1689978496	1689978496	1	1	GUIGLIANO, AMY L MD	7/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113721	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
53700	Fee-for-Service	1710065594	1710065594	1	1	GUTIERREZ, JORGE A JR MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68605	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
53721	Fee-for-Service	1952083784	1952083784	1	1	GUIDED TRANSITIONS MARRIAGE	11/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AND FAMILY COUNSELING	16041 KAMANA RD	STE A	APPLE VALLEY	CA	92307	1331	36	06071	34.54277199	-117.2713892	San Bernardino County
53781	Fee-for-Service	1790947331	1790947331	1	1	GARCIA, PATRICIA MD	11/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151401	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
53785	Fee-for-Service	1972585313	1972585313	1	1	GOODING, ISSAC A MD	11/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80592	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
53788	Fee-for-Service	1093000341	1093000341	1	1	GUSTAFSON, LISA A NP	9/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
53800	Fee-for-Service	1598840373	1598840373	1	1	GORDON,GARET 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	111 E 210TH ST	None	BRONX	NY	10469	2401	00	None	40.879872	-73.8798975	Bronx County
53842	Fee-for-Service	1629120092	1629120092	1	1	GARAY, NELA MD	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62561	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
53860	Fee-for-Service	1407679194	1407679194	1	1	GALEN INPATIENT PHYSICIANS P	3/5/2025	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
53864	Fee-for-Service	1295141505	1295141505	1	1	GOYAL, VIVEK MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149321	41	Internal Medicine	0	In state provider	None	3000 Q ST	FL 3	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
53890	Fee-for-Service	1043248297	1043248297	1	1	GOLDBERG,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	15225 SHADY GROVE RD	STE 201	ROCKVILLE	MD	20850	3278	00	None	39.10706489	-77.18961474	Montgomery County
53929	Fee-for-Service	1770886251	1770886251	1	1	GRACE WANJIRU	3/14/2011	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3378 NIMES LANE	None	RIVERSIDE	CA	92503	8906	33	06065	33.92170338	-117.4273151	Riverside County
53953	Fee-for-Service	1710067673	1710067673	1	1	GASTROINTESTINAL HEALTHCARE	11/8/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	OF ORANGE COUNTY, INC.	26691 PLAZA	150	MISSION VIEJO	CA	92691	6329	30	06059	33.56533763	-117.6645538	Orange County
53959	Fee-for-Service	1235206160	1235206160	1	1	GRYPMA, LYDIA M MD	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49235	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
53963	Fee-for-Service	1013065002	1013065002	1	1	GUZMAN, ERWIN MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70779	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
53977	Fee-for-Service	1023233400	1023233400	1	1	GUSTAFSON, ERIC A MD	3/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98818	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
53995	Fee-for-Service	1811014715	1811014715	1	1	GOR, ANITA OD	4/10/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	36 W YOKUTS AVE	STE 1	STOCKTON	CA	95207	5713	39	06077	37.99833959	-121.3074229	San Joaquin County
54003	Fee-for-Service	1376628032	1376628032	1	1	GREENBERG, ROBERT M MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79081	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
54023	Fee-for-Service	1457977209	1457977209	1	1	GENVIEW DIAGNOSIS INC	12/27/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	5252 HOLLISTER ST	520	HOUSTON	TX	77040	6214	00	None	29.84322762	-95.50620734	Harris County
54036	Fee-for-Service	1487732129	1487732129	1	1	GARCIA, GORDON S MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64869	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
54081	Fee-for-Service	1407813322	1407813322	1	2	GONZALEZ, HECTOR A MD	12/15/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	50580	-	NOT APPLICABLE	0	In state provider	None	5723 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3024	19	06037	34.01838548	-118.1475832	Los Angeles County
54114	Fee-for-Service	1730405440	1730405440	1	1	GVOZDYEV, BORYS MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144225	20	Orthopedic Surgery	0	In state provider	None	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4045	30	06059	33.714	-117.9333585	Orange County
54122	Fee-for-Service	1477752681	1477752681	1	1	GORDON MARION BUTLER, M.D	1/9/2012	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	0001	00	None	32.812245	-96.841584	Dallas County
54128	Fee-for-Service	1811946692	1811946692	1	1	GONZALEZ, JUAN M G MD	10/31/1982	207P00000X	NA	Other	026	PHYSICIANS	33385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
54138	Fee-for-Service	1063640738	1063640738	1	3	GOLDEN GATE UROLOGY INC	12/1/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2999 REGENT ST	#612	BERKELEY	CA	94705	2121	01	06001	37.85592021	-122.2566436	Alameda County
54156	Fee-for-Service	1710037684	1710037684	1	1	GWIAZDOWSKI, STEVEN G MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68324	40	Pediatrics	0	In state provider	NORTH BAY NEONATOLOGY	1860 PENNSYLVANIA AVE	STE 145	FAIRFIELD	CA	94533	3547	48	06095	38.261952	-122.0498745	Solano County
54187	Fee-for-Service	1730123001	1730123001	1	1	GARFIELD BEACH CVS, LLC	12/13/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1607	19	06037	34.02025092	-117.8093263	Los Angeles County
54190	Fee-for-Service	1659808384	1659808384	1	1	GRAIFMAN, TREVOR J DO	9/20/2023	207L00000X	NA	Other	026	PHYSICIANS	19447	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
54217	Fee-for-Service	1023199890	1023199890	1	1	GAHRAHMAT, LEYLA MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81339	08	Family Practice	0	In state provider	None	240 SPRUCE ST	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
54239	Fee-for-Service	1285393975	1285393975	1	1	GOMEZ KNUPP, JOANNE RN BS	1/17/2023	163WP1700X	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
54241	Fee-for-Service	1659662351	1659662351	1	1	G & C SWAN INC	1/22/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	239 W 9TH STREET	None	UPLAND	CA	91786	5979	36	06071	34.09609546	-117.6542685	San Bernardino County
54278	Fee-for-Service	1043956485	1043956485	1	1	GOLDEN HORIZON SENIOR CARE	1/19/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	1524 S EUCLID AVE	None	ONTARIO	CA	91762	5821	36	06071	34.045875	-117.6513525	San Bernardino County
54291	Fee-for-Service	1851658124	1851658124	1	1	GRAHAM, KATHLEEN W DO	12/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13332	01	General Practice	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
54300	Fee-for-Service	1972749919	1972749919	1	1	GALLEGOS, ALEX LMFT	7/17/2024	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
54324	Fee-for-Service	1699740456	1699740456	1	1	GALLAGHER, GARY OD	8/10/2011	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3080 VICTOR AVE	None	REDDING	CA	96002	1449	45	06089	40.562622	-122.3395155	Shasta County
54341	Fee-for-Service	1053420745	1053420745	1	1	GARCIA, ALFREDO M MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69814	40	Pediatrics	0	In state provider	None	610 W YOSEMITE AVE	None	MADERA	CA	93637	4523	20	06039	36.95738363	-120.0661469	Madera County
54380	Fee-for-Service	1518423631	1518423631	1	1	GILL PHARMACY INC	4/12/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12648 BENTLEY ST	None	WATERFORD	CA	95386	9009	50	06099	37.64105958	-120.7606132	Stanislaus County
54423	Fee-for-Service	1407389265	1407389265	1	1	GOMEZ, GRICELDA MD	12/5/2022	208800000X	NA	Other	026	PHYSICIANS	182688	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
54426	Fee-for-Service	1699727347	1699727347	1	1	GREBENC, MARY L MD	8/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87233	30	Radiology	0	In state provider	None	5555 GROSSMONT CENTER DR	# 1A	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
54441	Fee-for-Service	1326514746	1326514746	1	1	GASTRO CARE INSTITUTE	6/4/2019	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	43944 15TH ST	201	LANCASTER	CA	93534	5207	19	06037	34.681626	-118.1566845	Los Angeles County
54446	Fee-for-Service	1659730778	1659730778	1	1	GARCIA, TEDAYSHIA P NP	3/30/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
54484	Fee-for-Service	1922427368	1922427368	1	1	GUPTA, NACHIKETA MD	8/17/2021	207P00000X	NA	Other	026	PHYSICIANS	170060	None	None	0	In state provider	None	347 ANDRIEUX STREET	None	SONOMA	CA	95476	6811	49	06097	38.28843573	-122.4651035	Sonoma County
54488	Fee-for-Service	1932951308	1932951308	1	1	GRAND TCM HEALING ACUPUNCTUR	4/15/2024	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	E INC	1351 HARRISON ST	None	SAN FRANCISCO	CA	94103	4334	38	06075	37.77196189	-122.4107316	San Francisco County
54493	Fee-for-Service	1598760266	1598760266	1	1	GUTH, DIANA S	12/21/1998	No Taxonomy Provided	NA	None	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2370 WESTWOOD BLVD	STE D	LOS ANGELES	CA	90064	2120	19	06037	34.0408993	-118.4291065	Los Angeles County
54542	Fee-for-Service	1174690481	1174690481	1	1	GANETSOS, BETH A CRNA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
54568	Fee-for-Service	1245337302	1245337302	1	1	GOODING, JUSTIN M MD	1/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	78989	None	None	0	In state provider	None	480 4TH AVE	STE 102	CHULA VISTA	CA	91910	4411	37	06073	32.63411298	-117.0816772	San Diego County
54612	Fee-for-Service	1699740456	1699740456	1	1	GALLAGHER, GARY OD	2/23/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3080 VICTOR AVE	None	REDDING	CA	96002	1449	45	06089	40.562622	-122.3395155	Shasta County
54613	Fee-for-Service	1164487989	1164487989	1	1	GONZALES, RALPH MD	12/2/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75629	66	Emergency Medicine (Urgent Care)	0	In state provider	PERMANENTE MEDICAL GROUP	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
54652	Fee-for-Service	1447330477	1447330477	1	1	GILMAN & VORSTER	7/15/2008	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY, INC	81800 DR CARREON BLVD	SUITE B	INDIO	CA	92201	5595	33	06065	33.70743053	-116.2372995	Riverside County
54665	Fee-for-Service	1285712034	1285712034	1	1	GOLDBERG, MARTIN G MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	34616	05	Anesthesiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
54679	Fee-for-Service	1336502269	1336502269	1	1	GOMEZ, SARAH T MD	8/9/2019	207P00000X	NA	Other	026	PHYSICIANS	162779	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
54686	Fee-for-Service	1982831376	1982831376	1	1	GARELL, CAMBRIA L MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116075	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
54688	Fee-for-Service	1689840233	1689840233	1	1	GREENFIELD, JENNA G. ND	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
54695	Fee-for-Service	1811144561	1811144561	1	1	GHODADRA, NEILESH S MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116163	20	Orthopedic Surgery	0	In state provider	None	6815 NOBLE AVE	None	VAN NUYS	CA	91405	3796	19	06037	34.19440435	-118.461871	Los Angeles County
54709	Fee-for-Service	1184041634	1184041634	1	1	GOOCH, MEGAN M MD	9/8/2021	163WP0218X	NA	Other	026	PHYSICIANS	156495	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
54721	Fee-for-Service	1932122371	1932122371	1	1	GRACE MEDICAL SUPPLY INC	11/16/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	18919 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2942	19	06037	33.98767704	-117.8912613	Los Angeles County
54723	Fee-for-Service	1861612665	1861612665	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	207Q00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DOS PALOS	1405 CALIFORNIA AVE	None	DOS PALOS	CA	93620	2300	24	06047	36.98665246	-120.6290163	Merced County
54732	Fee-for-Service	1932287489	1932287489	1	1	GALE, JONATHAN P DO INC	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8632	08	Family Practice	0	In state provider	None	40700 CALIFORNIA OAKS RD	STE 207	MURRIETA	CA	92562	5789	33	06065	33.57067363	-117.2045035	Riverside County
54745	Fee-for-Service	1972632750	1972632750	1	1	GROPPETTI, LORA A MFT	2/11/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3075 CITRUS CIR	STE 165	WALNUT CREEK	CA	94598	2669	07	06013	37.92928071	-122.0135447	Contra Costa County
54789	Fee-for-Service	1992867501	1992867501	1	1	GOLDSTONE, JOEL B LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
54805	Fee-for-Service	1336397330	1336397330	2	1	GARFIELD BEACH CVS LLC	6/2/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12795 MAIN ST	None	HESPERIA	CA	92345	9110	36	06071	34.424496	-117.383643	San Bernardino County
54825	Fee-for-Service	1932653797	1932653797	1	1	GALL, JACQUELINE CA	8/22/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	121927	-	NOT APPLICABLE	0	In state provider	None	34 PRADO RD	None	SAN LUIS OBISPO	CA	93401	7313	40	06079	35.25596696	-120.6723865	San Luis Obispo County
54845	Fee-for-Service	1912087263	1912087263	1	1	GARCIA-PRATS, JOSEPH A MD	12/1/2020	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
54856	Fee-for-Service	1699853259	1699853259	1	1	GALITZ, ALAN M MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52588	01	General Practice	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
54858	Fee-for-Service	1013387182	1013387182	1	1	GALLI, KELLEEN NP	3/10/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
54899	Fee-for-Service	1164487989	1164487989	1	1	GONZALES, RALPH MD	12/2/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75629	04	Otology, Laryngology, Rhinology	0	In state provider	PERMANENTE MEDICAL GROUP	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
54976	Fee-for-Service	1831445808	1831445808	1	1	GRIMM, LAUREL J MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116992	01	General Practice	0	In state provider	None	1441 CONSTITUTION BLVD.	None	SALINAS	CA	93912	3195	27	06053	36.696987	-121.633164	Monterey County
54983	Fee-for-Service	1003881798	1003881798	1	1	GUISTO, 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	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
54996	Fee-for-Service	1588802144	1588802144	1	1	GOOD SAVIOR LLC	8/27/2015	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8205 SOMERSET BLVD	None	PARAMOUNT	CA	90723	3518	19	06037	33.89648848	-118.155843	Los Angeles County
55002	Fee-for-Service	1487158911	1487158911	1	1	GOLDRING, ANNE E MD	9/25/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	190064	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
55004	Fee-for-Service	1295171866	1295171866	1	1	GUNASEKARAN, KULOTHUNGAN MD	3/29/2024	207RC0200X	NA	Other	026	PHYSICIANS	179278	None	None	0	In state provider	None	1100 N PALM CANYON DR	SUITE 203	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
55012	Fee-for-Service	1861612665	1861612665	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DOS PALOS	1405 CALIFORNIA AVE	None	DOS PALOS	CA	93620	2300	24	06047	36.98665246	-120.6290163	Merced County
55053	Fee-for-Service	1518019967	1518019967	1	1	GONZALES, MARIA JUANA LMFT	10/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
55076	Fee-for-Service	1598151524	1598151524	1	1	GENTLE TOUCH HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15600 DEVONSHIRE ST	SUITE 202	GRANADA HILLS	CA	91344	7242	19	06037	34.25730352	-118.473084	Los Angeles County
55138	Fee-for-Service	1922665694	1922665694	1	1	GERLACH, ANGELA D AU	2/21/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
55167	Fee-for-Service	1023495975	1023495975	1	1	GRUBBS, JUSTIN C MD	5/5/2023	207L00000X	NA	Other	026	PHYSICIANS	167111	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
55179	Fee-for-Service	1588740005	1588740005	1	1	GIFFORD, MICHAEL E MD	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84494	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55205	Fee-for-Service	1174601827	1174601827	1	1	GLOVER, ARTHUR T MD	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65863	18	Ophthalmology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
55214	Fee-for-Service	1023058476	1023058476	1	1	GRANDHE, JANARDHAN R MD	6/28/2009	207LP2900X	NA	Other	026	PHYSICIANS	52798	05	Anesthesiology	0	In state provider	None	3611 STOCKDALE HWY	STE B	BAKERSFIELD	CA	93309	2193	15	06029	35.35409649	-119.044332	Kern County
55220	Fee-for-Service	1316232010	1316232010	1	1	GAFFEY, ANN C MD	12/14/2021	208600000X	NA	General Surgery	026	PHYSICIANS	175295	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
55222	Fee-for-Service	1811233778	1811233778	1	1	GANTES, VANESSA PSYD	4/30/2021	101YM0800X	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
55248	Fee-for-Service	1215982855	1215982855	1	1	GONG, HENRY P MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43569	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2220 GLADSTONE DR	STE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
55328	Fee-for-Service	1952753907	1952753907	1	1	GARRIDO, BRIAN E MD	10/28/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162371	40	Pediatrics	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
55366	Fee-for-Service	1598151524	1598151524	1	1	GENTLE TOUCH HOSPICE INC	10/26/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15600 DEVONSHIRE ST	SUITE 202	GRANADA HILLS	CA	91344	7242	19	06037	34.25730352	-118.473084	Los Angeles County
55368	Fee-for-Service	1235240987	1235240987	1	1	GREENWALD, DANIEL R MD	9/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75508	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
55372	Fee-for-Service	1841378916	1841378916	1	1	GIBBS, MICHAEL A MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	46830	66	Emergency Medicine (Urgent Care)	0	In state provider	SUITE 106	1850 PENNSYLVANIA AVE	None	FAIRFIELD	CA	94533	3515	48	06095	38.26176599	-122.049827	Solano County
55399	Fee-for-Service	1902268220	1902268220	1	1	GUARDIAN PHARMACY OF SOUTHER	7/22/2016	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	N CALIFORNIA LLC	10121 CARROLL CANYON ROA	None	SAN DIEGO	CA	92131	1109	37	06073	32.902776	-117.107208	San Diego County
55401	Fee-for-Service	1487093969	1487093969	2	1	GRINAGE, EGBERT F MD	3/2/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	3001 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1114	00	None	42.25288307	-121.7896138	Klamath County
55403	Fee-for-Service	1881230514	1881230514	1	1	GUARDIAN ANGEL HOME CARE OF	4/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	FRESNO LLC	1100 W SHAW AVE	STE 130	FRESNO	CA	93711	3708	10	06019	36.80852149	-119.811303	Fresno County
55432	Fee-for-Service	1205107489	1205107489	1	1	GRIFFIN, WILLIAM M MD PC	6/4/2012	193400000X	NA	Other	026	PHYSICIANS	65062	30	Radiology	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
55439	Fee-for-Service	1346394459	1346394459	1	1	GUZIEL & SCHOENFELD	10/6/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	NEPHROLOGY & INTERNAL	7230 MEDICAL CENTER DR	SUITE 205	WEST HILLS	CA	91307	4007	19	06037	34.20172814	-118.6294322	Los Angeles County
55472	Fee-for-Service	1710968219	1710968219	1	1	GOBB, PATRICK 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	2900 12TH AVE N	STE 160W	BILLINGS	MT	59101	7508	00	None	45.792225	-108.518706	Yellowstone County
55483	Fee-for-Service	1194292763	1194292763	1	1	GUTIERREZ, VANESSA I CNP	3/7/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
55486	Fee-for-Service	1710406707	1710406707	1	1	GUARDIAN FLIGHT LLC	4/29/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1212 E ATLANTIC ST	None	HANCOCK	MI	49930	1415	00	None	47.12910667	-88.60145065	Houghton County
55508	Fee-for-Service	1447314729	1447314729	1	1	GREENE, KRISTI	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
55514	Fee-for-Service	1770048738	1770048738	1	1	GOLDEN SEASONS HOSPICE INC	9/22/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3089 N LIMA ST	SUITE A	BURBANK	CA	91504	2013	19	06037	34.206192	-118.346528	Los Angeles County
55516	Fee-for-Service	1285988386	1285988386	1	2	GELLER, OLENA A PSYD	6/19/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
55534	Fee-for-Service	1215982855	1215982855	1	1	GONG, HENRY P MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	43569	41	Internal Medicine	0	In state provider	None	2220 GLADSTONE DR	STE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
55536	Fee-for-Service	1104839620	1104839620	1	1	GENDELMAN, ARKADY MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75922	08	Family Practice	0	In state provider	None	1375 SUTTER ST	STE 201	SAN FRANCISCO	CA	94109	5438	38	06075	37.78738239	-122.4229066	San Francisco County
55560	Fee-for-Service	1982880894	1982880894	1	1	GANDHI, BHERU B MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108563	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
55570	Fee-for-Service	1760837009	1760837009	1	1	GAO, YUQING A MD	7/14/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	187222	None	None	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
55592	Fee-for-Service	1295903334	1295903334	1	1	GABALDON, MONICA P MD	1/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95908	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
55595	Fee-for-Service	1942521653	1942521653	1	1	GIBANI, SIRAJ M MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141014	14	Neurological Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
55604	Fee-for-Service	1598178329	1598178329	1	1	GAO, JINGYUN MD	8/1/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	179320	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
55655	Fee-for-Service	1235240987	1235240987	1	1	GREENWALD, DANIEL R MD	9/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75508	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
55663	Fee-for-Service	1841378916	1841378916	1	1	GIBBS, MICHAEL A MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	46830	13	Neurology (M.D. only)	0	In state provider	SUITE 106	1850 PENNSYLVANIA AVE	None	FAIRFIELD	CA	94533	3515	48	06095	38.26176599	-122.049827	Solano County
55683	Fee-for-Service	1992905871	1992905871	1	1	GARFIAS, DENIA A MD	5/7/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	96370	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
55705	Fee-for-Service	1477097228	1477097228	1	1	GABRIEL, KATRIN A	10/25/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
55714	Fee-for-Service	1619164159	1619164159	1	1	GARCIGA, SYLVIA	10/5/2009	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 WEST 6TH ST	SUITE 111	LOS ANGELES	CA	90017	1823	19	06037	34.05416748	-118.2622848	Los Angeles County
55726	Fee-for-Service	1346394459	1346394459	1	1	GUZIEL & SCHOENFELD	10/6/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	NEPHROLOGY & INTERNAL	7230 MEDICAL CENTER DR	SUITE 205	WEST HILLS	CA	91307	4007	19	06037	34.20172814	-118.6294322	Los Angeles County
55802	Fee-for-Service	1770048738	1770048738	1	1	GOLDEN SEASONS HOSPICE INC	9/22/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3089 N LIMA ST	SUITE A	BURBANK	CA	91504	2013	19	06037	34.206192	-118.346528	Los Angeles County
55821	Fee-for-Service	1619949872	1619949872	1	1	GAMACHE, 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	1200 1ST AVE E	None	SPENCER	IA	51301	4342	00	None	43.14997136	-95.1438297	Clay County
55829	Fee-for-Service	1053602151	1053602151	1	1	GREEN, CHERYL L MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141366	36	Psychiatry	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
55852	Fee-for-Service	1043239015	1043239015	1	1	GAITONDE, SATISH S PT	6/6/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1723 27TH ST	None	BAKERSFIELD	CA	93301	2807	15	06029	35.38383629	-119.0218323	Kern County
55897	Fee-for-Service	1508362856	1508362856	1	1	GENESIS HEALTHCARE PRODUCTS,	3/2/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC.	830 E VISTA WAY	113	VISTA	CA	92084	5216	37	06073	33.21010765	-117.2343677	San Diego County
55943	Fee-for-Service	1639330954	1639330954	1	1	GHANDFOROUSH, ASLAN T DO	7/21/2015	333600000X	NA	Pharmacies	026	PHYSICIANS	13941	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
55953	Fee-for-Service	1740486471	1740486471	1	1	GUZMAN-MARIN, RUBEN MD	6/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110471	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
56012	Fee-for-Service	1265639579	1265639579	1	1	GIEL, ANNE L LMFT	11/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	341 BROADWAY	SUITE 323	CHICO	CA	95928	5345	04	06007	39.72853436	-121.8398597	Butte County
56077	Fee-for-Service	1932734217	1932734217	1	1	GOLDEN GATE TRANZ	11/25/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7004 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2715	19	06037	34.24782716	-118.2836619	Los Angeles County
56111	Fee-for-Service	1215399639	1215399639	1	1	GONZALEZ GALLARDO, KELVIS MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157046	01	General Practice	0	In state provider	None	1101 N CHERRY STREET	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
56129	Fee-for-Service	1861491250	1861491250	1	1	GUZALO, ERICA A MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86522	30	Radiology	0	In state provider	None	24401 CALLE DE LA LOUISA	STE 200	LAGUNA HILLS	CA	92653	3624	30	06059	33.60941999	-117.7083212	Orange County
56138	Fee-for-Service	1619006954	1619006954	1	1	GEARHART, LORIE A MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	97994	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
56223	Fee-for-Service	1376640045	1376640045	1	1	GOWDY, KENNETH L MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137083	05	Anesthesiology	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
56230	Fee-for-Service	1760132799	1760132799	1	1	GUPTA, ARPITA MD	3/13/2025	2279E0002X	NA	Other	026	PHYSICIANS	187810	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
56231	Fee-for-Service	1639330954	1639330954	1	1	GHANDFOROUSH, ASLAN T DO	7/21/2015	333600000X	NA	Pharmacies	026	PHYSICIANS	13941	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
56234	Fee-for-Service	1578641650	1578641650	1	1	GHIAMI, ELIZABETH P MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91006	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
56283	Fee-for-Service	1033580931	1033580931	1	1	GETTYSBURG MEDICAL CLINIC IN	10/1/2019	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1130 COFFEE RD	BUILDING 10	MODESTO	CA	95355	4228	50	06099	37.65884948	-120.9755938	Stanislaus County
56316	Fee-for-Service	1841871852	1841871852	1	1	GOBRAN, ANTHONY M MD	6/14/2023	390200000X	NA	Other	026	PHYSICIANS	184107	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
56319	Fee-for-Service	1366561573	1366561573	1	1	GEORGE J NIXON	1/11/2013	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1113 TEXAS ST	None	FAIRFIELD	CA	94533	5745	48	06095	38.2492245	-122.0475915	Solano County
56321	Fee-for-Service	1467410522	1467410522	1	1	GALINDO, CECILIA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65655	41	Internal Medicine	0	In state provider	None	650 S ZEDIKER AVE	None	PARLIER	CA	93648	2639	10	06019	36.60500164	-119.5210273	Fresno County
56346	Fee-for-Service	1538367115	1538367115	1	1	GLOBAL DOCTORS MEDICAL	9/24/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	1617 E 1ST ST	STE A	SANTA ANA	CA	92701	6385	30	06059	33.74616534	-117.8462414	Orange County
56368	Fee-for-Service	1801000542	1801000542	1	1	GABAL-SHEHAB LAMIA L MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61924	34	Urology and Urological Surgery	0	In state provider	None	720 N TUSTIN AVE	STE 101	SANTA ANA	CA	92705	3606	30	06059	33.75168221	-117.8342151	Orange County
56375	Fee-for-Service	1457697971	1457697971	1	1	GUPTA, PRIYANKA MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138055	41	Internal Medicine	0	In state provider	None	4053 LONE TREE WAY	SUITE 101	ANTIOCH	CA	94521	6210	07	06013	37.97569499	-121.800733	Contra Costa County
56377	Fee-for-Service	1538427638	1538427638	1	1	GOERZEN, RACHEL DO	12/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	13062	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
56378	Fee-for-Service	1649561382	1649561382	1	1	GOMEZ, GABRIEL MD	7/6/2017	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	148286	04	Otology, Laryngology, Rhinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
56387	Fee-for-Service	1285988386	1285988386	1	1	GELLER, OLENA A PSYD	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21467	-	NOT APPLICABLE	0	In state provider	None	1111 MARKET STREET	None	SAN FRANCISCO	CA	94103	1513	38	06075	37.78018987	-122.4128297	San Francisco County
56426	Fee-for-Service	1033288204	1033288204	1	2	GRAUSZ, BRADLEY I DO	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	235 W 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
56427	Fee-for-Service	1053935817	1053935817	1	1	GUERRERO, MARLENE C NP	7/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
56460	Fee-for-Service	1942706676	1942706676	1	1	GHAVAMI, BABAK MD	2/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174251	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
56461	Fee-for-Service	1730110487	1730110487	1	1	GHUMAN, TEJINDER P MD	7/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39001	40	Pediatrics	0	In state provider	None	481 PLUMAS BLVD	None	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
56518	Fee-for-Service	1760132799	1760132799	1	1	GUPTA, ARPITA MD	3/13/2025	2279E0002X	NA	Other	026	PHYSICIANS	187810	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
56523	Fee-for-Service	1457906281	1457906281	1	1	GARFIELD BEACH CVS LLC	11/6/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6865 HOLLISTER AVE	None	GOLETA	CA	93117	3017	42	06083	34.43008512	-119.8682063	Santa Barbara County
56535	Fee-for-Service	1013900737	1013900737	1	1	GRANDAW, PETER P MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79712	40	Pediatrics	0	In state provider	None	1892 BUENAVENTURA BLVD	None	REDDING	CA	96001	3761	45	06089	40.55575496	-122.3943712	Shasta County
56544	Fee-for-Service	1679615439	1679615439	1	1	GUILLERMO, CARMEN R	7/1/1998	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	HEARING PATHWAYS	1115 COTTONWOOD ST	None	WOODLAND	CA	95695	4318	57	06113	38.666277	-121.7933425	Yolo County
56619	Fee-for-Service	1407871569	1407871569	1	1	GAMBLE, PAUL N MD	1/31/1988	207R00000X	NA	Other	026	PHYSICIANS	57051	01	General Practice	0	In state provider	None	225 DICKINSON ST	# H207	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
56624	Fee-for-Service	1104357169	1104357169	1	1	GROM, EDWARD D MD	4/1/2021	207P00000X	NA	Other	026	PHYSICIANS	159915	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
56630	Fee-for-Service	1538367115	1538367115	1	1	GLOBAL DOCTORS MEDICAL	9/24/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	1617 E 1ST ST	STE A	SANTA ANA	CA	92701	6385	30	06059	33.74616534	-117.8462414	Orange County
56661	Fee-for-Service	1265958623	1265958623	1	1	GUO, XIAOFEI NP	10/2/2023	363L00000X	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
56667	Fee-for-Service	1770542326	1770542326	1	1	GERWEIN, KATYA T MD	9/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79621	40	Pediatrics	0	In state provider	None	652 W 11TH ST	STE 129	TRACY	CA	95376	3821	39	06077	37.73965047	-121.435452	San Joaquin County
56718	Fee-for-Service	1639296957	1639296957	1	1	GRAY, JILLIAN S DO	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8683	41	Internal Medicine	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
56731	Fee-for-Service	1790744308	1790744308	1	1	GREGORY ALLEN MD	4/14/2016	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
56750	Fee-for-Service	1730110487	1730110487	1	1	GHUMAN, TEJINDER P MD	7/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	39001	01	General Practice	0	In state provider	None	481 PLUMAS BLVD	None	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
56756	Fee-for-Service	1700987799	1700987799	1	1	GAYMON, BARI J PT	6/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
56822	Fee-for-Service	1831374644	1831374644	1	1	GIERMASZ, ADAM S MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103790	68	Hematology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
56839	Fee-for-Service	1750368387	1750368387	1	1	GRACE HOME, INC	3/1/1966	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13435 PEACH AVE	None	LIVINGSTON	CA	95334	9312	24	06047	37.37502552	-120.7312516	Merced County
56844	Fee-for-Service	1770757486	1770757486	1	1	GO, CLAUDINE CO MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137115	41	Internal Medicine	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
56851	Fee-for-Service	1043446834	1043446834	1	1	GO, NEL R G MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156110	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
56871	Fee-for-Service	1538796107	1538796107	1	1	GOMEZ-MUSTAFA, CARLOS MD	8/14/2023	208M00000X	NA	Other	026	PHYSICIANS	179745	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
56874	Fee-for-Service	1174682207	1174682207	1	1	GAITHER, KIMBERLY B MD	6/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3269 STOCKTON HILL ROAD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
56878	Fee-for-Service	1417979022	1417979022	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10820 JEFFERSON BLVD	None	CULVER CITY	CA	90230	4935	19	06037	33.998994	-118.3954445	Los Angeles County
56906	Fee-for-Service	1295252856	1295252856	1	1	GARIBAY, KEVIN I LCSW	8/16/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
56909	Fee-for-Service	1194732511	1194732511	1	1	GARCIA, JORGE	7/27/2004	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13006 PHILADELPHIA ST	STE 502	WHITTIER	CA	90601	4228	19	06037	33.97905852	-118.0370565	Los Angeles County
56930	Fee-for-Service	1669933966	1669933966	1	1	GHIAM, BENJAMIN K MD	7/14/2023	207WX0109X	NA	Ophthalmology	026	PHYSICIANS	185865	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 2505	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
56956	Fee-for-Service	1962957514	1962957514	1	1	GARFIELD BEACH CVS LLC	4/3/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9665 CAMPO RD	None	SPRING VALLEY	CA	91977	1228	37	06073	32.74797653	-116.9878635	San Diego County
56965	Fee-for-Service	1447547146	1447547146	1	1	GUPTA, PUNEET MD	6/11/2019	207P00000X	NA	Other	026	PHYSICIANS	152880	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
56983	Fee-for-Service	1144391897	1144391897	1	1	GRISSOM, NIMA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38970	02	General Surgery	0	In state provider	None	1700 CALIFORNIA ST	STE 550	SAN FRANCISCO	CA	94109	4591	38	06075	37.79030099	-122.4230289	San Francisco County
57029	Fee-for-Service	1306446042	1306446042	1	1	GORCZYCA, MELODY K LMFT	11/15/2022	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
57031	Fee-for-Service	1316039753	1316039753	1	1	GIM, RONALD D MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67690	41	Internal Medicine	0	In state provider	None	1045 ATLANTIC AVE	STE 506	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
57055	Fee-for-Service	1396788691	1396788691	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18080 IMPERIAL HWY	None	YORBA LINDA	CA	92886	3436	30	06059	33.89287302	-117.8194305	Orange County
57058	Fee-for-Service	1508478322	1508478322	1	1	GUARDIAN ANGELS HOME	6/28/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE INC	12509 OXNARD STREET	STE 206	NORTH HOLLYWOOD	CA	91606	4443	19	06037	34.17943548	-118.405683	Los Angeles County
57065	Fee-for-Service	1700953452	1700953452	1	1	GALLAGHER, TIMOTHY M MD	1/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
57080	Fee-for-Service	1235426487	1235426487	1	1	GORANTLA, SASIKANTH MD	5/25/2023	2084S0012X	NA	Neurology	026	PHYSICIANS	186585	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
57087	Fee-for-Service	1265525174	1265525174	1	1	GURUDEVAN, SWAMINATHA MD	6/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70212	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
57109	Fee-for-Service	1831374644	1831374644	1	1	GIERMASZ, ADAM S MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103790	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
57129	Fee-for-Service	1942869425	1942869425	1	1	GARFIELD BEACH CVS LLC	1/14/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	777 S HARBOR BLVD	STE E-164	LA HABRA	CA	90631	6882	30	06059	33.922539	-117.935496	Orange County
57172	Fee-for-Service	1043731557	1043731557	1	1	GRAY, JOSEPH M OD	8/26/2019	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
57173	Fee-for-Service	1013084839	1013084839	1	1	GAILANI, FAWAZ MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39036	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
57185	Fee-for-Service	1417538380	1417538380	1	1	GLENWOOD HOME HEALTH INC	5/13/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 304B	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
57224	Fee-for-Service	1255575965	1255575965	1	1	GORDON, NICOLE T MD	5/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145721	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
57226	Fee-for-Service	1427146547	1427146547	1	1	GARTNER, CHRISTINE S MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61927	36	Psychiatry	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
57245	Fee-for-Service	1578674727	1578674727	1	1	GRENCH, CAROL S MD	1/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85092	08	Family Practice	0	In state provider	None	2020 SUTTER PL	# 101	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
57351	Fee-for-Service	1932405594	1932405594	1	1	GOLDBERG, ANDREW D MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107694	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
57371	Fee-for-Service	1447554563	1447554563	1	1	GENNA, VINCENT T NP	1/25/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
57374	Fee-for-Service	1679998108	1679998108	1	1	GARFIELD BEACH CVS LLC	4/18/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1720 CENTRAL AVE	None	MCKINLEYVILLE	CA	95519	3602	12	06023	40.93648493	-124.1009488	Humboldt County
57395	Fee-for-Service	1215943089	1215943089	1	1	GOLDSCHMIDT, THOMAS G MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134589	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7307	56	06111	34.27623479	-119.2520218	Ventura County
57398	Fee-for-Service	1831374644	1831374644	1	1	GIERMASZ, ADAM S MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103790	41	Internal Medicine	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
57399	Fee-for-Service	1013976570	1013976570	1	1	GOWDA, UMA H MD	9/30/1987	207RH0003X	NA	Oncology	026	PHYSICIANS	44614	68	Hematology	0	In state provider	None	406 SUNRISE AVE	None	ROSEVILLE	CA	95661	4106	31	06061	38.73944898	-121.2720559	Placer County
57422	Fee-for-Service	1396124020	1396124020	1	1	GONZALEZ, TINA M LMFT	4/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5050 PALO VERDE STREET	107	MONTCLAIR	CA	91763	2333	36	06071	34.08145549	-117.69516	San Bernardino County
57432	Fee-for-Service	1780626697	1780626697	1	1	GREENSPAN, JASON L MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70847	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91773	3219	19	06037	34.20289797	-118.6294006	Los Angeles County
57444	Fee-for-Service	1619359874	1619359874	1	1	GHOBRIAL, BASSEM MD	2/1/2022	208C00000X	NA	General Surgery	026	PHYSICIANS	153509	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
57492	Fee-for-Service	1376648279	1376648279	1	1	GULLA, VANESSA D MD	1/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113017	34	Urology and Urological Surgery	0	In state provider	None	160 GREEN VALLEY RD	STE 203	FREEDOM	CA	95019	3160	44	06087	36.93732602	-121.7715374	Santa Cruz County
57511	Fee-for-Service	1265474142	1265474142	1	1	GOLDMAN, LAUREN E MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78608	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
57517	Fee-for-Service	1083764849	1083764849	1	1	GOLDBERGER, SILIM MD	6/1/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	44068	None	None	0	In state provider	None	40 ALTON AVE	None	SAN FRANCISCO	CA	94116	1401	38	06075	37.75017128	-122.4626827	San Francisco County
57538	Fee-for-Service	1275989550	1275989550	1	1	GOULD, TRACY A DO	6/20/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	15878	40	Pediatrics	0	In state provider	None	11175 CAMPUS STREET	COLEMAN PAVILION RMA1120	LOMA LINDA	CA	92350	0001	36	06071	34.049547	-117.2656245	San Bernardino County
57555	Fee-for-Service	1508228354	1508228354	1	1	GOMEZ, CHRISTOPHER R MD	11/20/2018	390200000X	NA	Other	026	PHYSICIANS	152390	08	Family Practice	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
57557	Fee-for-Service	1912964719	1912964719	1	1	GUIDO,GEORGE 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	2901 N CENTRAL AVE	STE# 500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
57597	Fee-for-Service	1396961678	1396961678	1	1	GUPTA, NEERJA	1/12/2011	No Taxonomy Provided	NA	None	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
57601	Fee-for-Service	1487007480	1487007480	1	1	GONZALEZ TAPIA, YESENIA LCS	11/29/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
57674	Fee-for-Service	1548643000	1548643000	1	1	GARFIELD HEALTH CENTER	4/28/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	701 S ATLANTIC BLVD	STE 100	MONTEREY PARK	CA	91754	3845	19	06037	34.05382447	-118.1363489	Los Angeles County
57710	Fee-for-Service	1265402465	1265402465	1	1	GOMEZ, MARIA A MD	8/4/2021	207L00000X	NA	Other	026	PHYSICIANS	76306	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
57723	Fee-for-Service	1033421383	1033421383	1	1	GERARD, KIMBERLY B MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126129	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
57802	Fee-for-Service	1205879517	1205879517	1	1	GOVINDARAJAN, PRASANTHI MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91577	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
57815	Fee-for-Service	1013566520	1013566520	1	1	GLUKHOVSKY, YEVGENIY CNP	11/29/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
57821	Fee-for-Service	1518290097	1518290097	1	1	GONZALES, RACHEL N LCSW	11/21/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1643 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
57827	Fee-for-Service	1093025546	1093025546	1	1	GUZMAN, MARIANA LMFT	2/6/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2200 BLISS CIR	None	OCEANSIDE	CA	92056	3594	37	06073	33.20698929	-117.2787551	San Diego County
57836	Fee-for-Service	1689602237	1689602237	1	1	GLODOWSKI, MITCHELL DPM	10/28/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3901 LAS POSAS RD	SUITE #9	CAMARILLO	CA	93010	1501	56	06111	34.2415821	-119.0183756	Ventura County
57841	Fee-for-Service	1023039591	1023039591	1	1	GILSON,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	593 EDDY ST	None	PROVIDENCE	RI	02905	0000	00	None	41.81122992	-71.40713931	Providence County
57897	Fee-for-Service	1295175628	1295175628	1	1	GIACONA, DANIELLE E DO	8/21/2023	2086S0122X	NA	General Surgery	026	PHYSICIANS	18168	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
57901	Fee-for-Service	1558762351	1558762351	1	1	GOMEZ, MAYRA R LCSW	5/4/2021	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
57963	Fee-for-Service	1548643000	1548643000	1	1	GARFIELD HEALTH CENTER	1/28/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	701 S ATLANTIC BLVD	STE 100	MONTEREY PARK	CA	91754	3845	19	06037	34.05382447	-118.1363489	Los Angeles County
57987	Fee-for-Service	1326496746	1326496746	1	1	GREENE, MICHAEL D MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	162342	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
58011	Fee-for-Service	1033421383	1033421383	1	1	GERARD, KIMBERLY B MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126129	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
58014	Fee-for-Service	1275510711	1275510711	1	1	GADDAM, SYAM R MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50714	10	Gastroenterology (M.D. only)	0	In state provider	None	1751 W ROMNEYA DR	STE J	ANAHEIM	CA	92801	1815	30	06059	33.85068001	-117.9438835	Orange County
58019	Fee-for-Service	1356319891	1356319891	1	1	GIRARD, PAUL J MD	5/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78346	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
58041	Fee-for-Service	1477134625	1477134625	1	2	GOLDEN DAY HOME HEALTH INC	1/11/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	417 ARDEN AVE	SUITE 105	GLENDALE	CA	91203	4046	19	06037	34.15847866	-118.2621835	Los Angeles County
58042	Fee-for-Service	1386836195	1386836195	1	1	GOLDSMITH, LYNNE A LMFT	3/4/2024	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
58043	Fee-for-Service	1679560197	1679560197	1	1	GORUM, CARLA C MD	5/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86939	40	Pediatrics	0	In state provider	None	4120 PRESCOTT RD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
58046	Fee-for-Service	1053311332	1053311332	1	1	GOLD WELLNESS, INC	1/12/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6022 W PICO BLVD	STE 107	LOS ANGELES	CA	90035	2676	19	06037	34.05246753	-118.3718521	Los Angeles County
58122	Fee-for-Service	1447331731	1447331731	1	1	GOULD MTU	5/1/2024	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	117 W. DUNHAM STREET	None	MADERA	CA	93637	5468	20	06039	36.95103049	-120.0573495	Madera County
58160	Fee-for-Service	1457779266	1457779266	1	1	GLENN, JOHN M DO	1/9/2023	208600000X	NA	General Surgery	026	PHYSICIANS	19585	None	None	0	In state provider	None	2250 HAYES ST	STE 302	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
58161	Fee-for-Service	1689657918	1689657918	1	1	GREGG, JEFFREY P MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	79883	69	Unknown	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
58182	Fee-for-Service	1801405741	1801405741	1	1	GORDON-SMITH, KIERRA S LMFT	3/17/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
58211	Fee-for-Service	1356906093	1356906093	1	1	GINA HOME CARE	12/4/2020	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	8891 WATSON STREET	SUITE 201	CYPRESS	CA	90630	2260	30	06059	33.83297519	-118.0392565	Orange County
58226	Fee-for-Service	1073036547	1073036547	1	1	GONG, RAYMOND MD	7/1/2021	207ZP0102X	NA	Other	026	PHYSICIANS	157247	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
58249	Fee-for-Service	1548643000	1548643000	1	1	GARFIELD HEALTH CENTER	1/28/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	701 S ATLANTIC BLVD	STE 100	MONTEREY PARK	CA	91754	3845	19	06037	34.05382447	-118.1363489	Los Angeles County
58298	Fee-for-Service	1144342601	1144342601	1	1	GORDON, DANIEL M MD	2/17/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42749	None	None	0	In state provider	None	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	40	06079	35.12986992	-120.6006027	San Luis Obispo County
58308	Fee-for-Service	1821316829	1821316829	1	1	GNESA, HEATHER A SP	10/19/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKON BLVD	None	SACRAMENTO	CA	95816	7098	34	06067	38.56554	-121.4664615	Sacramento County
58350	Fee-for-Service	1275981912	1275981912	1	1	GORMAN, JENNIFER L LMFT	4/14/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2202 N 1ST ST	STE 2210	SAN JOSE	CA	95131	2007	43	06085	37.37749791	-121.921213	Santa Clara County
58376	Fee-for-Service	1548704018	1548704018	1	1	GO BEYOND PHYSICAL THERAPY,	9/25/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39 QUAIL CT	SUITE 300	WALNUT CREEK	CA	94596	5770	07	06013	37.88807869	-122.0553886	Contra Costa County
58405	Fee-for-Service	1487191516	1487191516	1	1	GERARDO CANCHOLA M.D., INC.	8/26/2019	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2621 S BRISTOL ST	STE 308	SANTA ANA	CA	92704	5766	30	06059	33.711876	-117.885371	Orange County
58422	Fee-for-Service	1366865008	1366865008	1	1	GHAHREMANI, MANDANA MD	2/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123004	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
58424	Fee-for-Service	1760566764	1760566764	1	1	GUO, MARGARET M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76449	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
58438	Fee-for-Service	1023127974	1023127974	1	1	GAYNON, MICHAEL W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37116	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
58469	Fee-for-Service	1851393862	1851393862	1	1	GARFIELD COMPREHENSIVE	8/23/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CARE MED CORP	333 S GARFIELD AVE	STE A	ALHAMBRA	CA	91801	3895	19	06037	34.09174728	-118.1245642	Los Angeles County
58514	Fee-for-Service	1760660062	1760660062	1	1	GREGORIUS, STEPHEN F MD	11/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100715	20	Orthopedic Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
58569	Fee-for-Service	1053198135	1053198135	1	1	GRACE ON WHEELS LLC	1/6/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2305 COURT ST	None	REDDING	CA	96001	2527	45	06089	40.57550148	-122.3926024	Shasta County
58590	Fee-for-Service	1780098194	1780098194	1	1	GILL, NATASHA MD	8/6/2020	2080P0204X	NA	Other	026	PHYSICIANS	169037	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
58604	Fee-for-Service	1740716539	1740716539	1	1	GRIGSBY, PHILLIP MD	1/2/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	157441	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
58619	Fee-for-Service	1396734471	1396734471	1	1	GLENDALE ADVENTIST MED	4/1/1983	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
58625	Fee-for-Service	1699305839	1699305839	1	1	GODWIN, SAMUEL C NP	5/30/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 CONTINENTAL BLVD	FL 6	EL SEGUNDO	CA	90245	5074	19	06037	33.92094913	-118.3907818	Los Angeles County
58630	Fee-for-Service	1669080511	1669080511	1	1	GARLAND, DANIEL J	5/21/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1015 W YOSEMITE AVE	None	MADERA	CA	93637	4581	20	06039	36.95442695	-120.0708623	Madera County
58634	Fee-for-Service	1326035601	1326035601	1	1	GORAB, ROBERT S MD	9/30/1996	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	64419	01	General Practice	0	In state provider	None	1140 W LA VETA AVE	STE 850	ORANGE	CA	92868	4218	30	06059	33.7802984	-117.8651669	Orange County
58660	Fee-for-Service	1154398816	1154398816	1	1	GREENFIELD, ANTJE MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	52322	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
58688	Fee-for-Service	1811157126	1811157126	1	1	GUPTA, ELLA A DO	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11966	41	Internal Medicine	0	In state provider	None	2720 LOW CT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
58689	Fee-for-Service	1902847825	1902847825	1	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9900 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	2916	19	06037	34.250508	-118.4673025	Los Angeles County
58692	Fee-for-Service	1265858625	1265858625	1	1	GLOBAL HOME HOSPICE SERVICE	5/19/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	221 N SAN DIMAS AVE	STE A	SAN DIMAS	CA	91773	2664	19	06037	34.109532	-117.8071585	Los Angeles County
58699	Fee-for-Service	1225569619	1225569619	1	1	GUERRA, FRANCISCO M MD	12/15/2023	207R00000X	NA	Other	026	PHYSICIANS	170147	None	None	0	In state provider	None	1355 EAST ST	SUITE 200	REDDING	CA	96001	0801	45	06089	40.58628506	-122.3887911	Shasta County
58707	Fee-for-Service	1649603325	1649603325	1	1	GHADERI, FARNOUSH DO	11/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14839	01	General Practice	0	In state provider	None	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
58723	Fee-for-Service	1508664798	1508664798	1	1	GEORGE NASR MD PROFESSIONAL	4/11/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	CORPORATION	234 E COMMONWEALTH AVE	STE. 200	FULLERTON	CA	92832	1911	30	06059	33.87036031	-117.9204459	Orange County
58748	Fee-for-Service	1740785021	1740785021	1	1	GALLI, CHRISTOPHER D DPM	7/18/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6620 COYLE AVE	STE 202	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
58755	Fee-for-Service	1851393862	1851393862	1	1	GARFIELD COMPREHENSIVE	8/23/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CARE MED CORP	333 S GARFIELD AVE	STE A	ALHAMBRA	CA	91801	3895	19	06037	34.09174728	-118.1245642	Los Angeles County
58768	Fee-for-Service	1841355237	1841355237	1	1	GUPTA, ALOK K MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51455	01	General Practice	0	In state provider	None	1301 PIONOLE VALLEY ROAD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
58813	Fee-for-Service	1811930118	1811930118	1	1	GILBERT, BENJAMIN N MD	5/8/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85718	18	Ophthalmology	0	In state provider	None	605 W EAST AVE	None	CHICO	CA	95926	7201	04	06007	39.75094119	-121.8710492	Butte County
58850	Fee-for-Service	1528351582	1528351582	1	1	GILL, ARVINDER S DO	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13593	05	Anesthesiology	0	In state provider	None	819 AUTO CENTER DRIVE	None	PALMDALE	CA	93551	4599	19	06037	34.59142164	-118.14665	Los Angeles County
58865	Fee-for-Service	1336378116	1336378116	1	1	GUTIERREZ, DIANE LMFT	1/2/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST 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
58876	Fee-for-Service	1255426763	1255426763	1	1	GUTCHER, LINDA J	2/28/1997	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5329 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0641	15	06029	35.36734574	-119.0620677	Kern County
58933	Fee-for-Service	1861627416	1861627416	2	1	GARCIA, IRENE LMFT	3/30/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14986 ELKHORN DR	None	FONTANA	CA	92336	5515	36	06071	34.13106988	-117.4779525	San Bernardino County
58948	Fee-for-Service	1134336928	1134336928	2	1	GARFIELD BEACH CVS LLC	4/24/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1751 UNIVERSITY DR	None	VISTA	CA	92083	7775	37	06073	33.17027826	-117.214478	San Diego County
58963	Fee-for-Service	1003806126	1003806126	1	1	GATEWAY HEALTHCARE PRODUCTS	3/29/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	112 E FREMONT AVE	None	SUNNYVALE	CA	94087	3201	43	06085	37.351233	-122.031657	Santa Clara County
58977	Fee-for-Service	1205832763	1205832763	1	1	GARCIA, PETER J CNP	8/18/2020	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
58978	Fee-for-Service	1265858625	1265858625	1	1	GLOBAL HOME HOSPICE SERVICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	221 N SAN DIMAS AVE	STE A	SAN DIMAS	CA	91773	2664	19	06037	34.109532	-117.8071585	Los Angeles County
59006	Fee-for-Service	1689602260	1689602260	1	1	GAO, LING MD	6/29/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	155410	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
59012	Fee-for-Service	1104939248	1104939248	1	1	GRIFFITHS, CHESTER F MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45673	04	Otology, Laryngology, Rhinology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
59016	Fee-for-Service	1447309893	1447309893	1	1	GRAVES, BRAD T MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
59042	Fee-for-Service	1114005022	1114005022	1	1	GHADIALY, ABBAS T MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50301	78	Neoplastic Diseases/Oncology	0	In state provider	None	575 E HARDY ST	STE 201	INGLEWOOD	CA	90301	4043	19	06037	33.94909392	-118.3477665	Los Angeles County
59059	Fee-for-Service	1043271620	1043271620	1	1	GEFT, IVOR MD	2/28/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37160	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8631 W 3RD ST	# 445E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
59084	Fee-for-Service	1568484293	1568484293	1	1	GIBBON, GARY W MD	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	41221	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	# 660W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
59094	Fee-for-Service	1972627776	1972627776	1	1	GUTERMUTH, ANGELA M	11/20/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	50 NUGGET LANE	STE A	WEAVERVILLE	CA	96093	2120	53	06105	40.72205851	-122.9293599	Trinity County
59107	Fee-for-Service	1952661845	1952661845	1	1	GARCIA, MICHAEL MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127599	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
59109	Fee-for-Service	1306030291	1306030291	2	1	GARFIELD BEACH CVS LLC	1/4/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	133 GENERAL STILLWELL DR	None	MARINA	CA	93933	6242	27	06053	36.66616556	-121.8106339	Monterey County
59129	Fee-for-Service	1861474199	1861474199	1	1	GREENHALGH, DAVID G MD	3/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83491	None	None	0	In state provider	None	4301 X ST	None	SACRAMENTO	CA	95817	2214	34	06067	38.5536003	-121.455135	Sacramento County
59136	Fee-for-Service	1710419262	1710419262	1	1	GINZBURG, NADIYA	11/9/2020	207R00000X	NA	Other	026	PHYSICIANS	165689	None	None	0	In state provider	None	3484 E 1ST ST	None	LOS ANGELES	CA	90063	2946	19	06037	34.0359727	-118.192576	Los Angeles County
59138	Fee-for-Service	1528351582	1528351582	1	1	GILL, ARVINDER S DO	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13593	01	General Practice	0	In state provider	None	819 AUTO CENTER DRIVE	None	PALMDALE	CA	93551	4599	19	06037	34.59142164	-118.14665	Los Angeles County
59139	Fee-for-Service	1831178169	1831178169	1	1	GOLD, MARGARET M MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56047	01	General Practice	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
59154	Fee-for-Service	1457354391	1457354391	1	1	GAW, BRIAN K MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49055	40	Pediatrics	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
59189	Fee-for-Service	1649275579	1649275579	1	1	GONZALEZ, JOHN B	2/28/1987	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	45253	None	None	0	In state provider	None	6800 BROCKTON AVE	None	RIVERSIDE	CA	92506	3810	33	06065	33.9496766	-117.3967147	Riverside County
59194	Fee-for-Service	1902072473	1902072473	1	1	GABRIELS ICF/DDN	12/17/2001	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	528 INDIANA ST	None	WOODBRIDGE	CA	95258	9100	39	06077	38.15383114	-121.3092233	San Joaquin County
59205	Fee-for-Service	1548507999	1548507999	1	1	GREATER PLACER PHARMACY INC	4/24/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3133 PROFESSIONAL DR	#17	AUBURN	CA	95603	2463	31	06061	38.9412	-121.100888	Placer County
59261	Fee-for-Service	1285839852	1285839852	1	1	GLAZIER, EVE M MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93608	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	SUITE 365,420,120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
59287	Fee-for-Service	1336184134	1336184134	1	1	GARFIELD BEACH CVS, LLC	5/1/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 S SUNRISE WAY	None	PALM SPRINGS	CA	92262	7640	33	06065	33.81631988	-116.5282432	Riverside County
59300	Fee-for-Service	1104939248	1104939248	1	1	GRIFFITHS, CHESTER F MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45673	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
59302	Fee-for-Service	1265230668	1265230668	1	1	GULLICKSON, IVY J	4/1/2025	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	56	06111	0	0	None
59304	Fee-for-Service	1487695391	1487695391	1	1	GARFIELD BEACH CVS,LLC	5/11/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7101 ATLANTIC AVE	None	BELL	CA	90201	3650	19	06037	33.97111519	-118.1881164	Los Angeles County
59310	Fee-for-Service	1790739191	1790739191	1	1	GOLUBEVA-GANELES, ARINA	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77100	78	Neoplastic Diseases/Oncology	0	In state provider	None	261 EL DORADO ST	STE 202	MONTEREY	CA	93940	2911	27	06053	36.59358228	-121.897093	Monterey County
59315	Fee-for-Service	1891998118	1891998118	1	1	GORGES, FIRAS H MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109538	08	Family Practice	0	In state provider	None	12408 HESPERIA RD SUITE	None	VICTORVILLE	CA	92395	4786	36	06071	34.47685861	-117.291289	San Bernardino County
59332	Fee-for-Service	1114005022	1114005022	1	1	GHADIALY, ABBAS T MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50301	68	Hematology	0	In state provider	None	575 E HARDY ST	STE 201	INGLEWOOD	CA	90301	4043	19	06037	33.94909392	-118.3477665	Los Angeles County
59361	Fee-for-Service	1457370868	1457370868	1	1	GERALD K ROWLAND, 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	1303 N MAIN ST	None	CEDAR CITY	UT	84721	9746	00	None	37.699596	-113.0664465	Iron County
59364	Fee-for-Service	1871641746	1871641746	1	1	GOGOLOK, JACEK F MD	10/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39591	45	Nephrology (Renal-Kidney)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
59421	Fee-for-Service	1316968332	1316968332	1	1	GEORGE C HESCOCK 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	200 HENRY CLAY AVE	None	NEW ORLEANS	LA	70118	5720	00	None	29.91737979	-90.12717371	Orleans Parish
59445	Fee-for-Service	1598860140	1598860140	1	1	GOLDBERG, TERESA A OD	2/1/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ALBANY BERKELEY OPTOMTRY	1313 SOLANO AVE	None	ALBANY	CA	94706	1825	01	06001	37.8906857	-122.2920823	Alameda County
59458	Fee-for-Service	1699035220	1699035220	1	1	GARCIA, JASON A PT	6/3/2020	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
59462	Fee-for-Service	1639283674	1639283674	1	1	GUPTA, PARUL MD	1/1/2002	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	67050	None	None	0	In state provider	None	858 N CHERRY ST	STE F	TULARE	CA	93274	2243	54	06107	36.22014749	-119.337642	Tulare County
59501	Fee-for-Service	1184659245	1184659245	1	1	GUPTA, PUNAM K MD	4/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94990	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
59546	Fee-for-Service	1417500703	1417500703	1	1	GANNON, VERONICA PT	3/10/2020	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
59598	Fee-for-Service	1790739191	1790739191	1	1	GOLUBEVA-GANELES, ARINA	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77100	66	Emergency Medicine (Urgent Care)	0	In state provider	None	261 EL DORADO ST	STE 202	MONTEREY	CA	93940	2911	27	06053	36.59358228	-121.897093	Monterey County
59600	Fee-for-Service	1063550069	1063550069	1	1	GLENN COUNTY HEALTH SERVICES	2/3/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1187 E SOUTH ST	None	ORLAND	CA	95963	9136	11	06021	39.736017	-122.167224	Glenn County
59608	Fee-for-Service	1154826972	1154826972	1	1	GIRN, SIMRUNN S MD	3/21/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165867	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
59621	Fee-for-Service	1083812978	1083812978	1	1	GRIMES, DEBORAH H LCSW	8/8/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	AHAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
59645	Fee-for-Service	1891788436	1891788436	1	1	GOODMAN, RANDALL L MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90496	18	Ophthalmology	0	In state provider	None	1414 E MAIN ST	None	SANTA MARIA	CA	93454	4806	42	06083	34.95286853	-120.4139295	Santa Barbara County
59651	Fee-for-Service	1871641746	1871641746	1	1	GOGOLOK, JACEK F MD	10/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39591	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
59666	Fee-for-Service	1699039446	1699039446	1	1	GONZALEZ, HECTOR DUENAS OD	8/14/2012	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
59669	Fee-for-Service	1801808332	1801808332	1	1	GARRISON, MATTHEW C DPM	12/2/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
59690	Fee-for-Service	1922622851	1922622851	1	1	GELUZ, RAMIR W MD	9/28/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190550	None	None	0	In state provider	None	2280 HARRISON AVE	STE K	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
59715	Fee-for-Service	1144777590	1144777590	1	1	GAVRILYUK, OLEG M MD PC	12/28/2016	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	6699 ALVARADO RD	STE 2302	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
59746	Fee-for-Service	1487882841	1487882841	1	1	GOODMAN, ADAM J MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114392	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
59779	Fee-for-Service	1093973752	1093973752	1	1	GRIFFITHS, OLIVIA H MD	5/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107079	40	Pediatrics	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
59834	Fee-for-Service	1407902331	1407902331	1	1	GUPTA, VINOD K MD	7/30/1990	174400000X	NA	Other	026	PHYSICIANS	45899	41	Internal Medicine	0	In state provider	None	858 N CHERRY ST	STE A	TULARE	CA	93274	2243	54	06107	36.22014749	-119.337642	Tulare County
59846	Fee-for-Service	1184202178	1184202178	1	1	GREYWAL, KAVEER MD	10/21/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
59874	Fee-for-Service	1447588835	1447588835	1	1	GRAY, ELIZABETH A	12/6/2010	No Taxonomy Provided	NA	None	037	SPEECH 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
59887	Fee-for-Service	1790739191	1790739191	1	1	GOLUBEVA-GANELES, ARINA	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77100	68	Hematology	0	In state provider	None	261 EL DORADO ST	STE 202	MONTEREY	CA	93940	2911	27	06053	36.59358228	-121.897093	Monterey County
59895	Fee-for-Service	1659333995	1659333995	1	1	GILL, TANYA N OD	9/6/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1960 BROADWAY	None	OAKLAND	CA	94612	2206	01	06001	37.80861936	-122.2684225	Alameda County
59920	Fee-for-Service	1588742381	1588742381	1	1	GEE, GARWOOD MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52232	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8450 EDES AVE	None	OAKLAND	CA	94621	1306	01	06001	37.74090103	-122.1948767	Alameda County
59961	Fee-for-Service	1689782484	1689782484	1	2	GORADIA MEDICAL CORPORATION	2/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	86829	14	Neurological Surgery	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
59979	Fee-for-Service	1679968572	1679968572	1	1	GONZALEZ, ANDRES MD	7/17/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	162647	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
59994	Fee-for-Service	1962775957	1962775957	1	1	GOLDFINGER, JONATHAN J MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115656	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
60006	Fee-for-Service	1902262512	1902262512	1	1	GARAY, DEBBIE C LCSW	10/26/2023	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
60010	Fee-for-Service	1548921752	1548921752	2	1	GENTLE RIDE INC	7/16/2024	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	657 S 2ND AVE	None	COVINA	CA	91723	3518	19	06037	34.07757788	-117.8874238	Los Angeles County
60021	Fee-for-Service	1265540462	1265540462	1	1	GONG, MERRY B MD	6/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	32302	01	General Practice	0	In state provider	None	2450 ASHBY AVE	RM 1002	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
60037	Fee-for-Service	1437536620	1437536620	1	1	GOULD, JESSICA B MD	10/25/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145972	08	Family Practice	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
60043	Fee-for-Service	1114573763	1114573763	1	1	GREISEN, MELINDA R LCSW	1/7/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
60114	Fee-for-Service	1073024451	1073024451	1	1	GOOD CHOICE HOME CARE INC	4/23/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17050 CHATSWORTH ST	STE 228	GRANADA HILLS	CA	91344	7828	19	06037	34.26477251	-118.5039945	Los Angeles County
60124	Fee-for-Service	1407902331	1407902331	1	1	GUPTA, VINOD K MD	7/30/1990	174400000X	NA	Other	026	PHYSICIANS	45899	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	858 N CHERRY ST	STE A	TULARE	CA	93274	2243	54	06107	36.22014749	-119.337642	Tulare County
60163	Fee-for-Service	1932295680	1932295680	2	1	GONZALEZ, BERTHA A	12/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	6849	None	None	0	In state provider	None	3106 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02373532	-118.1368368	Los Angeles County
60174	Fee-for-Service	1356499164	1356499164	1	1	GUO, ADAM W MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72479	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
60177	Fee-for-Service	1861434268	1861434268	1	1	GALVIN, HELEN B MD	11/1/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33455	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
60188	Fee-for-Service	1891841722	1891841722	1	1	GOOD SAMARITAN HOSP	1/1/1995	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	901 OLIVE DR	None	BAKERSFIELD	CA	93308	4144	15	06029	35.41225153	-119.0396655	Kern County
60202	Fee-for-Service	1740339274	1740339274	1	2	GALLONI ENTERPRISES MEDICAL	2/6/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	CORPORATION	1127 WILSHIRE BLVD	SUITE 408	LOS ANGELES	CA	90017	3905	19	06037	34.05270508	-118.2641005	Los Angeles County
60208	Fee-for-Service	1588742381	1588742381	1	1	GEE, GARWOOD MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52232	41	Internal Medicine	0	In state provider	None	8450 EDES AVE	None	OAKLAND	CA	94621	1306	01	06001	37.74090103	-122.1948767	Alameda County
60211	Fee-for-Service	1285837021	1285837021	1	1	GEHLAWAT, DILBAGH MD INC	10/31/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	325 S LEXINGTON ST	None	DELANO	CA	93215	3693	15	06029	35.75574317	-119.2408471	Kern County
60258	Fee-for-Service	1215793815	1215793815	1	1	GASKILL, AMY	4/23/2024	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	12	06023	0	0	None
60261	Fee-for-Service	1487712865	1487712865	1	1	GITTER, MICHAEL	6/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	20658	None	None	0	In state provider	None	431 N BRAND BLVD	STE 203	GLENDALE	CA	91203	2310	19	06037	34.1527469	-118.25514	Los Angeles County
60337	Fee-for-Service	1114056389	1114056389	1	1	GOOD MEDICINE A MEDICAL	7/1/1994	193400000X	NA	Other	026	PHYSICIANS	5992	12	Manipulative Therapy (D.O. only)	0	In state provider	CORPORATION	101 OLD MCCLOUD RD	None	MOUNT SHASTA	CA	96067	2796	47	06093	41.30516006	-122.3104613	Siskiyou County
60356	Fee-for-Service	1114028727	1114028727	1	1	GAN, TERESITA B MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36516	01	General Practice	0	In state provider	None	14100 FRANCISQUITO AVE	STE 19	BALDWIN PARK	CA	91706	6120	19	06037	34.06417203	-117.9682344	Los Angeles County
60436	Fee-for-Service	1790247831	1790247831	1	1	GUERRERO, ESTEBAN A MD	1/17/2023	207R00000X	NA	Other	026	PHYSICIANS	181133	None	None	0	In state provider	None	2000 STOCKTON BLVD	2300	SACRAMENTO	CA	95817	1348	34	06067	38.559222	-121.462362	Sacramento County
60447	Fee-for-Service	1972989010	1972989010	1	1	GONZALEZ, ALYSSA W OT	10/14/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	556 N 1ST ST	SUITE 201	SAN JOSE	CA	95112	5300	43	06085	37.34591974	-121.8977166	Santa Clara County
60482	Fee-for-Service	1497812507	1497812507	1	1	GEORGIE, SUJA MD	9/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101405	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
60490	Fee-for-Service	1740339274	1740339274	1	2	GALLONI ENTERPRISES MEDICAL	11/1/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORPORATION	1127 WILSHIRE BLVD	SUITE 408	LOS ANGELES	CA	90017	3905	19	06037	34.05270508	-118.2641005	Los Angeles County
60553	Fee-for-Service	1528137478	1528137478	1	1	GARVEY PHARMACY INC	10/1/2001	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7837 GARVEY AVE	STE 100A	ROSEMEAD	CA	91770	3013	19	06037	34.06265748	-118.098162	Los Angeles County
60624	Fee-for-Service	1437470507	1437470507	1	1	GHAFFARI, MASOUMEH MD	10/31/2017	207R00000X	NA	Other	026	PHYSICIANS	124292	41	Internal Medicine	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
60625	Fee-for-Service	1124469663	1124469663	1	1	GINWALA, CAITLIN N LMFT	5/15/2023	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
60626	Fee-for-Service	1114056389	1114056389	1	1	GOOD MEDICINE A MEDICAL	7/1/1994	193400000X	NA	Other	026	PHYSICIANS	5992	08	Family Practice	0	In state provider	CORPORATION	101 OLD MCCLOUD RD	None	MOUNT SHASTA	CA	96067	2796	47	06093	41.30516006	-122.3104613	Siskiyou County
60650	Fee-for-Service	1124220926	1124220926	1	1	GARFIELD BEACH CVS, LLC	1/15/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	997 WOODLAND PKWY	None	SAN MARCOS	CA	92069	2200	37	06073	33.15663509	-117.1292808	San Diego County
60662	Fee-for-Service	1790821163	1790821163	1	1	GROSS, ROBERT A MD	1/1/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	21342	10	Gastroenterology (M.D. only)	0	In state provider	None	3831 HUGHES AVE	STE 706	CULVER CITY	CA	90232	6840	19	06037	34.02243278	-118.3981492	Los Angeles County
60693	Fee-for-Service	1891723482	1891723482	1	1	GINZBURG, OLGA MD	5/17/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54200	41	Internal Medicine	0	In state provider	None	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
60702	Fee-for-Service	1891873428	1891873428	1	1	GLUCKIN, DOREEN S MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47743	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
60704	Fee-for-Service	1891873436	1891873436	1	1	GOLD, MARIAN D MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	57353	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
60724	Fee-for-Service	1528751732	1528751732	1	1	G TRANSPORTATION INC.	8/4/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2130 N ARROWHEAD AVE	207 G	SAN BERNANDINO	CA	92405	4029	19	06037	34.13450029	-117.289686	San Bernardino
60752	Fee-for-Service	1568664977	1568664977	1	1	GEORGE, JAYA A MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94897	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DR	STE 409	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
60761	Fee-for-Service	1295007656	1295007656	1	1	GUZEL, LISA M CRNA	4/5/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOJAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
60795	Fee-for-Service	1255859906	1255859906	1	1	GONZALES, SAMANTHA E CNP	2/23/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23357 MULHOLLAND DR	None	WOODLAND HILLS	CA	91364	2734	19	06037	34.15788221	-118.6355139	Los Angeles County
60814	Fee-for-Service	1275685646	1275685646	1	1	GOODMAN, STEVEN L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38909	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
60831	Fee-for-Service	1366942229	1366942229	1	1	GUEVARRA, RAQUEL B NP	10/1/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	985 W VERNON AVE	None	LOS ANGELES	CA	90037	3038	19	06037	34.00370943	-118.2912135	Los Angeles County
60842	Fee-for-Service	1366455784	1366455784	1	1	GUPTA, RAHUL MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52297	30	Radiology	0	In state provider	None	945 SHASTA ST	None	YUBA CITY	CA	95991	4114	51	06101	39.14392271	-121.6160328	Sutter County
60855	Fee-for-Service	1144710112	1144710112	1	1	GREWAL, SIMARVIR MD	12/18/2023	207L00000X	NA	Other	026	PHYSICIANS	184860	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
60903	Fee-for-Service	1962537126	1962537126	1	1	GONZALEZ, MARIA A PHD	9/24/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	813 W WHITTIER BLVD	SUITE D	MONTEBELLO	CA	90640	5234	19	06037	34.01011387	-118.1086769	Los Angeles County
60984	Fee-for-Service	1689679797	1689679797	1	1	GIBSON, CHRIS S	11/1/1995	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2906 DARWIN ST	None	SACRAMENTO	CA	95823	4510	34	06067	38.618253	-121.4173125	Sacramento County
61012	Fee-for-Service	1750434254	1750434254	1	1	GRUPO MEDICO FAMILIAR	12/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SANTA FE INC	4070 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3332	19	06037	34.01885853	-118.186938	Los Angeles County
61055	Fee-for-Service	1922101971	1922101971	1	1	GORMLEY, DANIEL E MD	1/1/1979	207N00000X	NA	Dermatology	026	PHYSICIANS	21148	07	Dermatology	0	In state provider	None	412 W CARROLL AVE	None	GLENDORA	CA	91741	4240	19	06037	34.13415622	-117.8702547	Los Angeles County
61057	Fee-for-Service	1124453030	1124453030	1	1	GARFIELD BEACH CVS, LLC	7/7/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1303 W SEPULVEDA BLVD	None	TORRANCE	CA	90501	5002	19	06037	33.81343634	-118.2988415	Los Angeles County
61091	Fee-for-Service	1609967413	1609967413	1	1	GREGORI, JEFFREY M DPM	7/20/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
61104	Fee-for-Service	1154770048	1154770048	1	1	GRIERSON, KEVIN 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
61201	Fee-for-Service	1174545255	1174545255	1	1	GELABART, HUGH A MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62704	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
61209	Fee-for-Service	1427002666	1427002666	1	1	GUPTA, MALKEET MD	2/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87246	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
61211	Fee-for-Service	1861596223	1861596223	1	1	GIM, ELLEN D MD	12/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	71544	41	Internal Medicine	0	In state provider	None	2742 DOW AVENUE	None	TUSTIN	CA	92780	7242	30	06059	33.71200542	-117.8088951	Orange County
61219	Fee-for-Service	1316225592	1316225592	1	1	GANDHI, NISHANT M MD	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122482	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
61238	Fee-for-Service	1346328101	1346328101	1	1	GETZ, CHARLES MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25283	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
61274	Fee-for-Service	1891758264	1891758264	1	1	GAMBURD INC	8/4/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	12420 MONTAGUE ST	UNIT D	PACOIMA	CA	91331	2102	19	06037	34.25331752	-118.403367	Los Angeles County
61295	Fee-for-Service	1235229196	1235229196	1	1	GARVIN, LAURA MD	7/21/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74707	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
61309	Fee-for-Service	1538433180	1538433180	1	1	GRANILLO, OLGA ELENA LCSW	11/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	222 N MOUNTAIN AVE	SUITE 212	UPLAND	CA	91786	5714	36	06071	34.096401	-117.6700615	San Bernardino County
61316	Fee-for-Service	1104307073	1104307073	1	1	GILHOOLY, LESLIE PSYD	7/8/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
61352	Fee-for-Service	1700224565	1700224565	1	1	GOPALSAMI, ANAND MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140824	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
61361	Fee-for-Service	1033240650	1033240650	1	1	GALDAMEZ, LUIS A MD INC	9/29/2004	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINICA MEDICA VIRGEN DE	6831 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4805	19	06037	33.97706276	-118.2225577	Los Angeles County
61422	Fee-for-Service	1427104306	1427104306	1	1	GRIFFIN, JOYCE N LCSW	5/6/2016	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
61439	Fee-for-Service	1528223542	1528223542	1	1	GOSALIA, NUPUR K MD	3/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122825	01	General Practice	0	In state provider	None	3142 VISTA WAY	SUITE 100	OCEANSIDE	CA	92056	3627	37	06073	33.18253858	-117.3252818	San Diego County
61448	Fee-for-Service	1811552680	1811552680	1	1	GRACE AND GLORY HOSPICE INC	2/2/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	101 WALDIE PLAZA	STE 2	ANTIOCH	CA	94509	1279	07	06013	38.01739634	-121.8149963	Contra Costa County
61472	Fee-for-Service	1366554560	1366554560	1	2	GIESBRECHT, MARK	2/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	84165	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
61516	Fee-for-Service	1861020554	1861020554	1	1	GUO, CHEN-YU C MD	8/25/2023	208M00000X	NA	Other	026	PHYSICIANS	185040	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
61535	Fee-for-Service	1295928513	1295928513	1	1	GARDNER, JOAN C NP	9/17/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	223839	-	NOT APPLICABLE	0	In state provider	None	115 E FESLER ST	None	SANTA MARIA	CA	93454	4404	42	06083	34.95648451	-120.435021	Santa Barbara County
61544	Fee-for-Service	1386626489	1386626489	1	1	GRAVES, RICHARD C MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50576	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
61569	Fee-for-Service	1679985592	1679985592	1	1	GOLDSTEIN, GREGORY MD	8/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	149422	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
61583	Fee-for-Service	1235229196	1235229196	1	1	GARVIN, LAURA MD	7/21/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74707	49	Unknown	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
61586	Fee-for-Service	1861146045	1861146045	1	1	GUTHRIE, SYLVIA C CNP	9/26/2022	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
61589	Fee-for-Service	1518453422	1518453422	1	1	GOGTE, PRIYANKA V MD	6/14/2023	207R00000X	NA	Other	026	PHYSICIANS	174257	None	None	0	In state provider	None	12462 PUTNAM ST	STE 506	WHITTIER	CA	90602	1002	19	06037	33.9709236	-118.0460596	Los Angeles County
61649	Fee-for-Service	1518165612	1518165612	1	1	GRAUBARD, MOSES B MD	5/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106691	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
61703	Fee-for-Service	1679517924	1679517924	1	1	GARFIELD BEACH CVS LLC	8/10/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1150 BAKER ST	None	COSTA MESA	CA	92626	4111	30	06059	33.68015852	-117.906831	Orange County
61726	Fee-for-Service	1831596485	1831596485	1	1	GUTIERREZ, YESENIA LMFT	9/28/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	105811	-	NOT APPLICABLE	0	In state provider	None	831 E ARROW HWY	None	POMONA	CA	91767	2535	19	06037	34.09030767	-117.7353578	Los Angeles County
61729	Fee-for-Service	1073222576	1073222576	1	1	GONZALEZ, GABRIELA CNP	2/13/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1900 19TH AVE	None	SAN FRANCISCO	CA	94116	1250	38	06075	37.75211157	-122.4762664	San Francisco County
61732	Fee-for-Service	1144839770	1144839770	2	1	GARCIA, EDGAR D LMFT	2/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CES	3610 CENTRAL AVE	SUITE 400	RIVERSIDE	CA	92506	5900	33	06065	33.95352247	-117.3917745	Riverside County
61737	Fee-for-Service	1811552680	1811552680	1	1	GRACE AND GLORY HOSPICE INC	2/2/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	101 WALDIE PLAZA	STE 2	ANTIOCH	CA	94509	1279	07	06013	38.01739634	-121.8149963	Contra Costa County
61747	Fee-for-Service	1538338793	1538338793	1	1	GRANCELL VILLAGE OF THE LA	7/1/2010	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	JEWISH HOME FOR AGING	7150 TAMPA AVE	None	RESEDA	CA	91335	3700	19	06037	34.2001266	-118.5534932	Los Angeles County
61826	Fee-for-Service	1104981166	1104981166	1	1	GARDINER, LYNN A LMFT	12/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4152 KATELLA AVE	101A	LOS ALAMITOS	CA	90720	3441	30	06059	33.80297352	-118.060506	Orange County
61839	Fee-for-Service	1407113061	1407113061	1	1	GONZALEZ, LESLIE A LMFT	9/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
61850	Fee-for-Service	1487016697	1487016697	1	1	GETZ, ARIANA MD DO	4/2/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	16435	None	None	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
61863	Fee-for-Service	1649462144	1649462144	2	1	GREEN, ABE MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48234	45	Nephrology (Renal-Kidney)	0	In state provider	None	2080 CENTURY PARK E	SUITE 1410	LOS ANGELES	CA	90067	2017	19	06037	34.05887194	-118.4122914	Los Angeles County
61929	Fee-for-Service	1164458170	1164458170	1	1	GLAZENER, CHRISTOPHER H	7/1/1989	207L00000X	NA	Other	026	PHYSICIANS	37699	None	None	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
61967	Fee-for-Service	1063001402	1063001402	1	1	GUZIEWICZ, KRISTIN K CCC-SLP	2/23/2021	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
61986	Fee-for-Service	1124470968	1124470968	1	1	GALLEGOS, DEANNA M LCSW	2/20/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
62009	Fee-for-Service	1306379508	1306379508	1	1	GONZALEZ, TARA J MD	1/21/2021	390200000X	NA	Other	026	PHYSICIANS	158829	None	None	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
62029	Fee-for-Service	1245239672	1245239672	1	1	GARB,LESLIE 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	5420 DASHWOOD	STE 100	HOUSTON	TX	77081	0000	00	None	29.70746993	-95.47502574	Harris County
62033	Fee-for-Service	1184885865	1184885865	1	1	GUPTA, SHALINI MD	9/25/2024	207RS0012X	NA	Other	026	PHYSICIANS	184938	41	Internal Medicine	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
62034	Fee-for-Service	1265477160	1265477160	1	1	GARFIELD BEACH CVS LLC	12/24/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4040 E CHAPMAN AVE	None	ORANGE	CA	92869	3917	30	06059	33.78773247	-117.810468	Orange County
62041	Fee-for-Service	1972104644	1972104644	1	1	GACHOMO, EUNICE W	11/20/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	31620 POMPEI LN	None	WINCHESTER	CA	92596	8695	33	06065	33.59150756	-117.1077773	Riverside County
62053	Fee-for-Service	1063449452	1063449452	1	1	GROVER, ATUL MD INC	11/1/1998	207L00000X	NA	Other	026	PHYSICIANS	55575	05	Anesthesiology	0	In state provider	None	1530 E CHEVY CHASE DR	STE 205A	GLENDALE	CA	91206	4168	19	06037	34.150689	-118.2303855	Los Angeles County
62087	Fee-for-Service	1356839229	1356839229	1	1	GUTOWSKI, KIMBERLY A MD	9/7/2021	207R00000X	NA	Other	026	PHYSICIANS	173902	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
62126	Fee-for-Service	1548228588	1548228588	1	1	GROSS, RUSSELL J MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31869	02	General Surgery	0	In state provider	None	7301 TOPANGA CANYON BLVD	STE 330	CANOGA PARK	CA	91303	1357	19	06037	34.203222	-118.605988	Los Angeles County
62157	Fee-for-Service	1831207877	1831207877	1	1	GILMAN,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	171 ASHLEY AVE	None	CHARLESTON	SC	29425	0001	00	None	32.78556	-79.9467075	Charleston County
62173	Fee-for-Service	1972504520	1972504520	1	1	GUPTA, RAVI MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	45396	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8737 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2401	19	06037	34.2284967	-118.4502302	Los Angeles County
62233	Fee-for-Service	1427347764	1427347764	1	1	GRONER, MORDECHAI MD	3/19/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	183131	None	None	0	In state provider	None	12021 WILMINGTON AVE	BUILDING 11, SUITE 1000	LOS ANGELES	CA	90059	3019	19	06037	33.922863	-118.2431655	Los Angeles County
62238	Fee-for-Service	1447212691	1447212691	1	1	GINSBURG, JERRY H MD	1/2/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	21014	41	Internal Medicine	0	In state provider	None	254 SAN JOSE ST	None	SALINAS	CA	93901	3900	27	06053	36.65812965	-121.6458796	Monterey County
62239	Fee-for-Service	1598780900	1598780900	1	1	GOLDYNE, MARC E MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	24290	07	Dermatology	0	In state provider	None	2299 POST ST	STE 310	SAN FRANCISCO	CA	94115	3475	38	06075	37.78434298	-122.4392033	San Francisco County
62276	Fee-for-Service	1174549901	1174549901	1	1	GRABIEL, FEDERICO A MD	5/31/1990	207P00000X	NA	Other	026	PHYSICIANS	42198	08	Family Practice	0	In state provider	None	CLAIRMONT HEIGHTS	None	REDDING	CA	96099	0000	45	06089	0	0	None
62289	Fee-for-Service	1083226575	1083226575	1	1	GREEN HILLS HOSPICE INC	12/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	121 W LEXINGTON DR	STE 305 A	GLENDALE	CA	91203	2230	19	06037	34.1517575	-118.2560706	Los Angeles County
62293	Fee-for-Service	1164953519	1164953519	1	1	GORADIA, YASHESH	7/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	312 W J ST	None	LOS BANOS	CA	93635	4069	24	06047	37.06221105	-120.8570564	Merced County
62327	Fee-for-Service	1972104644	1972104644	1	1	GACHOMO, EUNICE W	11/20/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	31620 POMPEI LN	None	WINCHESTER	CA	92596	8695	33	06065	33.59150756	-117.1077773	Riverside County
62331	Fee-for-Service	1356426019	1356426019	1	1	GRAMMER, JACKLIN S MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84008	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
62347	Fee-for-Service	1144989096	1144989096	1	1	GREAT GRACE HOME INC	4/28/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	SUITE 834	GLENDALE	CA	91203	4451	19	06037	34.151958	-118.255149	Los Angeles County
62366	Fee-for-Service	1932306230	1932306230	1	1	GERLACH, KAREN E MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118446	30	Radiology	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
62395	Fee-for-Service	1548500259	1548500259	1	1	GARG, ANU MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139624	40	Pediatrics	0	In state provider	None	9375 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
62397	Fee-for-Service	1336603422	1336603422	1	1	GAYNOR, ERYN L CCC-SLP	11/14/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1040 TIERRA DEL REY	SUITE 107	CHULA VISTA	CA	91910	7865	37	06073	32.63789897	-117.0176377	San Diego County
62455	Fee-for-Service	1033748132	1033748132	1	1	GOPALAKRISHNAN, HANSAA MD	1/12/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
62459	Fee-for-Service	1699821835	1699821835	1	1	GOETSCH-STINGL, JONICA	3/13/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
62469	Fee-for-Service	1649483306	1649483306	1	1	GOLDEN VALLEY HEALTH	7/1/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTERS-LOS BANOS DENTAL	725 I ST	None	LOS BANOS	CA	93635	4308	24	06047	37.06001109	-120.8459687	Merced County
62475	Fee-for-Service	1184987372	1184987372	1	1	GOKHROO, RAHUL MD FACC	2/22/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	175041	None	None	0	In state provider	None	949 CALHOUN PL	STE D	HEMET	CA	92543	4403	33	06065	33.7502744	-116.9618423	Riverside County
62494	Fee-for-Service	1659829059	1659829059	1	1	GONZALES, MICHELLE S NP	9/28/2018	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
62536	Fee-for-Service	1306079660	1306079660	1	1	GRIFFITH, ELEONOR L DO	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12052	08	Family Practice	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
62577	Fee-for-Service	1083226575	1083226575	1	1	GREEN HILLS HOSPICE INC	12/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	121 W LEXINGTON DR	STE 305 A	GLENDALE	CA	91203	2230	19	06037	34.1517575	-118.2560706	Los Angeles County
62586	Fee-for-Service	1134134687	1134134687	1	1	GNAUCK, 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	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
62616	Fee-for-Service	1629417464	1629417464	1	1	GONZALEZ, VERONICA A LCSW	4/19/2021	1835P1300X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
62618	Fee-for-Service	1023024254	1023024254	1	1	GLYNN, JAMES J MD INC	8/13/1975	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	22422	20	Orthopedic Surgery	0	In state provider	None	1496 PROFESSIONAL DRIVE	SUITE 601	PETALUMA	CA	94952	0000	49	06097	38.25575122	-122.6329158	Sonoma County
62622	Fee-for-Service	1659669737	1659669737	1	1	GLOCKE, STEVEN C JR MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122661	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
62690	Fee-for-Service	1760936595	1760936595	1	1	GARFIELD BEACH CVS LLC	3/30/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	336 N MILPAS ST	None	SANTA BARBARA	CA	93103	3257	42	06083	34.42518543	-119.6837379	Santa Barbara County
62696	Fee-for-Service	1124007430	1124007430	1	2	GREENE, GILBERT E DO	10/5/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	4367	-	NOT APPLICABLE	0	In state provider	None	1111 N EL DORADO STREET	None	STOCKTON	CA	95202	1305	39	06077	37.96379262	-121.2929073	San Joaquin County
62706	Fee-for-Service	1366700817	1366700817	1	1	GALEN INPATIENT PHYSICIANS P	1/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
62739	Fee-for-Service	1750327813	1750327813	1	1	GARFIELD BEACH CVS LLC	4/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4235 PACIFIC COAST HWY	None	TORRANCE	CA	90505	5525	19	06037	33.80817211	-118.3588219	Los Angeles County
62775	Fee-for-Service	1649483306	1649483306	1	1	GOLDEN VALLEY HEALTH	7/1/2005	1223G0001X	NA	Dental Provider	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTERS-LOS BANOS DENTAL	725 I ST	None	LOS BANOS	CA	93635	4308	24	06047	37.06001109	-120.8459687	Merced County
62802	Fee-for-Service	1114285574	1114285574	1	1	GORDON-ELDRED, RACHEL	8/28/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST 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
62842	Fee-for-Service	1083880256	1083880256	1	1	GARLICH HORNER, FIONA M MD	4/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137178	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
62882	Fee-for-Service	1790440360	1790440360	1	1	GENOA HEALTHCARE LLC	11/10/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2178 JOHNSON AVE	SUITE P1	SAN LUIS OBISPO	CA	93401	4535	40	06079	35.27488974	-120.6468257	San Luis Obispo County
62903	Fee-for-Service	1366704652	1366704652	1	1	GREWAL, INDERVIR S MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139470	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
62930	Fee-for-Service	1881753465	1881753465	1	1	GARCIA, CHARLES R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43627	77	Infectious Disease	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
62932	Fee-for-Service	1104297696	1104297696	1	1	GOULD, HILARY PHD	9/15/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
62955	Fee-for-Service	1508511346	1508511346	1	1	GREENBAUM, HANNAH	6/5/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
62967	Fee-for-Service	1013913664	1013913664	1	1	GUADAGNI, JAMES R MD	1/31/1985	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	53529	20	Orthopedic Surgery	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
63005	Fee-for-Service	1629189659	1629189659	1	1	GEHRING, JANE C 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
63064	Fee-for-Service	1972366698	1972366698	1	1	GARFIELD BEACH CVS, L.L.C.	9/11/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12920 FOOTHILL BLVD	None	SAN FERNANDO	CA	91340	0000	19	06037	34.29306	-118.41786	Los Angeles County
63091	Fee-for-Service	1174784425	1174784425	2	1	GARFIELD BEACH CVS LLC	5/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2705 TELLER RD	None	THOUSAND OAKS	CA	91320	1190	56	06111	34.18993551	-118.934019	Ventura County
63113	Fee-for-Service	1073892956	1073892956	1	1	GALLEGOS, GUADALUPE LCSW	9/14/2023	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
63193	Fee-for-Service	1497747562	1497747562	1	1	GLINN & GIORDANO PHYSICAL TH	9/25/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERAPY, INC.	9501 FLUSHING QUAIL RD	SUITES 8,9 & 10	BAKERSFIELD	CA	93312	2660	15	06029	35.38617049	-119.10825	Kern County
63214	Fee-for-Service	1881753465	1881753465	1	1	GARCIA, CHARLES R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43627	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
63221	Fee-for-Service	1568490563	1568490563	1	1	GARRITY, KELLY	2/26/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
63264	Fee-for-Service	1568524213	1568524213	1	1	GELLNER, ZUZANA R OD	6/27/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EUREKA OPTOMETRIC CENTER	2369 HARRISON AVE	None	EUREKA	CA	95501	3216	12	06023	40.7855811	-124.1396109	Humboldt County
63277	Fee-for-Service	1609801299	1609801299	1	1	GREINER, ALEXANDER N MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77327	41	Internal Medicine	0	In state provider	None	9610 GRANITE RIDGE DR	STE B	SAN DIEGO	CA	92123	2684	37	06073	32.80529877	-117.1207841	San Diego County
63282	Fee-for-Service	1619003282	1619003282	1	1	GLADSTONE, HAYES B MD	10/1/2000	207N00000X	NA	Dermatology	026	PHYSICIANS	52367	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
63293	Fee-for-Service	1831134725	1831134725	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	455 N STATE COLLEGE BLVD	None	FULLERTON	CA	92831	4258	30	06059	33.87384106	-117.8896414	Orange County
63328	Fee-for-Service	1649640988	1649640988	1	1	GRAVIN, ANTHONY S	6/14/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1528 PLUMAS COURT	SUITE 200	YUBA CITY	CA	95991	2973	51	06101	39.15297032	-121.6186294	Sutter County
63353	Fee-for-Service	1245367945	1245367945	1	1	GOLDBERG, ANNELISE MD	2/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73730	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
63373	Fee-for-Service	1164148722	1164148722	1	1	GUILES, NATALIA CNP	6/26/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	683 LOMAS SANTA FE DR	None	SOLANA BEACH	CA	92075	1412	37	06073	32.99596006	-117.2594441	San Diego County
63402	Fee-for-Service	1023534443	1023534443	1	1	GHC OF SAN RAFAEL, LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1550 SILVEIRA PKWY	None	SAN RAFAEL	CA	94903	4879	21	06041	38.01999969	-122.5256819	Marin County
63412	Fee-for-Service	1144884388	1144884388	2	1	GREWAL, DILRAJ K MD	5/26/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179935	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
63448	Fee-for-Service	1518112382	1518112382	1	1	GUERRERO, RICHARD A JR	4/3/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	MD AMC	11100 WARNER AVE	STE 258	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
63468	Fee-for-Service	1235494360	1235494360	1	1	GINSBERG, CHARLES MD	6/22/2018	163WN0300X	NA	Other	026	PHYSICIANS	135730	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
63485	Fee-for-Service	1821754383	1821754383	1	1	GREEN TREE HOME CARE LLC	9/6/2023	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	9466 CUYAMACA ST	STE 102	SANTEE	CA	92071	5923	37	06073	32.84914754	-116.9835027	San Diego County
63501	Fee-for-Service	1184735086	1184735086	1	1	GARCIA, PAUL A MD	4/30/1990	2084N0400X	NA	Neurology	026	PHYSICIANS	65947	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	# A887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63520	Fee-for-Service	1750405296	1750405296	1	1	GONZALEZ, LUCIA C LCSW	5/26/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
63527	Fee-for-Service	1518916881	1518916881	1	1	GABRIEL, ANTHONY E MD	1/3/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	82095	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
63557	Fee-for-Service	1265506109	1265506109	1	1	GASKINS, HAMPTON MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	36905	20	Orthopedic Surgery	0	In state provider	None	548 N 13TH AVE	STE 304	UPLAND	CA	91786	4976	36	06071	34.10032426	-117.6334669	San Bernardino County
63569	Fee-for-Service	1609801299	1609801299	1	1	GREINER, ALEXANDER N MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77327	03	Allergy	0	In state provider	None	9610 GRANITE RIDGE DR	STE B	SAN DIEGO	CA	92123	2684	37	06073	32.80529877	-117.1207841	San Diego County
63612	Fee-for-Service	1801260773	1801260773	1	1	GOLLIN, GERALD MD INC	8/1/2016	2086S0120X	NA	General Surgery	026	PHYSICIANS	84953	40	Pediatrics	0	In state provider	None	317 N EL CAMINO REAL	STE 502	ENCINITAS	CA	92024	2816	37	06073	33.05428107	-117.2615637	San Diego County
63633	Fee-for-Service	1861507626	1861507626	1	1	GINTHER, BRET E MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
63680	Fee-for-Service	1386722486	1386722486	1	1	GINCAUSKAS, AURELIA T MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	40550	08	Family Practice	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
63685	Fee-for-Service	1255369542	1255369542	1	1	GUPTA, MUKESH B MD	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70036	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	STE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
63710	Fee-for-Service	1093210981	1093210981	1	1	GUSTAFSON, KEVIN M MD	6/6/2022	390200000X	NA	Other	026	PHYSICIANS	165714	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
63720	Fee-for-Service	1063560076	1063560076	1	1	GELFAND, LILIA OD	11/17/2014	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
63727	Fee-for-Service	1053840660	1053840660	1	1	GARCIA, EVELYN CNP	10/20/2022	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
63748	Fee-for-Service	1285793943	1285793943	1	1	GBENEDIO, FRANKLIN D DO	10/12/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6495	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
63762	Fee-for-Service	1508956178	1508956178	1	1	GREEMBERG. STEWARD 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
63815	Fee-for-Service	1518916881	1518916881	1	1	GABRIEL, ANTHONY E MD	1/3/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	82095	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
63834	Fee-for-Service	1629013537	1629013537	1	1	GUTKIND, DAVID A	2/26/2015	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
63840	Fee-for-Service	1790250306	1790250306	1	1	GROVEN, AMY LMFT	8/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4016 SAN CARLOS WAY	None	SACRAMENTO	CA	95820	2712	34	06067	38.538279	-121.4621325	Sacramento County
63856	Fee-for-Service	1023470309	1023470309	1	1	GOLDEN, ADAM C MD	9/3/2024	2086S0102X	NA	General Surgery	026	PHYSICIANS	153566	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3630 IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
63890	Fee-for-Service	1306194196	1306194196	1	1	GONZALES, CHRISTOPHER M LCSW	4/30/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95146	-	NOT APPLICABLE	0	In state provider	None	1340 TULLY ROAD	301 AND 304	SAN JOSE	CA	95122	3055	43	06085	37.31710924	-121.8334186	Santa Clara County
63891	Fee-for-Service	1962625384	1962625384	1	1	GUDAPATI, SANDHYA R MD	9/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	46239	26	Psychiatry (child)	0	In state provider	None	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
63904	Fee-for-Service	1801260773	1801260773	1	1	GOLLIN, GERALD MD INC	8/1/2016	2086S0120X	NA	General Surgery	026	PHYSICIANS	84953	02	General Surgery	0	In state provider	None	317 N EL CAMINO REAL	STE 502	ENCINITAS	CA	92024	2816	37	06073	33.05428107	-117.2615637	San Diego County
63923	Fee-for-Service	1861507626	1861507626	1	1	GINTHER, BRET E MD	10/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55385	01	General Practice	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
63945	Fee-for-Service	1487018578	1487018578	1	1	GADDAM, DURGA SIVACHARAN	5/18/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172641	None	None	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
63967	Fee-for-Service	1851816383	1851816383	1	1	GONSALVES, DIANA L CRNA	8/18/2021	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
63968	Fee-for-Service	1184653628	1184653628	1	1	GUZMAN, JULIO V MD	12/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66211	08	Family Practice	0	In state provider	JULIO V GUZMAN MD INC	4214 BEVERLY BLVD	STE 212	LOS ANGELES	CA	90004	4429	19	06037	34.0762665	-118.3010445	Los Angeles County
63981	Fee-for-Service	1558688572	1558688572	1	1	GIPP, MELANIE S MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113250	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
63989	Fee-for-Service	1023336831	1023336831	1	1	GURUSINGHE, DUMINDRA MD	7/27/2020	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	145203	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
64038	Fee-for-Service	1285793943	1285793943	1	1	GBENEDIO, FRANKLIN D DO	10/12/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6495	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
64044	Fee-for-Service	1952471914	1952471914	1	1	GOOD SAMARITAN HOSP	6/28/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2222 PHILADELPHIA DR	None	DAYTON	OH	45406	1891	00	None	39.78749248	-84.23490647	Montgomery County
64066	Fee-for-Service	1538524475	1538524475	1	1	GILLESPIE, BRYANA CRNA	3/8/2016	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
64095	Fee-for-Service	1831276765	1831276765	1	1	GONG, I-CHING MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69061	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
64097	Fee-for-Service	1346639077	1346639077	1	1	GONZALES, STEVEN P SR	3/3/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4836 N FIRST ST	STE 102	FRESNO	CA	93726	0527	10	06019	36.80566205	-119.7720258	Fresno County
64105	Fee-for-Service	1457316705	1457316705	1	1	GRAY, BRIAN CHARLES MD	12/3/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54225	None	None	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
64121	Fee-for-Service	1356483861	1356483861	2	1	GRAHAM, DRAYTON P JR MD	12/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	27833	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4477 W 118TH ST	STE 401	HAWTHORNE	CA	90250	2269	19	06037	33.92734752	-118.354221	Los Angeles County
64137	Fee-for-Service	1871884569	1871884569	1	1	GARCIA, ALFRED J MD	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119403	None	None	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
64152	Fee-for-Service	1598912982	1598912982	1	1	GUAJARDO, ANGELICA LMFT	12/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ERAPY OF THE DESERT	78046 CALLE BARCELONA	STE 7	LA QUINTA	CA	92253	3932	33	06065	33.67408846	-116.30286	Riverside County
64179	Fee-for-Service	1962625384	1962625384	1	1	GUDAPATI, SANDHYA R MD	9/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	46239	36	Psychiatry	0	In state provider	None	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
64206	Fee-for-Service	1346574829	1346574829	1	1	GUNION, SABRINA M MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117053	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 L ST	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
64281	Fee-for-Service	1083710891	1083710891	1	1	GOLDSBY, ROBERT E MD	4/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76127	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
64317	Fee-for-Service	1609811405	1609811405	1	1	GARFIELD BEACH CVS, LLC	10/26/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3120 W IMPERIAL HWY	None	INGLEWOOD	CA	90303	3112	19	06037	33.929676	-118.3272705	Los Angeles County
64336	Fee-for-Service	1952471914	1952471914	1	1	GOOD SAMARITAN HOSP	8/25/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2222 PHILADELPHIA DR	None	DAYTON	OH	45406	1891	00	None	39.78749248	-84.23490647	Montgomery County
64340	Fee-for-Service	1437237047	1437237047	1	1	GONZALEZ, MARTHA C MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82328	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
64370	Fee-for-Service	1629145636	1629145636	1	1	GUISS, LEWIS W JR MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	32716	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
64372	Fee-for-Service	1366487266	1366487266	1	1	GARFIELD BEACH CVS, LLC	9/3/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2510 EL CAMINO REAL	None	CARLSBAD	CA	92008	1273	37	06073	33.17942276	-117.3266425	San Diego County
64406	Fee-for-Service	1356483861	1356483861	2	1	GRAHAM, DRAYTON P JR MD	12/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	27833	41	Internal Medicine	0	In state provider	None	4477 W 118TH ST	STE 401	HAWTHORNE	CA	90250	2269	19	06037	33.92734752	-118.354221	Los Angeles County
64422	Fee-for-Service	1558690396	1558690396	1	1	GONZALES, REMEDIOS D NP	11/14/2017	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
64428	Fee-for-Service	1093970287	1093970287	1	1	GERRY, RYAN R MD	6/6/2022	208600000X	NA	General Surgery	026	PHYSICIANS	174296	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
64458	Fee-for-Service	1861480998	1861480998	1	1	GENTILE, MARY C DO	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	6416	08	Family Practice	0	In state provider	None	8881 FLETCHER PKWY	STE 105	LA MESA	CA	91942	3132	37	06073	32.78442148	-117.0073814	San Diego County
64466	Fee-for-Service	1134392822	1134392822	1	1	GINORY, LAURA MD	11/25/2024	2084P0804X	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
64510	Fee-for-Service	1558096073	1558096073	1	1	GRIGGS, BRITTANY LMFT	3/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
64554	Fee-for-Service	1558362954	1558362954	1	1	GATLIN, JARVIS MD	7/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64705	41	Internal Medicine	0	In state provider	None	11539 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
64570	Fee-for-Service	1083710891	1083710891	1	1	GOLDSBY, ROBERT E MD	4/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76127	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
64584	Fee-for-Service	1871506808	1871506808	1	1	GOTTLIEB, MICHAEL S MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	34195	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 505	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
64631	Fee-for-Service	1013175363	1013175363	1	1	GOPEZ, KATHRYN MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108979	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
64711	Fee-for-Service	1659662351	1659662351	1	3	G & C SWAN INC	12/21/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	T	227 N PALM AVE	None	UPLAND	CA	91786	5939	36	06071	34.096689	-117.6537295	San Bernardino County
64721	Fee-for-Service	1417983792	1417983792	1	1	GRIGSBY, KENNETH J MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
64736	Fee-for-Service	1265635445	1265635445	1	1	GARCHA, SONNY MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105000	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
64749	Fee-for-Service	1770019580	1770019580	1	1	GOLFEIZ, HOOMAN MD	1/6/2021	207L00000X	NA	Other	026	PHYSICIANS	148299	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
64753	Fee-for-Service	1982849394	1982849394	1	1	GOLD, JEREMY B MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131451	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
64780	Fee-for-Service	1659888410	1659888410	1	1	GOETHEL, JAMES W LMFT	8/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	835 5TH AVE	STE 407	SAN DIEGO	CA	92101	6136	37	06073	32.71418749	-117.1601296	San Diego County
64790	Fee-for-Service	1407317209	1407317209	1	1	GHAZARIAN, ARMEN S MD	6/28/2022	207R00000X	NA	Other	026	PHYSICIANS	177619	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
64816	Fee-for-Service	1275162265	1275162265	1	1	GARCIA, ANTONIO MD	8/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185817	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
64834	Fee-for-Service	1366520033	1366520033	1	1	GARAPATI, SRIDEVI MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76346	41	Internal Medicine	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
64838	Fee-for-Service	1447814710	1447814710	1	1	GRAY, JASMINE A MD	11/5/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	180558	36	Psychiatry	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
64851	Fee-for-Service	1417088055	1417088055	1	1	GLASS, CRAIG W LMFT	10/5/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE ST	STE 6	MISSION HILLS	CA	91345	2755	19	06037	34.25726849	-118.4664285	Los Angeles County
64878	Fee-for-Service	1982870945	1982870945	1	1	GOMEZ, CARLOS A LMFT	6/13/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	48207	-	NOT APPLICABLE	0	In state provider	None	1334 POST AVE	None	TORRANCE	CA	90501	2620	19	06037	33.83521638	-118.3175802	Los Angeles County
64886	Fee-for-Service	1053733121	1053733121	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5630 COTTLE ROAD	None	SAN JOSE	CA	95123	3696	43	06085	37.25079598	-121.803905	Santa Clara County
64890	Fee-for-Service	1366175002	1366175002	1	1	GEORGE, KIMBERLY D CNM	1/11/2023	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
64892	Fee-for-Service	1285697144	1285697144	1	1	GARI, RODOLFO MD	6/24/2020	207LP2900X	NA	Other	026	PHYSICIANS	89391	05	Anesthesiology	0	In state provider	None	295 IMPERIAL HWY	SUITE 100	FULLERTON	CA	92835	1020	30	06059	33.91748047	-117.9291825	Orange County
64935	Fee-for-Service	1013106640	1013106640	1	1	GABHART, JULIA M MD	8/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105203	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
64942	Fee-for-Service	1891039616	1891039616	1	1	GONZALEZ, DEBORAH H	3/6/2019	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
64954	Fee-for-Service	1831159714	1831159714	1	1	GOODMAN, JEFFREY S MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67030	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	8631 W 3RD ST	STE 445E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
64973	Fee-for-Service	1154980571	1154980571	1	1	GEORGE, SANMISOLA MD	10/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183488	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
64987	Fee-for-Service	1518966035	1518966035	1	1	GERKEN, VICTORIA MD	2/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	64845	33	Thoracic Surgery	0	In state provider	None	5533 W HILLSDALE AVE	STE C	VISALIA	CA	93291	5138	54	06107	36.329238	-119.35251	Tulare County
65007	Fee-for-Service	1609890573	1609890573	1	2	GOLDEN, PATRICK A MD	12/4/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	51665	-	NOT APPLICABLE	0	In state provider	None	1275 E SPRUCE	SUITE 103	FRESNO	CA	93720	9936	10	06019	36.84188784	-119.7601013	Fresno County
65014	Fee-for-Service	1538256680	1538256680	1	1	GREGORY S. HALL, M.D.	5/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	# 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
65029	Fee-for-Service	1952390577	1952390577	1	1	GOLDEN GATE URGENT CARE INC	9/8/2004	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	HEALTH PHYS MED GRP, INC	750 REDWOOD HWY	SUITE 1204	MILL VALLEY	CA	94941	2483	21	06041	37.89525674	-122.5158838	Marin County
65032	Fee-for-Service	1851377741	1851377741	1	1	GENG, JULIE MD	6/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88051	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
65034	Fee-for-Service	1295776235	1295776235	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	900 SPECTRUM CENTER DR	None	IRVINE	CA	92618	4958	30	06059	33.648057	-117.7410555	Orange County
65035	Fee-for-Service	1093009060	1093009060	1	1	GLASSNER, CATHY LMFT	2/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24977 WASHINGTON AVENUE	SUITES K & L	MURRIETA	CA	92562	6149	33	06065	33.55150034	-117.2118708	Riverside County
65040	Fee-for-Service	1073633731	1073633731	1	1	GREGSON, CHESTER T LMFT	4/4/2022	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
65045	Fee-for-Service	1609850700	1609850700	1	1	GIACONI, MIRKO A MD INC	11/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	25678	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1360 W 6TH ST	STE 205	SAN PEDRO	CA	90732	3567	19	06037	33.73886546	-118.3075065	Los Angeles County
65165	Fee-for-Service	1134150881	1134150881	1	1	GUANZON, JOSE MARIA MD	12/21/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	46670	41	Internal Medicine	0	In state provider	None	2350 MCKEE RD	None	SAN JOSE	CA	95116	1617	43	06085	37.36631785	-121.848368	Santa Clara County
65167	Fee-for-Service	1447870639	1447870639	1	1	GUARDIAN ANGEL FAMILY COUNSE	5/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LING PC	12371 LEWIS ST	103	GARDEN GROVE	CA	92840	4687	30	06059	33.78341032	-117.8984137	Orange County
65197	Fee-for-Service	1730241589	1730241589	1	1	GAUDIANI, LINDA M MD	10/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	35364	67	Endocrinology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
65242	Fee-for-Service	1831159714	1831159714	1	1	GOODMAN, JEFFREY S MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67030	41	Internal Medicine	0	In state provider	INC	8631 W 3RD ST	STE 445E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
65268	Fee-for-Service	1477554988	1477554988	1	1	GAYID, MAMDOOH Z MD	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85467	41	Internal Medicine	0	In state provider	None	5957 W RAMSEY ST	None	BANNING	CA	92220	3058	33	06065	33.92937645	-116.942463	Riverside County
65274	Fee-for-Service	1518966035	1518966035	1	1	GERKEN, VICTORIA MD	2/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	64845	02	General Surgery	0	In state provider	None	5533 W HILLSDALE AVE	STE C	VISALIA	CA	93291	5138	54	06107	36.329238	-119.35251	Tulare County
65307	Fee-for-Service	1407129687	1407129687	1	1	GREEN-RUSSELL, KIMBERLY N LM	3/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
65319	Fee-for-Service	1952390577	1952390577	1	1	GOLDEN GATE URGENT CARE INC	9/8/2004	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	HEALTH PHYS MED GRP, INC	750 REDWOOD HWY	SUITE 1204	MILL VALLEY	CA	94941	2483	21	06041	37.89525674	-122.5158838	Marin County
65323	Fee-for-Service	1164606885	1164606885	1	1	GILBERT, HEATHER M MD	4/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105643	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
65336	Fee-for-Service	1053304170	1053304170	1	1	GREENLEE, JEREMY D MD	6/20/2021	207T00000X	NA	General Surgery	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
65338	Fee-for-Service	1629205307	1629205307	1	1	GHARIBIAN, EMIN PSYD	10/18/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
65355	Fee-for-Service	1386713774	1386713774	1	1	GALLA CORP	4/5/2010	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ENCINO ADULT DAY HEALTH	17815 VENTURA BLVD	None	ENCINO	CA	91316	3610	19	06037	34.16304434	-118.5206593	Los Angeles County
65366	Fee-for-Service	1669463964	1669463964	1	1	GWINUP, GRANT R MD	2/28/1988	207P00000X	NA	Other	026	PHYSICIANS	57154	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
65389	Fee-for-Service	1861484420	1861484420	1	1	GRIER, MELISSA M MD	4/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	82969	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	44105 15TH ST W	STE 301	LANCASTER	CA	93534	4089	19	06037	34.684218	-118.1568465	Los Angeles County
65394	Fee-for-Service	1154943330	1154943330	1	1	GARCIA, ULYSSES R DO	6/20/2023	207P00000X	NA	Other	026	PHYSICIANS	19809	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
65427	Fee-for-Service	1023462181	1023462181	1	1	GENE RICHARD RADINO	10/1/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	823 E ORANGEBURG AVE	None	MODESTO	CA	95350	4619	50	06099	37.66364047	-120.98268	Stanislaus County
65429	Fee-for-Service	1912263500	1912263500	1	1	GUZMAN, AMANDA P MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138401	01	General Practice	0	In state provider	None	1301 MISSION ST	None	SANTA CRUZ	CA	95060	3528	44	06087	36.96817615	-122.0381947	Santa Cruz County
65448	Fee-for-Service	1457365512	1457365512	1	1	GUPTA, RADHA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72480	67	Endocrinology	0	In state provider	None	16444 PARAMOUNT BLVD	STE 103	PARAMOUNT	CA	90723	5453	19	06037	33.8848179	-118.1599671	Los Angeles County
65524	Fee-for-Service	1871642058	1871642058	1	1	GONZALEZ, RAUL LCSW	4/7/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	7515 VAN NUYS BLVD	URGENT CARE ROOMS 122,12	VAN NUYS	CA	91405	1949	19	06037	34.207344	-118.4487995	Los Angeles County
65548	Fee-for-Service	1780752873	1780752873	1	1	GUTOW, ANDREW P MD	10/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81408	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
65557	Fee-for-Service	1518083765	1518083765	1	1	GORDON, KAREN J NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2103 E GONZALES RD	None	OXNARD	CA	93036	3757	56	06111	34.2189506	-119.151337	Ventura County
65558	Fee-for-Service	1831258433	1831258433	1	1	GARCIA, JOSE M MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68292	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
65566	Fee-for-Service	1851697478	1851697478	1	1	GOETTE, CHRISTINA C MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116584	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
65569	Fee-for-Service	1255560967	1255560967	1	1	GERMAN, AIMEE S P MD	1/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110747	07	Dermatology	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
65607	Fee-for-Service	1952390577	1952390577	1	1	GOLDEN GATE URGENT CARE INC	9/8/2004	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	HEALTH PHYS MED GRP, INC	750 REDWOOD HWY	SUITE 1204	MILL VALLEY	CA	94941	2483	21	06041	37.89525674	-122.5158838	Marin County
65640	Fee-for-Service	1902578578	1902578578	1	1	GENUINE HOME HEALTH INC	5/15/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14242 VENTURA BLVD	STE 234	SHERMAN OAKS	CA	91423	2757	19	06037	34.14999696	-118.4433632	Los Angeles County
65663	Fee-for-Service	1801974977	1801974977	1	1	GRULLON, KENNETH E MD	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	76376	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
65678	Fee-for-Service	1265508980	1265508980	1	1	GAMBOA, EDGAR A MD	12/23/2014	208600000X	NA	General Surgery	026	PHYSICIANS	41857	02	General Surgery	0	In state provider	None	1745 S IMPERIAL AVE	STE 104	EL CENTRO	CA	92243	4243	13	06025	32.77792365	-115.569499	Imperial County
65682	Fee-for-Service	1669549671	1669549671	1	1	GAMBRELL, JOSEPH M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36959	40	Pediatrics	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
65691	Fee-for-Service	1467689513	1467689513	1	1	GOERIG, RYAN C MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113581	07	Dermatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
65714	Fee-for-Service	1568676492	1568676492	1	1	GAPASIN MANOR INC	9/21/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2451 SHROPSHIRE DR	None	STOCKTON	CA	95209	1701	39	06077	38.03234791	-121.3449731	San Joaquin County
65725	Fee-for-Service	1891163374	1891163374	1	1	GONZALEZ BARAJAS, BRENDA LC	6/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	1255 W COLTON AVE STE 58	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
65726	Fee-for-Service	1598416752	1598416752	1	1	GRAMAJO-REYES, SHARON LMSW	12/12/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4000 MAGNOLIA BLVD	A	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
65737	Fee-for-Service	1457365512	1457365512	1	1	GUPTA, RADHA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72480	41	Internal Medicine	0	In state provider	None	16444 PARAMOUNT BLVD	STE 103	PARAMOUNT	CA	90723	5453	19	06037	33.8848179	-118.1599671	Los Angeles County
65807	Fee-for-Service	1447727235	1447727235	1	1	GARDENA PHYSICAL THERAPY INC	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
65831	Fee-for-Service	1558121434	1558121434	1	1	GENSLER, BRANDEE L LCSW	6/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
65838	Fee-for-Service	1477534204	1477534204	1	1	GARUDA, SANJAY R MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54101	10	Gastroenterology (M.D. only)	0	In state provider	None	39400 PASEO PADRE PARKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
65854	Fee-for-Service	1215608195	1215608195	1	1	GNA HOME HEALTH CARE	10/5/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6240 LAUREL CANYON BLVD	STE 207	NORTH HOLLYWOOD	CA	91606	3219	19	06037	34.184367	-118.3965135	Los Angeles County
65862	Fee-for-Service	1295399012	1295399012	1	1	GILL, PUNEET K DO	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	19569	None	None	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
65924	Fee-for-Service	1174581839	1174581839	2	1	GRUBB, KRISTEN R MD	12/13/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53036	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
65930	Fee-for-Service	1609924786	1609924786	1	1	GONZALES, STEPHANIE E LCSW	8/14/2017	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
65938	Fee-for-Service	1124484209	1124484209	1	1	GRAND VENICE LLC	3/24/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2974 WILSHIRE BLVD	None	LOS ANGELES	CA	90010	1101	19	06037	34.0617567	-118.2863693	Los Angeles County
65940	Fee-for-Service	1386904985	1386904985	1	1	GENASCI, GENO G MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130721	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
65953	Fee-for-Service	1154724854	1154724854	1	1	GREEN VALLEY HOSPICE &	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	19031 HWY 18	SUITE 160	APPLE VALLEY	CA	92307	2515	36	06071	34.53673256	-117.2487466	San Bernardino County
65955	Fee-for-Service	1669632220	1669632220	1	1	GROSS, ERIC R MD	10/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105620	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
66058	Fee-for-Service	1821370040	1821370040	1	1	GEORGE, SHARON MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134788	41	Internal Medicine	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
66093	Fee-for-Service	1336400381	1336400381	1	1	GARCIA, MELISSA R MD	6/13/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	None	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
66140	Fee-for-Service	1558627174	1558627174	1	1	GARG, ASHU MD	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146722	01	General Practice	0	In state provider	None	4700 NORTHGATE BLVD	STE 100	SACRAMENTO	CA	95834	1128	34	06067	38.654262	-121.4770455	Sacramento County
66158	Fee-for-Service	1699916643	1699916643	1	1	GORDON, COURTNEY K 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
66160	Fee-for-Service	1619908829	1619908829	1	1	GREENWALD, BRUCE MD	6/30/1986	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	48134	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
66164	Fee-for-Service	1275799538	1275799538	1	1	GRAFMAN, SUSAN	12/17/2012	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	100 NORTH BRAND	SUITE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
66193	Fee-for-Service	1992865315	1992865315	1	1	GELKE, CYNTHIA K LMFT	3/23/2021	106H00000X	NA	Mental Health Outpatient Services	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
66200	Fee-for-Service	1487029153	1487029153	1	1	GRAY, NAIDERA LCSW	11/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
66202	Fee-for-Service	1609885037	1609885037	1	1	GILLESPIE, CRAIG L MD	7/1/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51486	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1525 WEBSTER ST	STE B	FAIRFIELD	CA	94533	4935	48	06095	38.2570563	-122.0475622	Solano County
66215	Fee-for-Service	1255451761	1255451761	1	1	GARY, MONIQUE L LCSW	12/18/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6200 WILSHIRE BLVD	SUITE 1008	LOS ANGELES	CA	90048	5811	19	06037	34.06319291	-118.3636025	Los Angeles County
66227	Fee-for-Service	1710107511	1710107511	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	9235 E BROADWAY	None	PLANADA	CA	95365	9573	24	06047	37.29049953	-120.3207705	Merced County
66230	Fee-for-Service	1932325206	1932325206	1	1	GALL, ROBERT CHARLES MD	1/13/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42435	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TERRANCE	EMERGENCY ROOM	GLENDALE	CA	91206	0000	19	06037	34.14950866	-118.2311155	Los Angeles County
66241	Fee-for-Service	1154724854	1154724854	1	1	GREEN VALLEY HOSPICE &	3/29/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	19031 HWY 18	SUITE 160	APPLE VALLEY	CA	92307	2515	36	06071	34.53673256	-117.2487466	San Bernardino County
66276	Fee-for-Service	1659900603	1659900603	1	1	GUPTA, KAVISH MD	6/29/2023	390200000X	NA	Other	026	PHYSICIANS	176542	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
66279	Fee-for-Service	1720008998	1720008998	1	1	GOLDEN, JOSHUA D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52933	36	Psychiatry	0	In state provider	None	591 CAMINO DE LA REINA	STE 1030	SAN DIEGO	CA	92108	3112	37	06073	32.76632791	-117.1616245	San Diego County
66311	Fee-for-Service	1861759888	1861759888	1	1	GOODWIN, BENJAMIN D MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148773	30	Radiology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
66333	Fee-for-Service	1164642583	1164642583	1	1	GARG, RISHI MD	1/4/2008	204D00000X	NA	Other	026	PHYSICIANS	90302	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
66341	Fee-for-Service	1790723351	1790723351	1	1	GOLDSTEIN, S MYRON MD FACS	8/20/2013	208600000X	NA	General Surgery	026	PHYSICIANS	26456	01	General Practice	0	In state provider	INC	431 N TUSTIN AVE	UNIT B	SANTA ANA	CA	92705	3821	30	06059	33.74883544	-117.8340691	Orange County
66381	Fee-for-Service	1033317268	1033317268	1	1	GREENWOOD, DANIEL J MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98863	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
66385	Fee-for-Service	1619083250	1619083250	1	2	GRETLOWSKI, LYNN S MD	9/23/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79304	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	116 S PALISADE DR	STE 104	SANTA MARIA	CA	93454	6917	42	06083	34.9523869	-120.4120717	Santa Barbara County
66388	Fee-for-Service	1306388087	1306388087	1	1	GOPIKA GANGUPANTULA, MD, INC	2/7/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1213 COFFEE ROAD	SUITE D	MODESTO	CA	95355	4229	50	06099	37.660401	-120.975669	Stanislaus County
66390	Fee-for-Service	1801815238	1801815238	1	1	GRANGE, JEFF T MD	5/1/1996	207P00000X	NA	Other	026	PHYSICIANS	54888	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	# A108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
66428	Fee-for-Service	1467778001	1467778001	1	1	GALVEZ-STRINGHAM, MARCY 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
66448	Fee-for-Service	1063842078	1063842078	1	1	GORDON, CAITLIN R	8/22/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
66468	Fee-for-Service	1336597582	1336597582	1	1	GLASS, MICHAEL W MD	2/28/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
66495	Fee-for-Service	1750731907	1750731907	1	1	GEORGE, CHRISTINE M MD	4/15/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191644	08	Family Practice	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
66518	Fee-for-Service	1194175299	1194175299	1	1	GONZALEZ, ELIZABETH LMFT	10/16/2021	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
66521	Fee-for-Service	1952363368	1952363368	1	1	GOLDEN TRIANGLE SURGICENTER	9/27/2018	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LP	25405 HANCOCK AVE	SUITE 103	MURRIETA	CA	92562	5982	33	06065	33.5580833	-117.1850127	Riverside County
66525	Fee-for-Service	1023406428	1023406428	1	1	GROVETOWN PHARMACY INC	7/7/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8640 W THIRD ST	SUITE 100	LOS ANGELES	CA	90048	3384	19	06037	34.07357646	-118.3813447	Los Angeles County
66562	Fee-for-Service	1730315169	1730315169	1	1	GLENN, TAMI S CRNA	3/15/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10 WOODLAND ROAD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
66598	Fee-for-Service	1336216191	1336216191	1	1	GUTIERREZ, TERESA S NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2814	19	06037	33.918975	-118.1291985	Los Angeles County
66607	Fee-for-Service	1982617494	1982617494	1	1	GOLDSTEIN, EDWARD M MD	8/24/2004	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	20087	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	480 4TH AVE	STE 412	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
66635	Fee-for-Service	1033569850	1033569850	1	1	GOOCH, JOHN R MD	6/1/2021	207P00000X	NA	Other	026	PHYSICIANS	172394	None	None	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
66636	Fee-for-Service	1477533511	1477533511	1	1	GLICK, JEFFREY A MD	3/31/1986	207R00000X	NA	Other	026	PHYSICIANS	58181	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
66646	Fee-for-Service	1962427633	1962427633	1	1	GIBSON, LANCE R MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	53949	08	Family Practice	0	In state provider	None	2400 BALFOUR RD	#120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
66647	Fee-for-Service	1144562810	1144562810	1	1	GO, SERGIO MD INC	4/1/2013	207L00000X	NA	Other	026	PHYSICIANS	50373	None	None	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
66649	Fee-for-Service	1700335809	1700335809	1	1	GOODNITE SLEEP SOLUTION, LLC	6/20/2017	261QS1200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	STE 160	REDLANDS	CA	92347	4527	36	06071	34.06785293	-117.2179967	San Bernardino County
66675	Fee-for-Service	1104127174	1104127174	1	1	GEMINI DIAGNOSTICS INC	5/13/2011	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	756 LAKEFIELD RD	SUITE C	WESTLAKE VILLAGE	CA	91361	2673	56	06111	34.15737086	-118.8308616	Ventura County
66679	Fee-for-Service	1134332398	1134332398	1	1	GOLDEN VALLEY HEALTH CTR	4/8/1996	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	GUSTINE-NEWMAN	637 MERCED ST	None	NEWMAN	CA	95360	9603	50	06099	37.31481158	-121.0162228	Stanislaus County
66697	Fee-for-Service	1962455337	1962455337	1	1	GLASSY, ERIC F MD	9/21/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	36186	22	Pathology (M.D. only)	0	In state provider	None	19951 MARINER AVE	STE 150	TORRANCE	CA	90503	1738	19	06037	33.85129396	-118.3504889	Los Angeles County
66833	Fee-for-Service	1740642776	1740642776	1	1	GARRETT, RILEY A MD	8/19/2020	207L00000X	NA	Other	026	PHYSICIANS	167174	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
66853	Fee-for-Service	1750322665	1750322665	1	1	GARFIELD BEACH CVS LLC	10/12/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3151 UNIVERSITY AVE	None	SAN DIEGO	CA	92104	2039	37	06073	32.74846542	-117.1257926	San Diego County
66862	Fee-for-Service	1245492628	1245492628	1	1	GAMEZ, LISA M	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
66866	Fee-for-Service	1205041308	1205041308	1	1	GASPER, 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	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
66896	Fee-for-Service	1871741769	1871741769	1	1	GHAZIANI, TAHEREH MD	8/19/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	156903	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
66910	Fee-for-Service	1992799050	1992799050	1	1	GRADY MEMORIAL HOSPITAL	12/20/2014	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CORPORATION	80 JESSE HILL JR DR SE	None	ATLANTA	GA	30303	3050	00	None	33.75222344	-84.38253074	Fulton County
66914	Fee-for-Service	1851492532	1851492532	1	1	GOTTLIEB, ALESSIA D MD	7/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83243	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
66925	Fee-for-Service	1457582934	1457582934	1	1	GANJIAN, SHAHROUZ D MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113978	40	Pediatrics	0	In state provider	None	8781 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2401	19	06037	34.22960628	-118.4502708	Los Angeles County
66934	Fee-for-Service	1366463572	1366463572	1	1	GROSSMAN, IRWIN MD	3/31/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	19219	30	Radiology	0	In state provider	None	2001 SOLAR DR	STE 100	OXNARD	CA	93036	2646	56	06111	34.22025454	-119.1449192	Ventura County
66940	Fee-for-Service	1619003084	1619003084	1	1	GOLDFARB, JEREMY W MD	11/27/2024	207L00000X	NA	Other	026	PHYSICIANS	84571	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
66967	Fee-for-Service	1134332398	1134332398	1	1	GOLDEN VALLEY HEALTH CTR	4/8/1996	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	GUSTINE-NEWMAN	637 MERCED ST	None	NEWMAN	CA	95360	9603	50	06099	37.31481158	-121.0162228	Stanislaus County
66988	Fee-for-Service	1134228752	1134228752	1	1	GOMEZ, ALBERT A MD	5/23/1996	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	30336	01	General Practice	0	In state provider	None	1333 WILLOW PASS RD	STE 202	CONCORD	CA	94520	7931	07	06013	37.96924618	-122.051411	Contra Costa County
66991	Fee-for-Service	1013963511	1013963511	1	1	GILES, STEVEN R MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	40298	05	Anesthesiology	0	In state provider	None	1530 E CHEVY CHASE DR	STE 205A	GLENDALE	CA	91206	4168	19	06037	34.150689	-118.2303855	Los Angeles County
67002	Fee-for-Service	1427476712	1427476712	1	1	GREENLAND, NANCY Y MD	6/8/2022	207ZC0500X	NA	Other	026	PHYSICIANS	141071	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
67022	Fee-for-Service	1720601354	1720601354	1	1	GET HOSPICE	2/4/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2750 N BELLFLOWER BLVD	STE 206	LONG BEACH	CA	90815	1146	19	06037	33.806259	-118.125183	Los Angeles County
67037	Fee-for-Service	1891170742	1891170742	1	1	GARCIA, LIDIA E LMFT	12/27/2022	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
67040	Fee-for-Service	1265492227	1265492227	1	1	GABALL, CURTIS W MD	12/16/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	116579	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
67094	Fee-for-Service	1043981574	1043981574	1	1	GOVEA, AIME LMFT	11/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	325 W HOSPITALITY LN	STE 200	SAN BERNARDINO	CA	92374	2861	36	06071	34.0658995	-117.29034	San Bernardino County
67136	Fee-for-Service	1780833756	1780833756	1	1	GUERRA, VERONICA PHD	8/2/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
67155	Fee-for-Service	1023379948	1023379948	1	1	GABRIELSEN, ASHLEY E MD	5/19/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
67199	Fee-for-Service	1992799050	1992799050	1	1	GRADY MEMORIAL HOSPITAL	12/20/2014	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CORPORATION	80 JESSE HILL JR DR SE	None	ATLANTA	GA	30303	3050	00	None	33.75222344	-84.38253074	Fulton County
67203	Fee-for-Service	1851492532	1851492532	1	1	GOTTLIEB, ALESSIA D MD	7/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83243	26	Psychiatry (child)	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
67213	Fee-for-Service	1750363966	1750363966	2	1	GILOFF, JUDITH B DO	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	6245	01	General Practice	0	In state provider	None	3070 CAMINO HEIGHTS DR	SUITE B	CAMINO	CA	95709	9508	09	06017	38.73599407	-120.7109181	El Dorado County
67247	Fee-for-Service	1174843205	1174843205	1	1	GIBSON, MATTHEW S MD	4/18/2020	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
67262	Fee-for-Service	1699862698	1699862698	1	1	GIERKE, PETER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	83254	41	Internal Medicine	0	In state provider	None	700 MOUNTAIN RANCH RD	STE B1	SAN ANDREAS	CA	95249	9707	05	06009	38.18960347	-120.6719165	Calaveras County
67282	Fee-for-Service	1336460583	1336460583	1	1	GORE, CHARLOTTE MD	11/20/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	118902	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
67309	Fee-for-Service	1194563445	1194563445	1	1	GAMEZ, DIANA CRNA	2/24/2025	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
67310	Fee-for-Service	1720601354	1720601354	1	1	GET HOSPICE	2/4/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2750 N BELLFLOWER BLVD	STE 206	LONG BEACH	CA	90815	1146	19	06037	33.806259	-118.125183	Los Angeles County
67441	Fee-for-Service	1023447489	1023447489	1	1	GILLETT, KATHERINE N OD	2/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	418 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3321	54	06107	36.06957964	-119.0264168	Tulare County
67483	Fee-for-Service	1316399769	1316399769	1	1	GUPTA, APOORVA MD	8/27/2020	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
67592	Fee-for-Service	1396119038	1396119038	1	1	GAINES, GRACE K LMFT	12/7/2023	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
67599	Fee-for-Service	1205870466	1205870466	1	1	GREENE, RANDY 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	2801 N. GANTENBEIN	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
67616	Fee-for-Service	1952448375	1952448375	1	1	GARY CENTER	7/15/2002	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	341 HILLCREST ST	None	LA HABRA	CA	90631	5394	30	06059	33.92889861	-117.953234	Orange County
67643	Fee-for-Service	1235323007	1235323007	1	1	GRANDE, ELMER J MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139074	None	None	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
67654	Fee-for-Service	1386110906	1386110906	1	1	GREEN, QUIMANI S LCSW	6/5/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1836 BAY RD UNIT D	None	EAST PALO ALTO	CA	94303	1311	41	06081	37.47227065	-122.133342	San Mateo County
67661	Fee-for-Service	1942384110	1942384110	1	1	GREENWOOD, BRETT R OD	7/1/2000	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7309 STOCKTON BLVD	None	SACRAMENTO	CA	95823	2782	34	06067	38.492028	-121.4267355	Sacramento County
67685	Fee-for-Service	1326209222	1326209222	1	1	GABRIEL, SIMON MD	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107925	30	Radiology	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
67696	Fee-for-Service	1447830518	1447830518	1	1	GAUTAM, AMBER MD	8/14/2024	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
67697	Fee-for-Service	1063431591	1063431591	1	1	GARCIA, SILVIA MD	4/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75598	08	Family Practice	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
67713	Fee-for-Service	1154747616	1154747616	1	1	GODWIN, MICHELLE L LCSW	10/29/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6765 GREEN VALLEY ROAD	None	PLACERVILLE	CA	95667	0543	09	06017	38.72039732	-120.8664353	El Dorado County
67724	Fee-for-Service	1952782237	1952782237	1	1	GALETTA, KRISTIN MD	4/13/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	179839	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
67811	Fee-for-Service	1679091680	1679091680	1	1	GASTON, DANIELLE LMFT	4/25/2021	101YM0800X	NA	Other	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
67824	Fee-for-Service	1023466695	1023466695	1	1	GRAY, ERIKA A LMFT	5/1/2024	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
67878	Fee-for-Service	1215122098	1215122098	1	1	GIRARD, DANA M PSYD	10/26/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1788 KANSAS ST	None	REDWOOD CITY	CA	94061	2635	41	06081	37.46030665	-122.2304988	San Mateo County
67902	Fee-for-Service	1578559217	1578559217	2	1	GOLDEN, JOHN S DO	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
67905	Fee-for-Service	1023378841	1023378841	1	1	GUTIERREZ, LUIS B MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129478	30	Radiology	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
67963	Fee-for-Service	1972521045	1972521045	1	1	GUZMAN, JUAN E MD	2/2/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	38124	-	NOT APPLICABLE	0	In state provider	None	2029 KEITH STREET	None	LOS ANGELES	CA	90031	3128	19	06037	34.06908127	-118.201305	Los Angeles County
67978	Fee-for-Service	1568954964	1568954964	1	1	GOLDSTEIN, ELIANNA MD	8/23/2023	111NR0200X	NA	Other	026	PHYSICIANS	185465	None	None	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
67980	Fee-for-Service	1063864874	1063864874	1	1	GHC OF SAC-SNF, LLC	7/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2200 GRAMERCY DR	None	SACRAMENTO	CA	95825	0308	34	06067	38.60631	-121.3975755	Sacramento County
67986	Fee-for-Service	1285693101	1285693101	1	1	GOLER, BERNIE R MD	9/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	28652	30	Radiology	0	In state provider	None	399 E HIGHLAND AVE	STE 220	SAN BERNARDINO	CA	92404	3805	36	06071	34.1358627	-117.2757898	San Bernardino County
67990	Fee-for-Service	1275799066	1275799066	1	1	GARCIA, MARTHA C NP	11/8/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5015 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3116	19	06037	34.02129255	-118.1613094	Los Angeles County
68011	Fee-for-Service	1154422681	1154422681	1	1	GARY HEDLUND	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
68012	Fee-for-Service	1518455419	1518455419	1	1	GOT IT MEDICINE	10/16/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	17122 BEACH BLVD	203	HUNTINGTON BEACH	CA	92647	5992	30	06059	33.71348004	-117.9889448	Orange County
68022	Fee-for-Service	1114161544	1114161544	1	1	GONZALES, MATTHEW J MD	6/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107359	01	General Practice	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
68066	Fee-for-Service	1659398568	1659398568	1	1	GALFFY, LASZLO Z MD APC	12/7/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	53830	05	Anesthesiology	0	In state provider	None	1509 WILSON TARRACE	None	GLENDALE	CA	91209	0951	19	06037	34.14950866	-118.2311155	Los Angeles County
68080	Fee-for-Service	1912948829	1912948829	1	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3644 EAST OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3129	19	06037	34.01879049	-118.198395	Los Angeles County
68117	Fee-for-Service	1639692080	1639692080	1	1	GOLDEN GATEIDENCE OPCO, LLC	3/15/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2121 PINE ST	None	SAN FRANCISCO	CA	94115	2829	38	06075	37.78824776	-122.4311213	San Francisco County
68121	Fee-for-Service	1093019929	1093019929	1	1	GHUMMAN, AMBRISH S MD	3/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114452	10	Gastroenterology (M.D. only)	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
68179	Fee-for-Service	1750867255	1750867255	1	1	GARCIA AYALA, LUIS G MD	7/31/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163873	08	Family Practice	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
68194	Fee-for-Service	1669490777	1669490777	1	1	GARY M BERKE MS CP	8/12/2004	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 WINWARD WAY	SUITE 100	SAN MATEO	CA	94404	2499	41	06081	37.55568909	-122.2822499	San Mateo County
68234	Fee-for-Service	1427322411	1427322411	1	1	GOLIAD DIALYSIS LLC	11/21/2012	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	251 LATHROP WAY	STE A	SACRAMENTO	CA	95815	4223	34	06067	38.596077	-121.4598915	Sacramento County
68243	Fee-for-Service	1245736669	1245736669	1	1	GOLDEN, DANIEL L MD	3/14/2022	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
68273	Fee-for-Service	1184667479	1184667479	1	1	GARFIELD BEACH CVS LLC	1/6/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15466 WHITTIER BLVD	None	WHITTIER	CA	90603	1301	19	06037	33.94559151	-117.9969364	Los Angeles County
68279	Fee-for-Service	1508131764	1508131764	1	1	GALEN INPATIENT PHYSICIANS	1/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9700	33	06065	33.591699	-117.2368285	Riverside County
68293	Fee-for-Service	1689306565	1689306565	1	1	GARDINA, SARAH L NP	10/1/2022	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
68300	Fee-for-Service	1326265174	1326265174	1	1	GRISI, MELISSA LCSW	7/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5735 ADOBE RD	None	TWENTYNINE PALMS	CA	92277	2363	36	06071	34.14943915	-116.054147	San Bernardino County
68311	Fee-for-Service	1114161544	1114161544	1	1	GONZALES, MATTHEW J MD	6/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107359	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
68335	Fee-for-Service	1861040032	1861040032	1	1	GOLDEN HOSPICE CARE INC	7/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 138	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
68345	Fee-for-Service	1144344763	1144344763	1	1	GIRGIS, EBTESAM LMFT	9/28/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2130 MAIN ST	STE 120	HUNTINGTON BEACH	CA	92648	6476	30	06059	33.680385	-117.9976275	Orange County
68355	Fee-for-Service	1437103777	1437103777	1	2	GOOD SAMARITAN HOSP, LP	5/14/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15891 LOS GATOS-ALMADEN	None	LOS GATOS	CA	95032	3742	43	06085	37.24361275	-121.9477516	Santa Clara County
68416	Fee-for-Service	1326112624	1326112624	1	1	GERARDI, SHARON N DO	5/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	5000	07	Dermatology	0	In state provider	None	4785 N 1ST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
68424	Fee-for-Service	1225080013	1225080013	1	1	GIRGIS, RAAFAT W MD	12/12/2005	2084P0800X	NA	Psychiatry	026	PHYSICIANS	52207	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
68435	Fee-for-Service	1932536802	1932536802	1	1	GUTIERREZ-DARVIN, LAARNI MD	10/17/2013	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	98770	40	Pediatrics	0	In state provider	INC	4566 E FLORENCE AVE	SUITE 1	CUDAHY	CA	90201	4345	19	06037	33.97001847	-118.1859258	Los Angeles County
68458	Fee-for-Service	1548567498	1548567498	1	7	GENESIS HEALTHCARE PARTNERS	6/1/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	5395 RUFFIN ROAD	SUITE 103	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
68470	Fee-for-Service	1629398177	1629398177	1	1	GIPP, NICOLE E CRNA	11/5/2012	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
68560	Fee-for-Service	1982643144	1982643144	1	1	GOLDBERGER, SAM MD	3/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	62027	18	Ophthalmology	0	In state provider	None	120 S SPALDING DR	STE 330	BEVERLY HILLS	CA	90212	1841	19	06037	34.06625419	-118.4088854	Los Angeles County
68596	Fee-for-Service	1073558870	1073558870	1	1	GARFIELD BEACH CVS, LLC	9/3/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6000 ATLANTIC AVE	None	LONG BEACH	CA	90805	3013	19	06037	33.863985	-118.1849305	Los Angeles County
68616	Fee-for-Service	1073977468	1073977468	1	1	GIRGIS, ALEXANDER M MD	7/16/2021	207L00000X	NA	Other	026	PHYSICIANS	152504	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
68624	Fee-for-Service	1861040032	1861040032	1	1	GOLDEN HOSPICE CARE INC	7/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 138	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
68643	Fee-for-Service	1437103777	1437103777	1	2	GOOD SAMARITAN HOSP, LP	5/14/2021	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15891 LOS GATOS-ALMADEN	None	LOS GATOS	CA	95032	3742	43	06085	37.24361275	-121.9477516	Santa Clara County
68677	Fee-for-Service	1477238673	1477238673	1	1	GATIDIS, SERGIOS MD	10/15/2024	2085P0229X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
68739	Fee-for-Service	1427190487	1427190487	1	2	GAREWAL, JAGDEEP S MD	11/18/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	64095	-	NOT APPLICABLE	0	In state provider	None	828 HIGH ST	SUITE A, B, C	DELANO	CA	93215	2960	15	06029	35.76731796	-119.2465757	Kern County
68800	Fee-for-Service	1902357296	1902357296	1	1	GIEBEL, JANA S OD	4/28/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8135 PAINTER AVE	SUITE 100	WHITTIER	CA	90602	3159	19	06037	33.965829	-118.032738	Los Angeles County
68805	Fee-for-Service	1902904998	1902904998	1	2	GUERRA, VENUSTIANO J MD	4/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53771	02	General Surgery	0	In state provider	None	1635 3RD AVE	STE E	CHULA VISTA	CA	91911	5883	37	06073	32.59663479	-117.064444	San Diego County
69028	Fee-for-Service	1164500799	1164500799	1	1	GOODMAN, AMNON MD	10/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	41302	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
69042	Fee-for-Service	1912542275	1912542275	1	1	GLOBAL PHARMACY GROUP INC.	9/28/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 SANTA MONICA BLVD	STE 100W	SANTA MONICA	CA	90404	2176	19	06037	34.02891163	-118.4797466	Los Angeles County
69056	Fee-for-Service	1144284373	1144284373	2	4	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	375 COHASSET RD	None	CHICO	CA	95926	2211	04	06007	39.75136313	-121.8492944	Butte County
69097	Fee-for-Service	1902904998	1902904998	1	2	GUERRA, VENUSTIANO J MD	4/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53771	01	General Practice	0	In state provider	None	1635 3RD AVE	STE E	CHULA VISTA	CA	91911	5883	37	06073	32.59663479	-117.064444	San Diego County
69117	Fee-for-Service	1568447936	1568447936	1	1	GALE, LEONARD A MD	5/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	23344	36	Psychiatry	0	In state provider	None	12433 LAMBERT RD	None	WHITTIER	CA	90606	2770	19	06037	33.96634621	-118.0474099	Los Angeles County
69148	Fee-for-Service	1144358748	1144358748	1	1	GARDNER FAMILY HLTH NTWR	9/5/2000	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	GARDNER SO CO HEALTH CTR	7526 MONTEREY ST	None	GILROY	CA	95020	5826	43	06085	37.00852861	-121.5694352	Santa Clara County
69179	Fee-for-Service	1598089997	1598089997	1	1	GONZALES, NICOLE A MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111874	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
69187	Fee-for-Service	1144284373	1144284373	2	6	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	188 COHASSET RD	None	CHICO	CA	95926	2206	04	06007	39.75161221	-121.8538418	Butte County
69188	Fee-for-Service	1912911926	1912911926	1	1	GARIBALDI, DENISE A	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 LIBERTY ST	None	PETALUMA	CA	94952	2330	49	06097	38.23363866	-122.6432657	Sonoma County
69221	Fee-for-Service	1346262953	1346262953	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1290 HAMNER AVE	None	NORCO	CA	92860	3117	33	06065	33.901182	-117.5648715	Riverside County
69223	Fee-for-Service	1205968492	1205968492	1	1	GREELEY, ADELA M MD	8/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86940	41	Internal Medicine	0	In state provider	None	7808 EL CAJON BLVD	None	SAN DIEGO	CA	92104	0000	37	06073	32.755302	-117.1248412	San Diego County
69240	Fee-for-Service	1518458793	1518458793	1	1	GORDIN, ROBERTA NP	1/11/2022	163WP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
69261	Fee-for-Service	1326193624	1326193624	2	1	GARRETT, VIRGINIA E MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	45812	25	Physical Medicine and Rehabilitation	0	In state provider	None	3737 MCCRAY ST	None	RIVERSIDE	CA	92506	2928	33	06065	33.94855347	-117.397764	Riverside County
69274	Fee-for-Service	1629558994	1629558994	1	1	GHALY, RENEE E	12/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8805 HAVEN AVE	SUITE 110	RANCHO CUCAMONGA	CA	91730	5149	36	06071	34.09424614	-117.5756838	San Bernardino County
69287	Fee-for-Service	1780736140	1780736140	1	1	GONCALVES, MANUEL MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80289	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
69290	Fee-for-Service	1780626978	1780626978	2	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5385 ALTON PARKWAY	None	IRVINE	CA	92604	8609	30	06059	33.67024298	-117.789103	Orange County
69310	Fee-for-Service	1659714186	1659714186	1	1	GATAN, MA CECILIA J NP	2/12/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	None	36.143271	-115.1254975	Clark County
69326	Fee-for-Service	1134880396	1134880396	1	1	GUEVARA, ARGEL V A	4/14/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	668 FRANKLIN ST	None	LINCOLN	CA	95648	8897	31	06061	38.89422	-121.334927	Placer County
69345	Fee-for-Service	1144284373	1144284373	2	4	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	41	Internal Medicine	0	In state provider	None	375 COHASSET RD	None	CHICO	CA	95926	2211	04	06007	39.75136313	-121.8492944	Butte County
69382	Fee-for-Service	1518179035	1518179035	1	1	GLASS, LYDIA PHD	5/22/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 E DEL MAR BLVD STE 2	None	PASADENA	CA	91105	2551	19	06037	34.14047497	-118.1464685	Los Angeles County
69436	Fee-for-Service	1144358748	1144358748	1	1	GARDNER FAMILY HLTH NTWR	9/5/2000	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	GARDNER SO CO HEALTH CTR	7526 MONTEREY ST	None	GILROY	CA	95020	5826	43	06085	37.00852861	-121.5694352	Santa Clara County
69473	Fee-for-Service	1245300771	1245300771	1	1	GAMO, KAY G MD	1/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73335	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
69475	Fee-for-Service	1144284373	1144284373	2	6	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	41	Internal Medicine	0	In state provider	None	188 COHASSET RD	None	CHICO	CA	95926	2206	04	06007	39.75161221	-121.8538418	Butte County
69587	Fee-for-Service	1417930249	1417930249	1	1	GROSSMONT HOSP D/P SNF	11/19/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
69615	Fee-for-Service	1134880396	1134880396	1	1	GUEVARA, ARGEL V A	4/14/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	668 FRANKLIN ST	None	LINCOLN	CA	95648	8897	31	06061	38.89422	-121.334927	Placer County
69632	Fee-for-Service	1417033937	1417033937	1	1	GOULD, ROBERT M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38241	22	Pathology (M.D. only)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
69690	Fee-for-Service	1952496291	1952496291	1	1	GAVRILYUK, OLEG M MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74418	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 STATE ST	None	EL CENTRO	CA	92243	3021	13	06025	32.79174849	-115.5535245	Imperial County
69701	Fee-for-Service	1124425293	1124425293	1	1	GARFIELD BEACH CVS LLC	6/9/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26059 MISSION BLVD	None	HAYWARD	CA	94544	2538	01	06001	37.65149585	-122.0673749	Alameda County
69722	Fee-for-Service	1144358748	1144358748	1	1	GARDNER FAMILY HLTH NTWR	9/5/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	GARDNER SO CO HEALTH CTR	7526 MONTEREY ST	None	GILROY	CA	95020	5826	43	06085	37.00852861	-121.5694352	Santa Clara County
69736	Fee-for-Service	1417055104	1417055104	1	1	GOMEZ, JAIRO MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38279	None	None	0	In state provider	None	3950 INGLEWOOD BLVD	APT 8	LOS ANGELES	CA	90066	4579	19	06037	34.00326088	-118.4265821	Los Angeles County
69739	Fee-for-Service	1558181891	1558181891	1	1	GARR, ALYSSA PSYD	12/6/2024	103T00000X	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
69765	Fee-for-Service	1184245896	1184245896	1	1	GALEON, CARL E CRNA	10/1/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
69792	Fee-for-Service	1962680421	1962680421	1	7	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E101	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
69833	Fee-for-Service	1548348642	1548348642	1	1	GROSSMAN, RICHARD F MD	3/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	70330	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
69834	Fee-for-Service	1922269943	1922269943	1	1	GARCIA, ARTURO MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110005	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
69836	Fee-for-Service	1528445889	1528445889	1	1	GABEL, JOSHUA A MD	3/7/2018	208600000X	NA	General Surgery	026	PHYSICIANS	143935	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
69849	Fee-for-Service	1962586966	1962586966	1	1	GOLDITCH, BRAD D MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55573	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
69859	Fee-for-Service	1093772659	1093772659	1	1	GARG, SANTOSH K MD	2/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	31300	40	Pediatrics	0	In state provider	None	1535 W MERCED AVE	STE 300	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
69894	Fee-for-Service	1982016911	1982016911	1	1	GOFF, DANIEL J MD	6/11/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	140321	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
69961	Fee-for-Service	1225501000	1225501000	1	1	GREY, JUDITH H LCSW	10/11/2021	1041C0700X	NA	Mental Health Outpatient Services	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
69986	Fee-for-Service	1851348288	1851348288	1	1	GENTILE, EDWARD M MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72813	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
69999	Fee-for-Service	1992194617	1992194617	1	1	GOLDEN HEARTS HOME HEALTH	6/14/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7200 VINELAND AVE	STE 203	SUN VALLEY	CA	91352	5089	19	06037	34.2016328	-118.3703012	Los Angeles County
70012	Fee-for-Service	1144358748	1144358748	1	1	GARDNER FAMILY HLTH NTWR	12/14/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	GARDNER SO CO HEALTH CTR	7526 MONTEREY ST	None	GILROY	CA	95020	5826	43	06085	37.00852861	-121.5694352	Santa Clara County
70021	Fee-for-Service	1437413184	1437413184	1	1	GARIBAY, ESMERALDA LCSW	5/25/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
70047	Fee-for-Service	1689036824	1689036824	1	1	GWALANI, JAIMISH MD	11/16/2020	163WP0000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	125 N JACKSON AVE	106	SAN JOSE	CA	95116	1903	43	06085	37.36117713	-121.8462226	Santa Clara County
70078	Fee-for-Service	1821508615	1821508615	1	1	GO FOR HELP HOME HEALTH, INC	12/21/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6454 VAN NUYS BLVD	STE 48	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
70083	Fee-for-Service	1962680421	1962680421	1	7	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E101	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
70101	Fee-for-Service	1982845145	1982845145	1	1	GRAUCH, JOHN MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109514	05	Anesthesiology	0	In state provider	None	2975 N SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
70107	Fee-for-Service	1396416343	1396416343	1	1	GIMADA INCORPORATED	12/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2602 OSTROM AVE	None	LONG BEACH	CA	90815	1601	19	06037	33.80355092	-118.10108	Los Angeles County
70149	Fee-for-Service	1093772659	1093772659	1	1	GARG, SANTOSH K MD	2/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	31300	01	General Practice	0	In state provider	None	1535 W MERCED AVE	STE 300	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
70169	Fee-for-Service	1619104411	1619104411	1	1	GOEL, APARNA MD	5/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114391	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
70210	Fee-for-Service	1275644155	1275644155	1	1	GRANADER, LAWRENCE MD	6/9/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38341	40	Pediatrics	0	In state provider	None	1647 VALENCIA ST	None	SAN FRANCISCO	CA	94110	5012	38	06075	37.74684497	-122.420149	San Francisco County
70212	Fee-for-Service	1639203680	1639203680	1	1	GIROUX, CAROLINE MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99259	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
70214	Fee-for-Service	1063572915	1063572915	1	1	GRANESE, MARSHA F MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	83534	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 525	MISSION VIEJO	CA	92691	8029	30	06059	33.56286021	-117.6673449	Orange County
70258	Fee-for-Service	1528644085	1528644085	1	1	GO, ALLISON DO	10/7/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22231	08	Family Practice	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
70274	Fee-for-Service	1215441852	1215441852	1	1	GENESIS NEW BEGINNING INC.	9/24/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	17822 BEACH BLVD	278	HUNTINGTON BEACH	CA	92647	7180	30	06059	33.70331388	-117.9890471	Orange County
70280	Fee-for-Service	1558673327	1558673327	1	1	GONZALEZ, CORINA L MD	1/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146092	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
70346	Fee-for-Service	1992799365	1992799365	1	1	GANGANI, YASMEEN MD	10/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46598	40	Pediatrics	0	In state provider	None	18550 DEPAUL DR	STE 102	MORGAN HILL	CA	95037	2911	43	06085	37.15297169	-121.6473528	Santa Clara County
70348	Fee-for-Service	1053909556	1053909556	1	1	GOLDEN STATE HEARING AID CEN	1/14/2021	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	TER, INC.	3995 N FRESNO ST	106	FRESNO	CA	93726	4031	10	06019	36.7901137	-119.7816283	Fresno County
70351	Fee-for-Service	1285120220	1285120220	1	1	GUADALUPE, CHETINA L LMFT	6/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
70355	Fee-for-Service	1497769814	1497769814	1	1	GLENDALE MRI MEDICAL CTR	3/1/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	624 S CENTRAL AVE	None	GLENDALE	CA	91204	2009	19	06037	34.13847846	-118.2578377	Los Angeles County
70357	Fee-for-Service	1356602734	1356602734	1	1	GARDNER, CHERYL LPCC	3/21/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
70366	Fee-for-Service	1457669228	1457669228	1	1	GUPTA, SAURABH MD	4/18/2023	163WG0100X	NA	Other	026	PHYSICIANS	173187	None	None	0	In state provider	None	2850 TELEGRAPH AVE	130	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
70372	Fee-for-Service	1962680421	1962680421	1	7	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E101	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
70390	Fee-for-Service	1225229867	1225229867	1	1	GUEVARA, NOEL M LCSW	8/23/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
70416	Fee-for-Service	1154862373	1154862373	1	1	GAMA, ERIC R MD	7/29/2020	390200000X	NA	Other	026	PHYSICIANS	164864	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
70423	Fee-for-Service	1982696068	1982696068	1	1	GOLDSWORTHY, MARK S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71503	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
70440	Fee-for-Service	1366519829	1366519829	1	1	GOINGS, ANDREA C MD	12/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	85048	40	Pediatrics	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
70455	Fee-for-Service	1619104411	1619104411	1	1	GOEL, APARNA MD	5/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114391	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
70510	Fee-for-Service	1235722398	1235722398	1	1	GONZALES, AMPORA L NP	2/20/2025	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
70518	Fee-for-Service	1427269067	1427269067	1	1	GREEN, ANGELIQUE MD	2/8/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	81954	-	NOT APPLICABLE	0	In state provider	None	30086 MISSION BOULEVARD	None	HAYWARD	CA	94544	7233	01	06001	37.62668651	-122.0433367	Alameda County
70522	Fee-for-Service	1174175483	1174175483	1	1	GOLLY, JESSICA LCSW	11/20/2024	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
70525	Fee-for-Service	1720126212	1720126212	1	1	GRANT, BRUCE F OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 N TUSTIN AVE	STE J	SANTA ANA	CA	92705	3605	30	06059	33.752241	-117.8342255	Orange County
70539	Fee-for-Service	1912138132	1912138132	1	1	GREGER, STEPHANIE C MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	102891	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
70556	Fee-for-Service	1851650758	1851650758	1	1	GERKEN, NOAH M A MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127970	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
70580	Fee-for-Service	1093970766	1093970766	1	1	GREBENCHTCHIKOVA, LARISSA MD	11/19/2013	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
70592	Fee-for-Service	1861727653	1861727653	1	1	GREGORICH, MARIANNE J NP	1/8/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
70628	Fee-for-Service	1811075682	1811075682	1	1	GURUSHANTHAIAH, DEEPAK	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82971	04	Otology, Laryngology, Rhinology	0	In state provider	MD	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
70634	Fee-for-Service	1548567498	1548567498	1	14	GENESIS HEALTHCARE PARTNERS	11/16/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	8851 CENTER DRIVE	SUITE 501	LA MESA	CA	91942	3017	37	06073	32.78189749	-117.0075062	San Diego County
70653	Fee-for-Service	1568669901	1568669901	1	1	GUZMAN PEREZ-CARRILLO,GLORIA	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112179	30	Radiology	0	In state provider	None	546 EAST PINE STREET	None	STOCKTON	CA	95204	5525	39	06077	37.97459526	-121.2889389	San Joaquin County
70656	Fee-for-Service	1508943473	1508943473	2	1	GUADALUPE PHARMACY INC	2/11/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16444 PARAMOUNT BLVD	STE 105	PARAMOUNT	CA	90723	5453	19	06037	33.8848179	-118.1599671	Los Angeles County
70658	Fee-for-Service	1356035232	1356035232	1	1	GROWING SEEDS, INC.	6/28/2023	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	34	06067	0	0	None
70663	Fee-for-Service	1073221354	1073221354	1	1	GARFIELD BEACH CVS LLC	7/13/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	501 MISSION AVE	None	OCEANSIDE	CA	92054	2829	37	06073	33.1959909	-117.3793445	San Diego County
70690	Fee-for-Service	1447386602	1447386602	1	1	GARDNER, PHYLLIS I MD	8/31/1985	207R00000X	NA	Other	026	PHYSICIANS	39477	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
70709	Fee-for-Service	1629288329	1629288329	1	1	GHAZARYAN, GEVORG MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104857	None	None	0	In state provider	None	1600 NORTH ROSE AVENUE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
70711	Fee-for-Service	1982696068	1982696068	1	1	GOLDSWORTHY, MARK S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71503	47	Miscellaneous	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
70761	Fee-for-Service	1821028283	1821028283	1	1	GABBAY, ROBERT J MD	12/28/2012	261QP2300X	NA	Other	026	PHYSICIANS	6451	08	Family Practice	0	In state provider	None	3775 BRICKWAY BLVD	STE 110	SANTA ROSA	CA	95403	9050	49	06097	38.51005295	-122.792984	Sonoma County
70769	Fee-for-Service	1891023693	1891023693	1	1	GLASER, RANDAL H	10/19/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10917 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3044	33	06065	33.90499038	-117.4738429	Riverside County
70822	Fee-for-Service	1942769104	1942769104	1	1	GREGG, ANDREW M MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	177654	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
70832	Fee-for-Service	1104337898	1104337898	1	1	GARFIELD BEACH CVS LLC	3/21/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3208 EAST FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5832	19	06037	33.97261399	-118.2104296	Los Angeles County
70840	Fee-for-Service	1386722965	1386722965	1	1	GONZALEZ, JAIME L MD	11/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80740	08	Family Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
70860	Fee-for-Service	1740588680	1740588680	1	1	GE, YUQIANG MD	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136950	45	Nephrology (Renal-Kidney)	0	In state provider	None	305 E GRANGER AVE	STE 202	MODESTO	CA	95350	4344	50	06099	37.66729751	-120.9891555	Stanislaus County
70949	Fee-for-Service	1730542747	1730542747	1	1	GOEB, YANNICK L MD	8/26/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	170529	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
70951	Fee-for-Service	1265509103	1265509103	1	1	GOLDIS, GLENN E MD	9/30/1985	207R00000X	NA	Other	026	PHYSICIANS	56436	41	Internal Medicine	0	In state provider	None	10339 BALBOA BLVD	STE 200	GRANADA HILLS	CA	91344	7319	19	06037	34.2586457	-118.5023394	Los Angeles County
70972	Fee-for-Service	1871604033	1871604033	1	1	GUIRGUIS, MICHAEL S MD	9/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88129	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
70995	Fee-for-Service	1992735518	1992735518	1	1	GOTTSCHALK, PATRICIA M CRNA	1/24/2011	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
71097	Fee-for-Service	1689134728	1689134728	1	1	GHASEMIESFE, MEHRNAZ MD	7/22/2024	207R00000X	NA	Other	026	PHYSICIANS	176075	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
71101	Fee-for-Service	1477576015	1477576015	1	1	GAGNON, ROBERT L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30363	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
71109	Fee-for-Service	1942769104	1942769104	1	1	GREGG, ANDREW M MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	177654	10	Gastroenterology (M.D. only)	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
71149	Fee-for-Service	1336351055	1336351055	1	1	GONZALES UNIFIED SD	4/1/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	600 ELKO ST	None	GONZALES	CA	93926	0000	27	06053	36.51119103	-121.4429573	Monterey County
71150	Fee-for-Service	1104022045	1104022045	1	1	GASPERINI, JULIE L MD	4/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98995	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
71191	Fee-for-Service	1316585169	1316585169	1	1	GALAXY INVESTMENT PHARMACY I	7/24/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10879 LOS ALAMITO BLVD	None	LOS ALAMITOS	CA	90720	2329	30	06059	33.80425394	-118.0719354	Orange County
71212	Fee-for-Service	1104983972	1104983972	1	1	GLENN, ESTHER LMFT	9/24/2018	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
71271	Fee-for-Service	1043247661	1043247661	1	1	GREEN, CATHY MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70424	40	Pediatrics	0	In state provider	None	88700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	0000	19	06037	34.076079	-118.3695821	Los Angeles County
71272	Fee-for-Service	1679896013	1679896013	1	1	GALLIGAN, BARBARA M MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116627	78	Neoplastic Diseases/Oncology	0	In state provider	None	1350 S ELISEO DR	STE 200	GREENBRAE	CA	94904	2018	21	06041	37.94490653	-122.537021	Marin County
71300	Fee-for-Service	1134377930	1134377930	1	1	GOMEZ, PHILIP JR	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
71312	Fee-for-Service	1568638807	1568638807	1	1	GAD, YOUHANNA M MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126322	None	None	0	In state provider	None	400 N PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
71350	Fee-for-Service	1548567498	1548567498	1	1	GENESIS HEALTHCARE PARTNERS	7/2/2012	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	9853 PACIFIC HTS BLVD	STE B	SAN DIEGO	CA	92121	4721	37	06073	32.89940783	-117.1888294	San Diego County
71421	Fee-for-Service	1861464166	1861464166	1	1	GANG, ELI S MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49587	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
71422	Fee-for-Service	1619395357	1619395357	1	1	GONSALVES, ROBERT DO	5/5/2023	2080P0205X	NA	Endocrinology	026	PHYSICIANS	-	67	Endocrinology	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
71450	Fee-for-Service	1700821329	1700821329	1	1	GINDI, MAGDI R MD	4/25/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	31902	01	General Practice	0	In state provider	None	1096 N WESTERN AVE	BLDG I	LOS ANGELES	CA	90029	2310	19	06037	34.090524	-118.309141	Los Angeles County
71464	Fee-for-Service	1073132221	1073132221	1	1	GLORIA, MARIA ANA C CNP	11/15/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
71497	Fee-for-Service	1174917041	1174917041	1	1	GROBER, AARON F MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144226	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
71518	Fee-for-Service	1336220839	1336220839	1	1	GILA REGIONAL MEDICAL CT	11/16/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1313 E 32ND ST	None	SILVER CITY	NM	88061	7251	00	None	32.79559634	-108.2609563	Grant County
71524	Fee-for-Service	1942524517	1942524517	1	1	GARCIA, MARIA E MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124320	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
71559	Fee-for-Service	1679896013	1679896013	1	1	GALLIGAN, BARBARA M MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116627	68	Hematology	0	In state provider	None	1350 S ELISEO DR	STE 200	GREENBRAE	CA	94904	2018	21	06041	37.94490653	-122.537021	Marin County
71567	Fee-for-Service	1821193467	1821193467	1	1	GERIA, VEEJAY N MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129982	None	None	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
71638	Fee-for-Service	1073950614	1073950614	1	1	GRAND VALLEY HEALTH CARE	6/1/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	13524 SHERMAN WAY	None	VAN NUYS	CA	91405	2830	19	06037	34.20116047	-118.4276835	Los Angeles County
71665	Fee-for-Service	1962694802	1962694802	1	1	GUTIERREZ, WILSON S MD	6/1/2022	208M00000X	NA	Other	026	PHYSICIANS	177800	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
71670	Fee-for-Service	1548358005	1548358005	1	1	GIEM, MARLA G MD	8/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	37340	41	Internal Medicine	0	In state provider	None	43839 15TH STREET W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
71674	Fee-for-Service	1336533579	1336533579	1	1	GILBERT, JASON G DO	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15306	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
71700	Fee-for-Service	1013225671	1013225671	1	1	GIBSON, YICHING NP	3/16/2020	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
71736	Fee-for-Service	1992701239	1992701239	1	1	GABOR, ERWIN P MD	4/23/2010	207RH0003X	NA	Oncology	026	PHYSICIANS	21520	41	Internal Medicine	0	In state provider	None	9735 WILSHIRE BLVD	STE 400	BEVERLY HILLS	CA	90212	2107	19	06037	34.06711051	-118.4074605	Los Angeles County
71751	Fee-for-Service	1366504524	1366504524	1	1	GARSON K LEE	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
71781	Fee-for-Service	1275539462	1275539462	1	1	GOLD, JULIAN A MD	8/8/1995	207L00000X	NA	Other	026	PHYSICIANS	41775	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
71785	Fee-for-Service	1962680421	1962680421	1	12	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1120 DELBON AVENUE	None	TURLOCK	CA	95382	2021	50	06099	37.51058463	-120.835755	Stanislaus County
71805	Fee-for-Service	1336220839	1336220839	1	1	GILA REGIONAL MEDICAL CT	11/16/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1313 E 32ND ST	None	SILVER CITY	NM	88061	7251	00	None	32.79559634	-108.2609563	Grant County
71822	Fee-for-Service	1033783642	1033783642	1	1	GARCIA, JUNE NOELLE B CNP	4/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1851 NORTH LOMBARD	STE 100	OXNARD	CA	93030	8230	56	06111	34.2183512	-119.1493247	Ventura County
71847	Fee-for-Service	1679896013	1679896013	1	1	GALLIGAN, BARBARA M MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116627	41	Internal Medicine	0	In state provider	None	1350 S ELISEO DR	STE 200	GREENBRAE	CA	94904	2018	21	06041	37.94490653	-122.537021	Marin County
71848	Fee-for-Service	1336516277	1336516277	1	1	GHIAM, JONATHAN A DO	1/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16421	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
71850	Fee-for-Service	1497304422	1497304422	1	1	GONZALEZ, GABRIEL J PT	5/7/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
71857	Fee-for-Service	1689606394	1689606394	1	1	GARG, MEENA MD	4/27/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	37408	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
71874	Fee-for-Service	1871911347	1871911347	1	1	GILL, BALI K MD	6/11/2020	207R00000X	NA	Other	026	PHYSICIANS	166229	41	Internal Medicine	0	In state provider	None	1071 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	1103	43	06085	37.2509447	-121.8743507	Santa Clara County
71950	Fee-for-Service	1548567498	1548567498	1	10	GENESIS HEALTHCARE PARTNERS	6/1/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	2466 FIRST AVE	SUITE B	SAN DIEGO	CA	92101	1408	37	06073	32.731137	-117.1639695	San Diego County
71967	Fee-for-Service	1407232358	1407232358	1	1	GOLDSCHMIDT, EZEQUIEL D MD	6/17/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	171371	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
71974	Fee-for-Service	1841222171	1841222171	1	1	GUERENA, MICHAEL PATRICK	1/15/1997	174400000X	NA	Other	026	PHYSICIANS	80926	34	Urology and Urological Surgery	0	In state provider	None	3230 WARING CT	STE A	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
72010	Fee-for-Service	1982005641	1982005641	1	1	GARCIA, AGUSTINA M LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
72023	Fee-for-Service	1649292459	1649292459	1	1	GHAFUR, NAEEMAH MD	4/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79585	08	Family Practice	0	In state provider	None	5700 CANOGA AVE	STE 500	WOODLAND HILLS	CA	91367	6582	19	06037	34.17400487	-118.5973608	Los Angeles County
72028	Fee-for-Service	1629204680	1629204680	1	1	GOFF, DONNA MD	9/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	91802	40	Pediatrics	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
72075	Fee-for-Service	1962680421	1962680421	1	12	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1120 DELBON AVENUE	None	TURLOCK	CA	95382	2021	50	06099	37.51058463	-120.835755	Stanislaus County
72105	Fee-for-Service	1417480500	1417480500	1	1	GUPTA, SUMAN J MD	3/2/2022	207P00000X	NA	Other	026	PHYSICIANS	175243	None	None	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
72146	Fee-for-Service	1689606394	1689606394	1	1	GARG, MEENA MD	4/27/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	37408	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
72150	Fee-for-Service	1124087390	1124087390	1	1	GANSERT, GARY G MD	5/5/2016	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
72154	Fee-for-Service	1043367220	1043367220	1	1	GOLDIN & NIES MDS INC	1/1/1982	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	23451 MADISON ST	STE 380	TORRANCE	CA	90505	4763	19	06037	33.81197627	-118.3478154	Los Angeles County
72205	Fee-for-Service	1053500181	1053500181	1	1	GANDHI, SEEMA S MD	11/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103678	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	0648	38	06075	37.7634502	-122.4579779	San Francisco County
72232	Fee-for-Service	1144284373	1144284373	2	5	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1 GILMORE LN	None	OROVILLE	CA	95966	5147	04	06007	39.50782179	-121.5406657	Butte County
72250	Fee-for-Service	1144284373	1144284373	2	3	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	50 CONCORDIA LN	None	OROVILLE	CA	95966	6300	04	06007	39.49624207	-121.5182906	Butte County
72324	Fee-for-Service	1972295673	1972295673	1	1	GARBUTT, BRENNAN NP	7/14/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
72351	Fee-for-Service	1992234199	1992234199	1	1	GHODS, DAVID DO	3/24/2025	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	16662	41	Internal Medicine	0	In state provider	None	1086 S FAIRFAX AVE	None	LOS ANGELES	CA	90019	4401	19	06037	34.05592638	-118.3648554	Los Angeles County
72359	Fee-for-Service	1447265939	1447265939	1	1	GREGG, JESSICA MD	5/29/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
72368	Fee-for-Service	1255637369	1255637369	1	1	GUZMAN, PEDRO CRNA	7/27/2011	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
72386	Fee-for-Service	1346362902	1346362902	1	1	GRAFF, BRUCE V OD	1/1/1979	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1406 BAILEY AVE	None	NEEDLES	CA	92363	3115	36	06071	34.83259864	-114.6183514	San Bernardino County
72388	Fee-for-Service	1619914967	1619914967	1	1	GRENIER, DANA J MD	9/30/1988	174400000X	NA	Other	026	PHYSICIANS	58395	07	Dermatology	0	In state provider	None	18364 CLARK ST	None	TARZANA	CA	91356	3502	19	06037	34.16975482	-118.5331876	Los Angeles County
72396	Fee-for-Service	1679832265	1679832265	1	1	GREEN, AMANDA J MD	2/24/2020	208C00000X	NA	General Surgery	026	PHYSICIANS	129105	02	General Surgery	0	In state provider	None	975 MAPLE ST	None	REDWOOD CITY	CA	94063	2057	41	06081	37.48822836	-122.2226601	San Mateo County
72413	Fee-for-Service	1417018813	1417018813	1	1	GRADY, BRIAN P MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60523	34	Urology and Urological Surgery	0	In state provider	None	1850 SULLIVAN AVE	STE 300	DALY CITY	CA	94015	2204	41	06081	37.68085904	-122.4728842	San Mateo County
72438	Fee-for-Service	1609871177	1609871177	1	1	GREENHOUSE, CATHERINE AU	9/16/2023	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
72509	Fee-for-Service	1861500662	1861500662	1	1	GRODAN, PAUL J MD	3/1/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30279	41	Internal Medicine	0	In state provider	None	150 N ROBERTSON BLVD	STE 211	BEVERLY HILLS	CA	90211	2145	19	06037	34.06812722	-118.3837146	Los Angeles County
72514	Fee-for-Service	1578506440	1578506440	1	1	GILMORE, CLARENCE E MD	7/28/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
72515	Fee-for-Service	1245261791	1245261791	1	2	GAMEZ, CORINNA A MD	11/24/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	69057	-	NOT APPLICABLE	0	In state provider	None	1380 HOWARD STREET	None	SAN FRANCISCO	CA	94103	2638	38	06075	37.77424669	-122.4141502	San Francisco County
72520	Fee-for-Service	1144284373	1144284373	2	5	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	41	Internal Medicine	0	In state provider	None	1 GILMORE LN	None	OROVILLE	CA	95966	5147	04	06007	39.50782179	-121.5406657	Butte County
72527	Fee-for-Service	1598432320	1598432320	1	1	GULRAIZ, ANAM NP	3/30/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	36	06071	34.52471945	-117.3042336	San Bernardino County
72538	Fee-for-Service	1144284373	1144284373	2	3	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	41	Internal Medicine	0	In state provider	None	50 CONCORDIA LN	None	OROVILLE	CA	95966	6300	04	06007	39.49624207	-121.5182906	Butte County
72582	Fee-for-Service	1609897339	1609897339	1	1	GOOD SAMARITAN REGIONAL	12/13/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH CENTER	605 N 12TH STREET	None	MT VERNON	IL	62864	2857	00	None	38.32267538	-88.90997965	Jefferson County
72641	Fee-for-Service	1760616270	1760616270	1	1	GREATER MODESTO MEDICAL	10/8/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	SURGICAL ASSOCIATES INC	1541 FLORIDA AVENUE	SUITE 200	MODESTO	CA	95350	4338	50	06099	37.666863	-120.9962775	Stanislaus County
72655	Fee-for-Service	1972344810	1972344810	1	1	GUIDED GROWTH FAMILY THERAPY	1/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	RVICES	2617 K ST	260	SACRAMENTO	CA	95816	5116	34	06067	38.573595	-121.4715825	Sacramento County
72692	Fee-for-Service	1285946228	1285946228	1	1	GUPTA, HANIKA MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124750	41	Internal Medicine	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
72693	Fee-for-Service	1265618136	1265618136	1	1	GUSTIN, STACY E. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	840 E MCKELLIPS RD	STE 101	MESA	AZ	85203	9654	00	None	33.451695	-111.812508	Maricopa County
72743	Fee-for-Service	1952801417	1952801417	1	1	GOMEZ, JACQUELINE LMFT	7/31/2020	163WP0807X	NA	Other	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
72796	Fee-for-Service	1861500662	1861500662	1	1	GRODAN, PAUL J MD	3/1/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30279	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	150 N ROBERTSON BLVD	STE 211	BEVERLY HILLS	CA	90211	2145	19	06037	34.06812722	-118.3837146	Los Angeles County
72813	Fee-for-Service	1548567498	1548567498	1	9	GENESIS HEALTHCARE PARTNERS	6/1/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	4060 FOURTH AVE	SUITE 310	SAN DIEGO	CA	92103	2120	37	06073	32.75053673	-117.1616539	San Diego County
72834	Fee-for-Service	1932280377	1932280377	1	1	GRUBER, STEPHEN B MD	2/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89235	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
72869	Fee-for-Service	1609897339	1609897339	1	1	GOOD SAMARITAN REGIONAL	12/13/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH CENTER	605 N 12TH STREET	None	MT VERNON	IL	62864	2857	00	None	38.32267538	-88.90997965	Jefferson County
72880	Fee-for-Service	1235331034	1235331034	1	1	GORDON, ERIN D MD	3/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98357	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
72885	Fee-for-Service	1780795039	1780795039	1	1	GREER, DINEEN J MD	12/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84396	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
72899	Fee-for-Service	1720518962	1720518962	1	1	GALUSTIAN, LILA LMFT	1/21/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
72920	Fee-for-Service	1831324128	1831324128	1	1	GEBREMICHAEL, HERMELA B	4/4/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 N LA BREA AVE	None	INGLEWOOD	CA	90301	1708	19	06037	33.96345848	-118.3533454	Los Angeles County
72923	Fee-for-Service	1881731909	1881731909	1	2	GUARDENIER, ANDREA M MD	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126103	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
72931	Fee-for-Service	1760616270	1760616270	1	1	GREATER MODESTO MEDICAL	10/8/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	SURGICAL ASSOCIATES INC	1541 FLORIDA AVENUE	SUITE 200	MODESTO	CA	95350	4338	50	06099	37.666863	-120.9962775	Stanislaus County
72951	Fee-for-Service	1922234657	1922234657	1	1	GRAY, JOHANN G MD	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145764	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
72971	Fee-for-Service	1043305303	1043305303	1	1	GOODRICH, CYNTHIA L	7/1/2004	163WH0200X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	887 PALMETTO AVE	None	CHICO	CA	95926	4078	04	06007	39.74145801	-121.8311445	Butte County
72985	Fee-for-Service	1871767210	1871767210	1	1	GONZALEZ, CYNTHIA G MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131602	13	Neurology (M.D. only)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
72990	Fee-for-Service	1578006607	1578006607	1	1	GALENS, JEFFREY LCSW	9/30/2022	1041C0700X	NA	Mental Health Outpatient Services	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
73022	Fee-for-Service	1396423695	1396423695	1	1	GENTRY CHIROPRACTIC INC	8/31/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	30486 AVENIDA DE LAS BAN	#D	RANCHO SANTA MARG	CA	92688	3948	30	06059	33.64278115	-117.5985362	Orange County
73031	Fee-for-Service	1841236908	1841236908	1	1	GARFIELD BEACH CVS, LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2103 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	6801	19	06037	34.03885159	-118.1443719	Los Angeles County
73112	Fee-for-Service	1437177532	1437177532	1	1	GIANG, ANDREW B MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68929	41	Internal Medicine	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
73128	Fee-for-Service	1023161684	1023161684	1	2	GONZALEZ, ENRIQUE J MD	12/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	74790	01	General Practice	0	In state provider	None	120 S MONTEBELLO BLVD	None	MONTEBELLO	CA	90640	4730	19	06037	34.00902509	-118.1084052	Los Angeles County
73138	Fee-for-Service	1699701680	1699701680	1	1	GLENN, BRADLEY J MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	63538	30	Radiology	0	In state provider	None	35800 BOB HOPE DRIVE	STE 150A	RANCHO MIRAGE	CA	92270	1739	33	06065	33.790527	-116.4058645	Riverside County
73144	Fee-for-Service	1194008276	1194008276	1	1	GHANNADI, SHIRIN PSYD	6/15/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3815 ATLANTIC AVE	6	LONG BEACH	CA	90807	3500	19	06037	33.827346	-118.1851085	Los Angeles County
73147	Fee-for-Service	1861927485	1861927485	1	1	GUY, KELLY L MD	7/15/2020	207R00000X	NA	Other	026	PHYSICIANS	157099	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
73156	Fee-for-Service	1316136187	1316136187	1	1	GLOBAL COMMERCE, LLC	6/8/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	GLOBAL MEDICAL SUPPLIES	14555 HAMLIN STREET	SUITE 3	VAN NUYS	CA	91411	1612	19	06037	34.18872722	-118.4506359	Los Angeles County
73188	Fee-for-Service	1467432609	1467432609	1	1	GIBBS, DAVID L MD	7/20/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79479	85	Surgery-Pediatric	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
73212	Fee-for-Service	1881731909	1881731909	1	2	GUARDENIER, ANDREA M MD	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126103	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
73217	Fee-for-Service	1760616270	1760616270	1	1	GREATER MODESTO MEDICAL	10/8/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	SURGICAL ASSOCIATES INC	1541 FLORIDA AVENUE	SUITE 200	MODESTO	CA	95350	4338	50	06099	37.666863	-120.9962775	Stanislaus County
73225	Fee-for-Service	1770538167	1770538167	1	1	GARTON, GABRIEL R	8/11/2021	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
73232	Fee-for-Service	1558933135	1558933135	1	1	GARCIA, MARIAH	1/20/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 S FARRELL DR	STE B210	PALM SPRINGS	CA	92262	7933	33	06065	33.81787498	-116.5180068	Riverside County
73267	Fee-for-Service	1205255858	1205255858	1	1	GUNAWARDENA, DELANI S MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143172	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
73268	Fee-for-Service	1275644593	1275644593	1	1	GLOSTER, MAURICE A MD	8/24/2004	207RE0101X	NA	Endocrinology	026	PHYSICIANS	33186	67	Endocrinology	0	In state provider	None	1020 29TH ST	STE 540	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
73277	Fee-for-Service	1326854878	1326854878	1	1	GLASSER, SHELBY PT	2/18/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	177 NORTH REINO RD	None	NEWBURY PARK	CA	91320	3710	56	06111	34.18076257	-118.9529104	Ventura County
73314	Fee-for-Service	1639141658	1639141658	1	1	GEORGE MEIRE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY OF CINCINNATI	234 GOODMAN	None	CINCINNATI	OH	45219	0000	00	None	39.13677965	-84.5023814	Hamilton County
73419	Fee-for-Service	1316495336	1316495336	1	1	GORLICK, AMANDA PHD	10/13/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
73424	Fee-for-Service	1740638550	1740638550	1	1	GAMBOA, MARIA AMANDA M MD	1/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161417	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
73435	Fee-for-Service	1598868655	1598868655	1	1	GENESIS HEALTHCARE SYSTEM	6/27/2023	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2951 MAPLE AVE	None	ZANESVILLE	OH	43701	1406	00	None	39.97549342	-82.01391977	Muskingum County
73436	Fee-for-Service	1720028897	1720028897	1	1	GRABOVAC, MARK T MD	6/1/2000	207L00000X	NA	Other	026	PHYSICIANS	76893	05	Anesthesiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
73484	Fee-for-Service	1609830215	1609830215	1	1	GAENSLER, KARIN MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	50093	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1580 VALENCIA ST	None	SAN FRANCISCO	CA	94110	4423	38	06075	37.74746923	-122.4202583	San Francisco County
73491	Fee-for-Service	1669005567	1669005567	1	1	GHOSN, OMAR MD	10/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	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
73505	Fee-for-Service	1154550119	1154550119	1	1	GROVES, ELLIOTT M MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111875	41	Internal Medicine	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
73552	Fee-for-Service	1720095334	1720095334	1	1	GREISNER,WILLIAM 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	171 NORTH EAGLE CREEK	DRIVE	LEXINGTON	KY	40509	0000	00	None	38.00149897	-84.43913298	Fayette County
73571	Fee-for-Service	1578220182	1578220182	1	1	GOLDEN STATE HOME HEALTH	8/21/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY INC	21133 VICTORY BLVD	SUITE 203	CANOGA PARK	CA	91303	4016	19	06037	34.18838848	-118.593693	Los Angeles County
73573	Fee-for-Service	1619185162	1619185162	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27100 EUCALYPTUS AVE	None	MORENO VALLEY	CA	92555	4522	33	06065	33.938001	-117.1896705	Riverside County
73575	Fee-for-Service	1942494430	1942494430	1	1	GREEN, SARI H MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107927	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
73636	Fee-for-Service	1801832753	1801832753	1	1	GAAB, MARIA R PHD	2/8/2015	103GC0700X	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5100 N 6TH STREET	STE 115A	FRESNO	CA	93710	7514	10	06019	36.810666	-119.763204	Fresno County
73672	Fee-for-Service	1134414568	1134414568	1	1	GILLASPY, BONNIE K LMFT	8/21/2018	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
73676	Fee-for-Service	1285046136	1285046136	1	1	GARCIA PENA, HAMLET R MD	12/2/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153375	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
73689	Fee-for-Service	1821253428	1821253428	1	1	GOMEZ, ANA M MD	2/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110112	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
73690	Fee-for-Service	1578996872	1578996872	1	1	GRATTAN, GIL J PSYD	4/11/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	446 S MARENGO AVE	SUITE A	PASADENA	CA	91101	3113	19	06037	34.138512	-118.1458425	Los Angeles County
73720	Fee-for-Service	1598868655	1598868655	1	1	GENESIS HEALTHCARE SYSTEM	6/27/2023	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2951 MAPLE AVE	None	ZANESVILLE	OH	43701	1406	00	None	39.97549342	-82.01391977	Muskingum County
73766	Fee-for-Service	1326243015	1326243015	1	1	GANJIANPOUR, MAHYAR DO A	11/21/2017	193400000X	NA	Other	026	PHYSICIANS	8206	05	Anesthesiology	0	In state provider	PROFESSIONAL CORPORATION	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4677	19	06037	34.22145548	-118.4566005	Los Angeles County
73847	Fee-for-Service	1952497513	1952497513	1	1	GRADY, YOLANDA T MD INC	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53673	08	Family Practice	0	In state provider	None	13768 ROSEWELL AVENUE	STE 202	CHINO	CA	91710	1405	36	06071	34.0038	-117.7218555	San Bernardino County
73864	Fee-for-Service	1497944755	1497944755	1	1	GARG, ROHIT MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100937	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
73903	Fee-for-Service	1407219116	1407219116	1	1	GRIFFIN, EZKIEL M LCSW	10/24/2023	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
73910	Fee-for-Service	1174181689	1174181689	1	1	GABRIEL ZACHARIA REAGLE DO	6/21/2019	2278C0205X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1400 E. CHURCH STREET	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
73945	Fee-for-Service	1255960001	1255960001	1	1	GONZALEZ, MICHAELA MD	10/4/2023	207P00000X	NA	Other	026	PHYSICIANS	189110	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
74026	Fee-for-Service	1396202339	1396202339	1	1	GHANAYEM, KATHLEEN M RCP	8/14/2020	2279P1004X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
74039	Fee-for-Service	1801994397	1801994397	1	1	GARFIELD BEACH CVS LLC	12/13/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10945 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3717	19	06037	34.18672753	-118.3697455	Los Angeles County
74088	Fee-for-Service	1588605497	1588605497	1	1	GARFIELD BEACH CVS LLC	5/1/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5944 N FIGUEROA AVE	None	LOS ANGELES	CA	90042	4230	19	06037	34.11123126	-118.1893738	Los Angeles County
74096	Fee-for-Service	1326601717	1326601717	1	1	GYORY, MICHAEL MD	4/15/2023	207P00000X	NA	Other	026	PHYSICIANS	180963	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
74255	Fee-for-Service	1275730335	1275730335	1	1	GUPTA, NAVDEEP MD	10/1/2021	208M00000X	NA	Other	026	PHYSICIANS	167749	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
74295	Fee-for-Service	1669681417	1669681417	2	1	GARFIELD BEACH CVS LLC	3/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 WESTMINSTER MALL	None	WESTMINSTER	CA	92683	4984	30	06059	33.74510218	-118.0116558	Orange County
74316	Fee-for-Service	1881737286	1881737286	1	1	GLATLEIDER, PAULINE M	2/8/2015	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1530 S OLIVE STREET	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
74331	Fee-for-Service	1629365275	1629365275	1	1	GANDHI, KABIR MD	5/30/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
74333	Fee-for-Service	1578681391	1578681391	1	1	GOLDLUST, ERIC J MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138544	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
74336	Fee-for-Service	1881612190	1881612190	1	1	GAFFEY, THOMAS MD	3/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85705	05	Anesthesiology	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
74337	Fee-for-Service	1811343759	1811343759	1	1	GILMOUR, DUNCAN M DO	10/12/2022	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
74343	Fee-for-Service	1083694780	1083694780	1	1	GUALTIERI, 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	2901 N CENTRAL AVE	STE 500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
74390	Fee-for-Service	1033522503	1033522503	1	1	GALLARDO, JAZZLYN R DO	12/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15350	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
74415	Fee-for-Service	1417124629	1417124629	1	1	GLORIA LINAREZ	3/24/2010	No Taxonomy Provided	Both NEMT & NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	AUTOMEDIC TRANSPORTATION	5360 MISSION BLVD	None	RIVERSIDE	CA	92509	4626	33	06065	33.99379037	-117.4009473	Riverside County
74439	Fee-for-Service	1285614909	1285614909	1	1	GARANT, MARC MD	1/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	60807	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
74447	Fee-for-Service	1346784865	1346784865	1	1	GONG, ALEXANDER O MD	7/19/2021	207R00000X	NA	Other	026	PHYSICIANS	166216	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
74472	Fee-for-Service	1295858512	1295858512	1	1	GREEN, WILLIAM S MD	2/24/2011	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	95223	20	Orthopedic Surgery	0	In state provider	None	1001 POTRERO AVE	RM 3A	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
74490	Fee-for-Service	1679727127	1679727127	1	1	GEHA, RULA C MD	5/18/2021	208600000X	NA	General Surgery	026	PHYSICIANS	104403	None	None	0	In state provider	None	3830 VALLEY CENTRE DR	SUITE 702	SAN DIEGO	CA	92130	3320	37	06073	32.93777252	-117.2318423	San Diego County
74493	Fee-for-Service	1790856771	1790856771	1	1	GANDHI, DEEPTI MD	9/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81785	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
74533	Fee-for-Service	1023236676	1023236676	1	1	GUERGUIS, JENNIFER LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
74550	Fee-for-Service	1598937468	1598937468	1	1	GRIGORIAN, ELA MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101344	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
74555	Fee-for-Service	1649292285	1649292285	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 N FREEWAY BLVD	None	SACRAMENTO	CA	95834	2902	34	06067	38.641041	-121.4987175	Sacramento County
74607	Fee-for-Service	1013927441	1013927441	1	3	GREENBERG, GREG A MD	8/13/2021	208M00000X	NA	Other	086	MEDICAL DIRECTORS	86727	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
74611	Fee-for-Service	1164836896	1164836896	1	1	GOLBOO, SEPEHR MD	8/31/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145455	08	Family Practice	0	In state provider	None	1690 BARTON RD	STE 106	REDLANDS	CA	92373	4230	36	06071	34.04836346	-117.2125293	San Bernardino County
74640	Fee-for-Service	1124053079	1124053079	2	1	GOLDBERG, STEVEN L MD	2/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	27045	02	General Surgery	0	In state provider	None	2216 N CALIFORNIA ST	STE A	STOCKTON	CA	95204	5533	39	06077	37.97386974	-121.2903465	San Joaquin County
74728	Fee-for-Service	1629001599	1629001599	1	1	GARDNER, MICHAEL O MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128959	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
74771	Fee-for-Service	1689860850	1689860850	1	1	GORDON, BENJAMIN H MD	7/15/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	103290	30	Radiology	0	In state provider	None	300 LEWIS STREET	None	SAN DIEGO	CA	92103	2108	37	06073	32.75191911	-117.1621589	San Diego County
74849	Fee-for-Service	1871145441	1871145441	1	1	GRACEFUL CARE HOME HEALTH	9/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	2082 NEWBURY RD	SUITE 2	NEWBURY PARK	CA	91320	3352	56	06111	34.18325613	-118.9246441	Ventura County
74852	Fee-for-Service	1407841315	1407841315	1	1	GRIMM, WILLIAM J	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	6067	41	Internal Medicine	0	In state provider	None	1330 N INDIAN CANYON DR	STE E	PALM SPRINGS	CA	92262	4880	33	06065	33.84144	-116.5455715	Riverside County
74856	Fee-for-Service	1568033926	1568033926	1	1	GALAN, MELANIE	2/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
74868	Fee-for-Service	1174568075	1174568075	1	1	GARFIELD BEACH CVS, LLC	1/14/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5822 S. VERMONT AVE	None	LOS ANGELES	CA	90044	3712	19	06037	33.987789	-118.291444	Los Angeles County
74898	Fee-for-Service	1740275619	1740275619	1	1	GILLETT, ROBERT D OD	9/15/2000	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	418 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3321	54	06107	36.06957964	-119.0264168	Tulare County
74903	Fee-for-Service	1801003686	1801003686	1	1	GRIGORYAN, MIKAYEL MD	3/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	107120	13	Neurology (M.D. only)	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 356	LOS ANGELES	CA	90033	2425	19	06037	34.05112725	-118.2173921	Los Angeles County
74928	Fee-for-Service	1417022336	1417022336	1	2	GREGERSON, PAUL G MD	11/25/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	55695	-	NOT APPLICABLE	0	In state provider	None	303 EAST 52ND STREET	None	LOS ANGELES	CA	90011	4513	19	06037	33.99526806	-118.2699516	Los Angeles County
74931	Fee-for-Service	1649762501	1649762501	1	1	GOLLA, ABHINAV MD MPH	10/2/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	164360	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
74996	Fee-for-Service	1831290477	1831290477	1	1	GREWAL, SHARNJIT S MD	9/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88367	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
75023	Fee-for-Service	1619055209	1619055209	1	1	GODDARD, SUSAN L MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86992	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
75039	Fee-for-Service	1780692814	1780692814	1	1	GAUSMAN, WILLIAM H JR MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	19556	08	Family Practice	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
75066	Fee-for-Service	1750065884	1750065884	1	1	GAO, BRUCE MD	9/29/2023	390200000X	NA	Other	026	PHYSICIANS	188603	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
75079	Fee-for-Service	1114176831	1114176831	1	1	GOOD SAMARITAN SHELTER	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	604 W OCEAN AVENUE	None	LOMPOC	CA	93436	6630	42	06083	34.63897253	-120.4643468	Santa Barbara County
75102	Fee-for-Service	1922624048	1922624048	1	1	GENERAL MEDICAL HOME HEALTH	9/30/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6470 FOOTHILL BLVD	STE D	TUJUNGA	CA	91042	2749	19	06037	34.24452205	-118.2728144	Los Angeles County
75112	Fee-for-Service	1710930094	1710930094	1	1	GARNIC, JOSEPH D MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51906	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
75118	Fee-for-Service	1245599570	1245599570	1	1	GARCIA, CARLA P LCSW	12/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	930 TRUXTUN AVE STE 206	None	BAKERSFIELD	CA	93301	4700	15	06029	35.37343547	-119.012751	Kern County
75126	Fee-for-Service	1962044404	1962044404	1	1	GEVORGYAN, MANEH OD	6/6/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	845 FOOTHILL BLVD	None	LA CANADA FLINTRI	CA	91011	3337	19	06037	34.20320018	-118.1972961	Los Angeles County
75127	Fee-for-Service	1306837521	1306837521	1	1	GOTTLIEB, ALAN R MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	34546	66	Emergency Medicine (Urgent Care)	0	In state provider	None	897 MACARTHUR BLVD	STE 101	SAN LEANDRO	CA	94577	3002	01	06001	37.7370484	-122.1413528	Alameda County
75143	Fee-for-Service	1033424247	1033424247	1	1	GONZALES, ANGELINA M LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	80027	-	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
75155	Fee-for-Service	1598887515	1598887515	1	1	GONG, TRACIE W MD	9/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95349	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
75166	Fee-for-Service	1275556573	1275556573	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	78935 US HWY 111	None	LA QUINTA	CA	92253	2072	33	06065	33.70967775	-116.2890775	Riverside County
75232	Fee-for-Service	1255725412	1255725412	1	1	GALVAN, JENNIFER PHD	2/16/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10404 DE SOTO AVE	None	CHATSWORTH	CA	91311	2303	19	06037	34.2592164	-118.5885595	Los Angeles County
75276	Fee-for-Service	1376571588	1376571588	1	1	GOLDEN, BRIAN K MD	6/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116274	34	Urology and Urological Surgery	0	In state provider	None	500 UNIVERSITY AVE	STE 200	SACRAMENTO	CA	95825	6524	34	06067	38.568402	-121.418019	Sacramento County
75278	Fee-for-Service	1144213299	1144213299	1	1	GAMBHIR, SANGEETA MD	8/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75064	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
75328	Fee-for-Service	1588730162	1588730162	1	1	GONZALEZ, JAIME MD INC	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87328	08	Family Practice	0	In state provider	None	350 VINTON AVENUE	SUITE 204	POMONA	CA	91767	3000	19	06037	34.07937061	-117.746663	Los Angeles County
75346	Fee-for-Service	1962760397	1962760397	1	1	GOODMAN, JARED N MD	7/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119611	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
75362	Fee-for-Service	1790097442	1790097442	1	1	GOODSTEIN, GELSEY L MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117548	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
75399	Fee-for-Service	1548567498	1548567498	1	12	GENESIS HEALTHCARE PARTNERS	10/25/2012	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	15644 POMERADO RD	STE 206	POWAY	CA	92064	2419	37	06073	32.99717879	-117.0579379	San Diego County
75420	Fee-for-Service	1831789296	1831789296	1	1	GRAVERSEN, MORTEN PT	12/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	802 MAGNOLIA AVENUE	SUITE 107	CORONA	CA	92879	3125	33	06065	33.8596449	-117.5529774	Riverside County
75439	Fee-for-Service	1922042290	1922042290	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10048 MILLS AVE	None	WHITTIER	CA	90604	1201	19	06037	33.94235429	-118.0287065	Los Angeles County
75450	Fee-for-Service	1790206761	1790206761	1	1	GOOD SAMARITAN SHELTER	9/18/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	401 B WEST MORRISON AVE	None	SANTA MARIA	CA	93458	2101	42	06083	34.94318724	-120.4410233	Santa Barbara County
75462	Fee-for-Service	1114119054	1114119054	1	1	G&R ALAMEDA HEALTHCARE SVS	9/1/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& REHAB CENTER	508 WESTLINE DR	None	ALAMEDA	CA	94501	5847	01	06001	37.76518099	-122.2715282	Alameda County
75474	Fee-for-Service	1487060463	1487060463	1	1	GARFIELD, RAHMIEL H NP	1/19/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
75483	Fee-for-Service	1710909346	1710909346	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9882 ADAMS AVE	None	HUNTINGTON BEACH	CA	92646	4808	30	06059	33.67226051	-117.9562635	Orange County
75498	Fee-for-Service	1871721043	1871721043	1	2	GREEN, JANELLE P DPM	2/18/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5709 MARKET STREET	I	OAKLAND	CA	94608	2811	01	06001	37.84173278	-122.2745576	Alameda County
75513	Fee-for-Service	1205817681	1205817681	1	1	GARDE, ANIL R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25189	10	Gastroenterology (M.D. only)	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
75542	Fee-for-Service	1043385131	1043385131	1	1	GRISSAM, TONYA M MD	11/21/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	151172	40	Pediatrics	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
75562	Fee-for-Service	1386756831	1386756831	1	1	GREEN, RICHARD M MD	7/1/1978	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30476	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2220 LYNN RD	STE 201	THOUSAND OAKS	CA	91360	8011	56	06111	34.20863046	-118.8852156	Ventura County
75578	Fee-for-Service	1942300983	1942300983	2	1	GAA PHARMACY INC	7/31/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1112 S GLENDALE AVE	None	GLENDALE	CA	91205	3203	19	06037	34.13307893	-118.2519885	Los Angeles County
75604	Fee-for-Service	1770893117	1770893117	1	2	GONZALEZ, JOSE L MD	10/16/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	114052	-	NOT APPLICABLE	0	In state provider	None	2010 ZONAL AVE	OPD 4P1 RM 1-15	LOS ANGELES	CA	90033	1026	19	06037	34.05986523	-118.2057472	Los Angeles County
75623	Fee-for-Service	1104923705	1104923705	1	1	GREIDER, BRADLEY W MD INC	3/18/2013	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2067 W VISTA WAY	SUITE 120	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
75633	Fee-for-Service	1013951367	1013951367	2	1	GARFIELD BEACH CVS, LLC	4/7/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	480 SOUTH MAIN ST	None	ORANGE	CA	92686	3836	30	06059	33.7808887	-117.8674012	Orange County
75637	Fee-for-Service	1174853584	1174853584	1	1	GENGOUX, GRACE W PHD	3/8/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
75639	Fee-for-Service	1700641834	1700641834	1	1	GO, SHIELA MAE G	12/11/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1091 AMBER RIDGE LN	None	VACAVILLE	CA	95687	5828	48	06095	38.34592711	-121.9607206	Solano County
75699	Fee-for-Service	1992871974	1992871974	1	1	GUILLET, MARC PT	10/2/2007	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
75708	Fee-for-Service	1124334941	1124334941	1	1	GILES, JANET LMFT	4/21/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1347 GRANT ST	None	RED BLUFF	CA	96080	2366	52	06103	40.18355103	-122.2401731	Tehama County
75750	Fee-for-Service	1427056928	1427056928	1	1	GATES, KATHLEEN P MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81253	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
75763	Fee-for-Service	1376567586	1376567586	1	1	GROTH, JAMES N MD	8/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60566	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
75770	Fee-for-Service	1659662351	1659662351	1	2	G & C SWAN INC	12/21/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	215 W 9TH ST	APT I, J, K	UPLAND	CA	91786	5910	36	06071	34.09609851	-117.653949	San Bernardino County
75772	Fee-for-Service	1144868746	1144868746	1	1	GREEN RIVER HOSPICE	11/30/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17332 IRVINE BLVD	SUITE 201	TUSTIN	CA	92780	3059	30	06059	33.748125	-117.8297258	Orange County
75791	Fee-for-Service	1558311779	1558311779	1	1	GREENVILLE HOSPITAL SYSTEM	6/29/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	729 SE MAIN ST	None	SIMPSONVILLE	SC	29681	3218	00	None	34.71876196	-82.24906413	Greenville County
75802	Fee-for-Service	1205817681	1205817681	1	1	GARDE, ANIL R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25189	41	Internal Medicine	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
75823	Fee-for-Service	1639101066	1639101066	1	1	GILMAN, ROSE D	10/31/1994	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	16133 VENTURA BLVD	STE 360	ENCINO	CA	91436	2426	19	06037	34.15656164	-118.4849569	Los Angeles County
75832	Fee-for-Service	1245394360	1245394360	1	1	GUPTA, SMITA R MD	9/15/2008	207RR0500X	NA	Other	026	PHYSICIANS	101037	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
75841	Fee-for-Service	1407940224	1407940224	1	1	GASTROENTEROLOGY ASSOCIATES	12/16/2014	174400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF THE EAST BAY MEDICAL	2510 WEBSTER STREET	None	BERKELEY	CA	94705	2119	01	06001	37.85564794	-122.2560479	Alameda County
75842	Fee-for-Service	1508352022	1508352022	1	1	GARCIA, NIKITA T	2/26/2019	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2505 W SHAW AVE	SUITE 101	FRESNO	CA	93711	3334	10	06019	36.80619423	-119.8359004	Fresno County
75891	Fee-for-Service	1427338409	1427338409	1	1	GORSI, SHAMAILA MD	3/15/2024	208M00000X	NA	Other	026	PHYSICIANS	173684	None	None	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
75894	Fee-for-Service	1871540815	1871540815	1	1	GRIMM, BRIAN M MD	1/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91113	08	Family Practice	0	In state provider	None	43839 15TH STREET WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
75911	Fee-for-Service	1104923705	1104923705	1	1	GREIDER, BRADLEY W MD INC	3/18/2013	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2067 W VISTA WAY	SUITE 120	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
75925	Fee-for-Service	1538217583	1538217583	1	1	GALLARDO,SHERWIN Q MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63445	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
75929	Fee-for-Service	1700641834	1700641834	1	1	GO, SHIELA MAE G	12/11/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1091 AMBER RIDGE LN	None	VACAVILLE	CA	95687	5828	48	06095	38.34592711	-121.9607206	Solano County
75932	Fee-for-Service	1992026553	1992026553	1	1	GUINTO, ELIZABETH K DO	10/3/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17351	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
75952	Fee-for-Service	1932436144	1932436144	1	1	GARCIA, LAUREN M LMFT	5/17/2023	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
75954	Fee-for-Service	1629028923	1629028923	1	1	GARFOLO, CRAIG S DPM	11/30/1984	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1350 W ROBINHOOD DR	STE 14	STOCKTON	CA	95207	5512	39	06077	37.9983704	-121.3242298	San Joaquin County
75960	Fee-for-Service	1356363147	1356363147	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2901 MING AVE	None	BAKERSFIELD	CA	93304	4144	15	06029	35.336565	-119.035854	Kern County
76022	Fee-for-Service	1568400455	1568400455	1	2	GATEWAY MEDICAL GROUP OF	8/20/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	SAN DIEGO INC	752 MEDICAL CENTER CT	SUITE 210	CHULA VISTA	CA	91911	6660	37	06073	32.61800405	-117.0232585	San Diego County
76050	Fee-for-Service	1477134625	1477134625	1	1	GOLDEN DAY HOME HEALTH INC	1/31/2024	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	417 ARDEN AVE	STE 105	GLENDALE	CA	91203	4046	19	06037	34.15847866	-118.2621835	Los Angeles County
76060	Fee-for-Service	1144868746	1144868746	1	1	GREEN RIVER HOSPICE	11/30/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17332 IRVINE BLVD	SUITE 201	TUSTIN	CA	92780	3059	30	06059	33.748125	-117.8297258	Orange County
76066	Fee-for-Service	1437187556	1437187556	1	1	GITTENS,M MELINDA 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	0000	00	None	39.14105892	-84.50040782	Hamilton County
76072	Fee-for-Service	1558311779	1558311779	1	1	GREENVILLE HOSPITAL SYSTEM	6/29/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	729 SE MAIN ST	None	SIMPSONVILLE	SC	29681	3218	00	None	34.71876196	-82.24906413	Greenville County
76093	Fee-for-Service	1215078381	1215078381	1	1	GIRARD, PHILIP M MD	7/31/1979	2084N0400X	NA	Neurology	026	PHYSICIANS	32812	13	Neurology (M.D. only)	0	In state provider	None	50 ALESSANDRO PL	STE 120	PASADENA	CA	91105	4010	19	06037	34.13101049	-118.151532	Los Angeles County
76105	Fee-for-Service	1174971048	1174971048	1	1	GAZIPURA, SHAHEENA N NP	11/20/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1720 W BALL RD	STE 4C	ANAHEIM	CA	92804	5500	30	06059	33.8178465	-117.9425115	Orange County
76120	Fee-for-Service	1245394360	1245394360	1	1	GUPTA, SMITA R MD	9/15/2008	207RR0500X	NA	Other	026	PHYSICIANS	101037	83	Rheumatology	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
76133	Fee-for-Service	1689733313	1689733313	1	1	GOEBELSMANN, EVELIA A NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1515 N VERMONT AVE	None	LOS ANGELES	CA	90027	5337	19	06037	34.09851639	-118.2918012	Los Angeles County
76158	Fee-for-Service	1265814164	1265814164	1	1	GILBERT, JOSH AU	9/20/2023	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
76214	Fee-for-Service	1659894673	1659894673	1	1	GOMEZ, GUILLERMO A MD	6/25/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151699	None	None	0	In state provider	None	31946 MISSION TRAIL	STE A	LAKE ELSINORE	CA	92530	4539	33	06065	33.65640803	-117.2979656	Riverside County
76224	Fee-for-Service	1265668552	1265668552	1	1	GONZALES, REFUGIO MD	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93390	84	Surgery-Head and Neck	0	In state provider	None	1409 EAST BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
76226	Fee-for-Service	1174934228	1174934228	1	1	GOLCHIN, ARMAND MD	1/28/2025	207RC0200X	NA	Other	026	PHYSICIANS	180072	41	Internal Medicine	0	In state provider	None	2623 SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
76241	Fee-for-Service	1063778520	1063778520	1	1	GELBER, KATHERINE M S MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141568	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
76275	Fee-for-Service	1548567498	1548567498	1	3	GENESIS HEALTHCARE PARTNERS	5/10/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	701 E GRAND AVE	SUITE 200	ESCONDIDO	CA	92025	4404	37	06073	33.1249585	-117.0726834	San Diego County
76278	Fee-for-Service	1457441206	1457441206	1	1	GOLAN, DAVID R MD	1/1/2002	207P00000X	NA	Other	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
76311	Fee-for-Service	1568400455	1568400455	1	2	GATEWAY MEDICAL GROUP OF	8/20/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SAN DIEGO INC	752 MEDICAL CENTER CT	SUITE 210	CHULA VISTA	CA	91911	6660	37	06073	32.61800405	-117.0232585	San Diego County
76328	Fee-for-Service	1922159474	1922159474	1	2	GABRIEL-COX, KATHERINE MD	1/5/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	90808	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	204 EAST BEACH ST	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
76330	Fee-for-Service	1831767433	1831767433	1	1	GHOSSEIN, NOAH	4/27/2024	390200000X	NA	Other	026	PHYSICIANS	184933	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
76337	Fee-for-Service	1578641197	1578641197	1	1	GOARD, CRAIG P MD	7/12/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	38821	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
76358	Fee-for-Service	1407180623	1407180623	1	1	GURJALA, ANANDEV N MD	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127408	24	Plastic Surgery	0	In state provider	None	2268 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324125	-122.4408692	San Francisco County
76377	Fee-for-Service	1295970242	1295970242	1	1	GARFIELD BEACH CVS, LLC	4/3/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	155 5TH ST	STE 175	HUNTINGTON BEACH	CA	92648	5516	30	06059	33.65816691	-118.0023872	Orange County
76388	Fee-for-Service	1295737179	1295737179	1	1	GOTTNER, ROBERT J MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70423	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2200 W 3RD ST	STE 370	LOS ANGELES	CA	90057	1939	19	06037	34.06329642	-118.2739484	Los Angeles County
76405	Fee-for-Service	1316017346	1316017346	1	1	GORELICK, SEYMOUR F MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32400	15	Obstetrics (D.O. only)	0	In state provider	A MEDICAL CORP	2100 LYNN RD	STE 120	THOUSAND OAKS	CA	91360	8033	56	06111	34.2074907	-118.8854443	Ventura County
76435	Fee-for-Service	1689647356	1689647356	1	1	GURNEY, JONATHAN MARC MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	85221	30	Radiology	0	In state provider	None	8745 AERO DR	STE 200	SAN DIEGO	CA	92123	1774	37	06073	32.80965551	-117.1391563	San Diego County
76439	Fee-for-Service	1013941475	1013941475	1	1	GARRISON, ROGER C DO	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7705	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
76440	Fee-for-Service	1811085467	1811085467	1	1	GOTTLIEB, JILL L LCSW	8/25/2022	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
76506	Fee-for-Service	1992821151	1992821151	1	1	GUADAGNINI, FRANK E CRNA	8/24/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
76518	Fee-for-Service	1942687298	1942687298	1	1	GODSEY-ERB, ROJEANIA L LMFT	11/8/2018	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
76519	Fee-for-Service	1982913661	1982913661	1	1	GEORGE, MEENA S MD	9/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120498	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
76529	Fee-for-Service	1700288958	1700288958	1	1	GLEASON, PATRICK J APN	7/10/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	214 E 23RD ST	None	CHEYENNE	WY	82001	3748	00	None	41.1402124	-104.8159812	Laramie County
76548	Fee-for-Service	1922204353	1922204353	1	1	GARRETTSON, BRYAN D OD	9/15/1980	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	175 COHASSET RD	STE 1	CHICO	CA	95926	2201	04	06007	39.75118564	-121.8543802	Butte County
76566	Fee-for-Service	1790407732	1790407732	1	1	GULOTTA, SAMANTHA LMFT	10/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
76576	Fee-for-Service	1023278132	1023278132	1	1	GOMEZ, RACHEL E MD	3/7/2011	208600000X	NA	General Surgery	026	PHYSICIANS	91906	02	General Surgery	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
76591	Fee-for-Service	1609130459	1609130459	1	2	G & K FOUNDATION	11/2/2020	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7325 MEDICAL CENTER DR	SUITE 102	WEST HILLS	CA	91307	1925	19	06037	34.20369349	-118.629837	Los Angeles County
76592	Fee-for-Service	1851458400	1851458400	1	1	GLATT, STEPHEN LMFT	6/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
76593	Fee-for-Service	1376839910	1376839910	1	1	GLEASON, STEPHANIE PT	6/21/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
76608	Fee-for-Service	1942235874	1942235874	1	1	GARCIA, RAYNADO F MD	4/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36032	01	General Practice	0	In state provider	None	682 E VISALIA RD	None	FARMERSVILLE	CA	93223	1641	54	06107	36.2977601	-119.2009571	Tulare County
76615	Fee-for-Service	1477985216	1477985216	1	1	GOSS, JENIFER LMFT	8/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 CHERRY ST	None	SANTA ROSA	CA	95404	4207	49	06097	38.444382	-122.712858	Sonoma County
76649	Fee-for-Service	1124641444	1124641444	1	1	GARCIA, EMELY R CRNA	10/1/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
76658	Fee-for-Service	1972647162	1972647162	1	1	GRGAS, KARLA C LMFT	5/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23300 CINEMA DR	SUITE 2908	SANTA CLARITA	CA	91355	1775	19	06037	34.41921148	-118.542807	Los Angeles County
76678	Fee-for-Service	1295737179	1295737179	1	1	GOTTNER, ROBERT J MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70423	01	General Practice	0	In state provider	None	2200 W 3RD ST	STE 370	LOS ANGELES	CA	90057	1939	19	06037	34.06329642	-118.2739484	Los Angeles County
76684	Fee-for-Service	1952887234	1952887234	1	1	GANSKE, WILLIAM MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	167175	02	General Surgery	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
76685	Fee-for-Service	1437184876	1437184876	1	1	GREGORIO, FEDERICO P MD	1/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50507	02	General Surgery	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2954	06	06011	39.20737704	-122.0004043	Colusa County
76694	Fee-for-Service	1649263682	1649263682	1	1	GORDON, JEOFFRY B MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	19279	08	Family Practice	0	In state provider	OCEAN BEACH MED GRP	1947 CABLE ST	None	SAN DIEGO	CA	92107	2807	37	06073	32.74639367	-117.2487717	San Diego County
76705	Fee-for-Service	1144781329	1144781329	1	1	GOODFRIEND, BRETT MD	7/22/2024	207P00000X	NA	Other	026	PHYSICIANS	183149	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
76737	Fee-for-Service	1154416279	1154416279	1	1	GREGURICH, JOSEPH N MD	4/29/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20621	41	Internal Medicine	0	In state provider	None	11100 WARNER AVE	SUITE 112	FOUNTAIN VALLEY	CA	92708	7500	30	06059	33.716291	-117.9355051	Orange County
76832	Fee-for-Service	1124551882	1124551882	1	1	GILBERT, STEPHANIE R	6/27/2024	207L00000X	NA	Other	026	PHYSICIANS	159609	05	Anesthesiology	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
76861	Fee-for-Service	1447869516	1447869516	1	1	GODFREY, SHANA J	8/6/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	609 POINSETTIA AVE	None	ROSAMOND	CA	93560	7432	15	06029	34.86676514	-118.1421301	Kern County
76863	Fee-for-Service	1548567498	1548567498	1	16	GENESIS HEALTHCARE PARTNERS	7/10/2024	174400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	2403 CASTILLO ST	STE 201	SANTA BARBARA	CA	93105	4301	42	06083	34.43053648	-119.7243139	Santa Barbara County
76952	Fee-for-Service	1861563835	1861563835	1	1	GORDON, GALE L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24417	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
76960	Fee-for-Service	1912945700	1912945700	1	1	GAMAL, YOUSSEF K MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74275	68	Hematology	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
76969	Fee-for-Service	1033120290	1033120290	1	1	GUILLEN, DAVID R MD	1/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87169	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
76970	Fee-for-Service	1295737179	1295737179	1	1	GOTTNER, ROBERT J MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70423	33	Thoracic Surgery	0	In state provider	None	2200 W 3RD ST	STE 370	LOS ANGELES	CA	90057	1939	19	06037	34.06329642	-118.2739484	Los Angeles County
76971	Fee-for-Service	1164955241	1164955241	1	1	GILL, SIMRAN S MD	11/20/2020	207R00000X	NA	Other	026	PHYSICIANS	170426	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
76975	Fee-for-Service	1437184876	1437184876	1	1	GREGORIO, FEDERICO P MD	1/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50507	66	Emergency Medicine (Urgent Care)	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2954	06	06011	39.20737704	-122.0004043	Colusa County
76982	Fee-for-Service	1649263682	1649263682	1	1	GORDON, JEOFFRY B MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	19279	01	General Practice	0	In state provider	OCEAN BEACH MED GRP	1947 CABLE ST	None	SAN DIEGO	CA	92107	2807	37	06073	32.74639367	-117.2487717	San Diego County
76988	Fee-for-Service	1528008117	1528008117	1	1	GOOD, CORRINNE I NP	8/8/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
76999	Fee-for-Service	1841654902	1841654902	1	1	GALARZA, JOAQUIN A MD	8/22/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151563	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
77010	Fee-for-Service	1174247712	1174247712	1	1	GRANLUND, RUTH M MD	3/28/2023	207P00000X	NA	Other	026	PHYSICIANS	66666	None	None	0	In state provider	None	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	04	06007	39.750084	-121.7934327	Butte County
77016	Fee-for-Service	1053757781	1053757781	1	1	GYULNAZARYAN, VAHE MD	8/20/2019	207R00000X	NA	Other	026	PHYSICIANS	154219	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
77026	Fee-for-Service	1154416279	1154416279	1	1	GREGURICH, JOSEPH N MD	4/29/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20621	01	General Practice	0	In state provider	None	11100 WARNER AVE	SUITE 112	FOUNTAIN VALLEY	CA	92708	7500	30	06059	33.716291	-117.9355051	Orange County
77029	Fee-for-Service	1912929555	1912929555	2	1	GARFIELD BEACH CVS LLC	6/13/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2425 CLARIBEL RD	None	RIVERBANK	CA	95367	9456	50	06099	37.713843	-120.9527595	Stanislaus County
77030	Fee-for-Service	1134332414	1134332414	1	1	GOODMAN, SETH A MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125566	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
77062	Fee-for-Service	1386644318	1386644318	1	1	GLENN RALPH LEAVITT, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1550 ELK CREEK DR	None	IDAHO FALLS	ID	83404	0000	00	None	43.46613889	-112.0029076	Bonneville County
77150	Fee-for-Service	1447869516	1447869516	1	1	GODFREY, SHANA J	8/6/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	609 POINSETTIA AVE	None	ROSAMOND	CA	93560	7432	15	06029	34.86676514	-118.1421301	Kern County
77175	Fee-for-Service	1912119934	1912119934	1	1	GRAYSON, KELLEN	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4070 BRIDGE ST	STE 3	FAIR OAKS	CA	95628	7557	34	06067	38.64042	-121.268799	Sacramento County
77183	Fee-for-Service	1699809251	1699809251	1	1	GLOOR MAUNG, PRISCA PHD	3/16/2021	101YM0800X	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
77227	Fee-for-Service	1255629994	1255629994	1	1	GROKE, STEVEN F MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129408	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
77229	Fee-for-Service	1821139437	1821139437	1	1	GILBERT, REBECCA L MD	2/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97734	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
77251	Fee-for-Service	1912945700	1912945700	1	1	GAMAL, YOUSSEF K MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74275	78	Neoplastic Diseases/Oncology	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
77286	Fee-for-Service	1598800062	1598800062	1	1	GAMMON, J ALLEN MD	5/13/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33438	40	Pediatrics	0	In state provider	None	500 COFFEE RD	STE F	MODESTO	CA	95355	4926	50	06099	37.65105	-120.9755325	Stanislaus County
77314	Fee-for-Service	1124663117	1124663117	1	1	GENIS, JOSHUA T PT	4/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5533 W HILLSDALE AVE	SUITE 'A'	VISALIA	CA	93291	5138	54	06107	36.329238	-119.35251	Tulare County
77315	Fee-for-Service	1205061595	1205061595	1	1	GUZMAN, RONALD R S MD	11/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153148	41	Internal Medicine	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
77390	Fee-for-Service	1962680421	1962680421	1	4	GOLDEN VALLEY HEALTH CENTERS	7/11/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	GVHC MOBILE UNIT-TENAYA	2101 TENAYA DR	None	MODESTO	CA	95354	3930	50	06099	37.6324545	-120.956463	Stanislaus County
77391	Fee-for-Service	1396362091	1396362091	1	1	GOEDDEL, JENNIFER MD	10/10/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1418 E MAIN ST.	STE 210	SANTA MARIA	CA	93454	4833	42	06083	34.95286855	-120.4137315	Santa Barbara County
77404	Fee-for-Service	1952488892	1952488892	1	1	GHAFFARI, FAEZEH	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68928	15	Obstetrics (D.O. only)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
77420	Fee-for-Service	1053434985	1053434985	1	1	GROSS, DAWN M MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	81792	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
77458	Fee-for-Service	1841247939	1841247939	1	1	GELVES, GABRIEL J DO	6/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11411	30	Radiology	0	In state provider	None	4000 EMPIRE DR	STE 100	BAKERSFIELD	CA	93309	0441	15	06029	35.37480064	-119.0459033	Kern County
77473	Fee-for-Service	1962680421	1962680421	1	11	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1100 DELBON AVENUE	None	TURLOCK	CA	95382	2021	50	06099	37.5106124	-120.8356611	Stanislaus County
77536	Fee-for-Service	1912945700	1912945700	1	1	GAMAL, YOUSSEF K MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74275	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
77576	Fee-for-Service	1598800062	1598800062	1	1	GAMMON, J ALLEN MD	5/13/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33438	18	Ophthalmology	0	In state provider	None	500 COFFEE RD	STE F	MODESTO	CA	95355	4926	50	06099	37.65105	-120.9755325	Stanislaus County
77586	Fee-for-Service	1457856031	1457856031	1	1	GUZMAN, JOSUE MD	6/13/2021	207P00000X	NA	Other	026	PHYSICIANS	166751	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
77596	Fee-for-Service	1962145029	1962145029	1	1	GNOSIS GERIATRIC WELLCARE CE	7/23/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NTER INC	12555 GARDEN GROVE BLVD	STE 304	GARDEN GROVE	CA	92843	1903	30	06059	33.77450946	-117.913041	Orange County
77603	Fee-for-Service	1013321850	1013321850	1	1	GIANG, HELEN PSYD	3/15/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
77606	Fee-for-Service	1710033329	1710033329	1	1	GOLESKI, MATHEW 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	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
77638	Fee-for-Service	1740633684	1740633684	1	1	GAUDIAN, LAURA A CCC-SLP	7/11/2019	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
77646	Fee-for-Service	1558590174	1558590174	1	1	GONZALES, APRIL	5/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25096 JEFFERSON	STE C	MURRIETA	CA	92562	1706	33	06065	33.55467605	-117.2033531	Riverside County
77652	Fee-for-Service	1760945836	1760945836	1	1	GRIFFITHS, LUKE K	7/1/2024	208800000X	NA	Other	026	PHYSICIANS	None	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
77661	Fee-for-Service	1447669379	1447669379	1	1	GIRARD, TRACIE L NP	8/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3045	33	06065	33.904782	-117.469323	Riverside County
77671	Fee-for-Service	1356446413	1356446413	1	1	GARCIA, MAMERTO G MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48917	18	Ophthalmology	0	In state provider	PEDIATRIC MED ASSOC	1211 W LA PALMA AVE	STE 401	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
77678	Fee-for-Service	1962680421	1962680421	1	4	GOLDEN VALLEY HEALTH CENTERS	7/11/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	GVHC MOBILE UNIT-TENAYA	2101 TENAYA DR	None	MODESTO	CA	95354	3930	50	06099	37.6324545	-120.956463	Stanislaus County
77703	Fee-for-Service	1881708824	1881708824	1	1	GEVORGIAN, ARTIN V DPM	4/1/2000	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2625 W ALAMEDA AVE	STE 314	BURBANK	CA	91505	4822	19	06037	34.1577056	-118.329779	Los Angeles County
77715	Fee-for-Service	1568690873	1568690873	1	1	GUTIERREZ, DAVID F MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114614	None	None	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
77720	Fee-for-Service	1033536404	1033536404	1	1	GERSTEN, DANA MD	7/13/2020	390200000X	NA	Other	026	PHYSICIANS	158980	08	Family Practice	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
77741	Fee-for-Service	1003254483	1003254483	1	1	GRAMMY, JUSTIN N DO MD	8/1/2018	207R00000X	NA	Other	026	PHYSICIANS	None	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
77758	Fee-for-Service	1134415177	1134415177	1	1	GE, BENJAMIN H MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131897	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
77762	Fee-for-Service	1962680421	1962680421	1	11	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1100 DELBON AVENUE	None	TURLOCK	CA	95382	2021	50	06099	37.5106124	-120.8356611	Stanislaus County
77771	Fee-for-Service	1346713989	1346713989	1	1	GENOMIC TESTING COOPERATIVE	9/16/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LCA	175 TECHNOLOGY DR	STE 100	IRVINE	CA	92618	2473	30	06059	33.66537047	-117.746983	Orange County
77783	Fee-for-Service	1871988436	1871988436	1	1	GILLIS, STEPHANIE D MD	9/3/2024	207L00000X	NA	Other	026	PHYSICIANS	143737	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
77786	Fee-for-Service	1861443509	1861443509	1	1	GREICIUS, MICHAEL D MD	1/25/2001	2084N0400X	NA	Neurology	026	PHYSICIANS	73822	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
77855	Fee-for-Service	1760986087	1760986087	1	1	GARZA, EDUARDO MD	2/15/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	188227	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
77858	Fee-for-Service	1225607690	1225607690	1	1	GAREL, JACOB B LMFT	4/12/2024	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
77884	Fee-for-Service	1962145029	1962145029	1	1	GNOSIS GERIATRIC WELLCARE CE	7/23/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	NTER INC	12555 GARDEN GROVE BLVD	STE 304	GARDEN GROVE	CA	92843	1903	30	06059	33.77450946	-117.913041	Orange County
77961	Fee-for-Service	1356446413	1356446413	1	1	GARCIA, MAMERTO G MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	48917	40	Pediatrics	0	In state provider	PEDIATRIC MED ASSOC	1211 W LA PALMA AVE	STE 401	ANAHEIM	CA	92801	2806	30	06059	33.84718298	-117.933758	Orange County
77963	Fee-for-Service	1295175180	1295175180	1	1	GENESIS WOMENS MEDICAL GROUP	9/30/2013	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	502 EUCLID AVE	SUITE 200	NATIONAL CITY	CA	91950	2984	37	06073	32.68505421	-117.0832793	San Diego County
77970	Fee-for-Service	1932257805	1932257805	1	1	GALLARZA-WILSON BELEN MD	12/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67872	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
77986	Fee-for-Service	1134581564	1134581564	1	1	GEORGE, AKEEM A MD	9/17/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
78026	Fee-for-Service	1073765517	1073765517	1	1	GNANASHANMUGAM, SWAMINADHAN	8/31/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	171765	None	None	0	In state provider	MD	3828 SCHAUFELE AVE	STE 340	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
78035	Fee-for-Service	1396214128	1396214128	1	1	GOOD LIFE HOME HEALTH INC	10/23/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11053 PENROSE ST	SUITE A	SUN VALLEY	CA	91352	5602	19	06037	34.22885828	-118.3719249	Los Angeles County
78052	Fee-for-Service	1972732576	1972732576	1	1	GODBOLE, KETAN D MD	1/10/2019	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	335 SE 8TH AVENUE	None	HILLSBORO	OR	97123	4246	00	None	45.51948957	-122.9773135	Washington County
78057	Fee-for-Service	1316963028	1316963028	1	1	GAYNOR, RANDALL L MD	1/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36646	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
78076	Fee-for-Service	1780694802	1780694802	1	1	GER, DANA S MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71865	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
78099	Fee-for-Service	1215291562	1215291562	1	1	GRAHAM, DAVID C DPM	10/16/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
78125	Fee-for-Service	1851885669	1851885669	1	1	GARCIA, MONICA A PHD	11/9/2022	103TC0700X	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
78189	Fee-for-Service	1508967662	1508967662	1	1	GROSSMONT MEDICAL CLINIC	2/3/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	8851 CENTER DR	STE 608	LA MESA	CA	91942	3199	37	06073	32.78189749	-117.0075062	San Diego County
78205	Fee-for-Service	1447637145	1447637145	1	1	GEORGES, FADI E MD	2/27/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159871	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
78213	Fee-for-Service	1588114979	1588114979	1	1	GARFIELD BEACH CVS LLC	7/20/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7500 MELROSE AVE	None	LOS ANGELES	CA	90046	7418	19	06037	34.08362828	-118.3536019	Los Angeles County
78225	Fee-for-Service	1477144210	1477144210	1	1	GORDON-NICHOLS, ANGELA V DOU	1/9/2023	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	33	06065	0	0	None
78259	Fee-for-Service	1124333562	1124333562	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6507 4TH AVE	None	SACRAMENTO	CA	95817	2611	34	06067	38.549196	-121.4265735	Sacramento County
78266	Fee-for-Service	1831504034	1831504034	1	1	GRAZIER, ROBERT K MD INC	8/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	23231	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
78267	Fee-for-Service	1205934593	1205934593	1	1	GIMNESS, MARY E DO	3/13/2024	207R00000X	NA	Other	026	PHYSICIANS	8635	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
78279	Fee-for-Service	1265489702	1265489702	1	1	GARABEDIAN, VICKEN 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
78325	Fee-for-Service	1972233468	1972233468	1	1	GRANTHAM, CHRISTINE LMFT	5/12/2023	101YM0800X	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
78331	Fee-for-Service	1730124629	1730124629	1	1	GARFIELD BEACH CVS LLC	3/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 E KATELLA AVE	None	ORANGE	CA	92867	5025	30	06059	33.80921553	-117.837216	Orange County
78333	Fee-for-Service	1437412384	1437412384	1	1	GOMEZ, STACY M MD	1/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126899	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
78351	Fee-for-Service	1750476651	1750476651	1	1	GAROFALO JOSEPH TD	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	122 S PATTERSON AVE	STE 101	SANTA BARBARA	CA	93111	4017	42	06083	34.43800958	-119.8082259	Santa Barbara County
78416	Fee-for-Service	1508979006	1508979006	2	1	GREIDER, BRADLEY W MD	7/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	46461	18	Ophthalmology	0	In state provider	None	2067 W VISTA WAY	SUITE 120	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
78449	Fee-for-Service	1932723293	1932723293	1	1	GO, CAMILLE C MD	2/12/2025	207P00000X	NA	Other	026	PHYSICIANS	192077	66	Emergency Medicine (Urgent Care)	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
78484	Fee-for-Service	1992723514	1992723514	1	1	GRANT-ANDERSON, BETTY S	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	55694	66	Emergency Medicine (Urgent Care)	0	In state provider	-	949 CALHOUN PL	None	HEMET	CA	92543	4403	33	06065	33.7502744	-116.9618423	Riverside County
78544	Fee-for-Service	1255785747	1255785747	1	1	GIANNINI, GABRIEL A MD	6/13/2022	207ZP0102X	NA	Other	026	PHYSICIANS	159995	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
78570	Fee-for-Service	1477504462	1477504462	1	1	GERSHWIN, DENISE R CNM	12/26/2014	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
78584	Fee-for-Service	1215496351	1215496351	1	1	GAO, JOHN Z MD	4/11/2024	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
78623	Fee-for-Service	1326153933	1326153933	1	1	GEE, ROYAL Y NP	1/22/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
78633	Fee-for-Service	1720455470	1720455470	1	1	GONZALEZ, BIANCA CNP	4/25/2020	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
78652	Fee-for-Service	1720393085	1720393085	2	1	GARFIELD BEACH CVS LLC	9/28/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	51 TIERRA REJADA RD	None	SIMI VALLEY	CA	93065	2902	56	06111	34.27241292	-118.7987552	Ventura County
78655	Fee-for-Service	1801047675	1801047675	1	1	GEORGE-BARBER, DEBRA A PHD	1/28/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
78706	Fee-for-Service	1588308753	1588308753	1	1	GARFIELD BEACH CVS LLC	1/19/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	28200 HIGHWAY 189	K100	LAKE ARROWHEAD	CA	92352	9700	36	06071	34.24991105	-117.1901486	San Bernardino County
78724	Fee-for-Service	1962680421	1962680421	1	14	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1199 DELBON AVENUE	SUITE 3	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
78739	Fee-for-Service	1578023768	1578023768	1	1	GHIJSEN, MICHAEL T MD	4/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	182026	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
78745	Fee-for-Service	1225228646	1225228646	1	1	GEORGE L MEE MEM HOSP	9/30/1985	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
78769	Fee-for-Service	1083955488	1083955488	1	1	GOLDSTEIN-BALL, JANET E LMFT	8/27/2018	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
78785	Fee-for-Service	1407866288	1407866288	1	1	GREENBERG, ADAM MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145782	41	Internal Medicine	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
78796	Fee-for-Service	1598747321	1598747321	1	1	GROOS, JENNIFER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1212 PLEASANT ST	STE 300	DES MOINES	IA	50309	1412	00	None	41.58994317	-93.63576902	Polk County
78797	Fee-for-Service	1932630936	1932630936	1	1	GEE, ERICA MD	10/7/2022	207L00000X	NA	Other	026	PHYSICIANS	172791	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
78800	Fee-for-Service	1417925843	1417925843	1	1	GENTRY,LINDELL R MD	9/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 HIGHLAND AVE	None	MADISON	WI	53792	3284	00	None	43.07868393	-89.4316606	Dane County
78831	Fee-for-Service	1962680421	1962680421	1	16	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 550	MODESTO	CA	95350	4573	50	06099	37.666233	-120.993933	Stanislaus County
78862	Fee-for-Service	1548567498	1548567498	1	13	GENESIS HEALTHCARE PARTNERS	11/16/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	5395 RUFFIN ROAD	SUITE 202	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
78865	Fee-for-Service	1699953604	1699953604	1	1	GORELIKOVA, SVETLANA V	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102339	08	Family Practice	0	In state provider	MD	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
78899	Fee-for-Service	1578642641	1578642641	1	1	GALDJIE, PARVIZ MD	10/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	32518	20	Orthopedic Surgery	0	In state provider	None	1762 WESTWOOD BLVD	STE 110	LOS ANGELES	CA	90024	5641	19	06037	34.05057734	-118.4376712	Los Angeles County
78930	Fee-for-Service	1902898026	1902898026	1	1	GOLESTAN, YAHYA J MD	2/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49808	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
78940	Fee-for-Service	1205348968	1205348968	1	1	GOMEZ, GREGORY R LMFT	3/4/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	109071	-	NOT APPLICABLE	0	In state provider	None	7885 ANNANDALE AVENUE	None	DESERT HOT SPRING	CA	92240	1419	33	06065	33.99048848	-116.5242885	Riverside County
78959	Fee-for-Service	1184880247	1184880247	1	1	GEZUKARAYAN, YERANUI R	8/5/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OD	6000 NORTH FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
78990	Fee-for-Service	1104450006	1104450006	1	1	GALLETA, ANH N NP	5/30/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9191 WESTMINSTER AVE	STE 106	GARDEN GROVE	CA	92844	2751	30	06059	33.75946879	-117.9688437	Orange County
79012	Fee-for-Service	1568400455	1568400455	1	1	GATEWAY MEDICAL GROUP OF	10/1/1993	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	SAN DIEGO INC	610 EUCLID AVE	STE 302	NATIONAL CITY	CA	91950	2953	37	06073	32.68419388	-117.0829524	San Diego County
79013	Fee-for-Service	1962680421	1962680421	1	14	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1199 DELBON AVENUE	SUITE 3	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
79014	Fee-for-Service	1730590563	1730590563	1	1	GRADY, CONOR MD	3/28/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	174417	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
79054	Fee-for-Service	1003892928	1003892928	1	1	GREENBERG, ODED MD	8/20/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	88436	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
79056	Fee-for-Service	1730508342	1730508342	1	1	GRIFFIN, LORI R	11/7/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11205 KNOTT AVE	STE B	CYPRESS	CA	90630	5489	30	06059	33.8006025	-118.0111199	Orange County
79070	Fee-for-Service	1366426421	1366426421	1	1	GREEN, GARTH A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	51547	30	Radiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
79093	Fee-for-Service	1134557531	1134557531	1	1	GLASS, BRITTANY L	11/25/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	18700 BEACH BLVD	STE 120	HUNTINGTON BEACH	CA	92648	2089	30	06059	33.69070037	-117.9886896	Orange County
79109	Fee-for-Service	1588145262	1588145262	1	1	GENOA HEALTHCARE, LLC	1/14/2019	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	474 W VERMONT AVE STE 10	None	ESCONDIDO	CA	92025	6584	37	06073	33.10046604	-117.0729623	San Diego County
79119	Fee-for-Service	1962680421	1962680421	1	16	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 550	MODESTO	CA	95350	4573	50	06099	37.666233	-120.993933	Stanislaus County
79140	Fee-for-Service	1750790002	1750790002	1	1	GAROFALO HOWES, JESSICA L	9/8/2014	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
79151	Fee-for-Service	1699301978	1699301978	1	1	GLORIA HAYWOOD	5/11/2020	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LY COUNSELING, INC.	9567 ARROW RTE	SUITE P	RANCHO CUCAMONGA	CA	91730	4550	36	06071	34.09927854	-117.5968935	San Bernardino County
79167	Fee-for-Service	1346377462	1346377462	1	1	GRINNA, ERICKA A MFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41175	-	NOT APPLICABLE	0	In state provider	None	2425 ENBORG LANE	None	SAN JOSE	CA	95128	2648	43	06085	37.31105733	-121.937923	Santa Clara County
79193	Fee-for-Service	1225051972	1225051972	1	1	GROSSO, GERALD J PSYD	11/21/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	34495	-	NOT APPLICABLE	0	In state provider	None	4000 BIRCH ST	SUITE 112A	NEWPORT BEACH	CA	92660	2211	30	06059	33.66463772	-117.8698289	Orange County
79207	Fee-for-Service	1639204357	1639204357	1	1	GREENE, SHEPARD J MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	51910	-	NOT APPLICABLE	0	In state provider	None	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	45	06089	40.5496754	-122.3791396	Shasta County
79228	Fee-for-Service	1689767113	1689767113	1	1	GORETSKY, ELIHU LMFT	12/4/2019	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
79240	Fee-for-Service	1912542325	1912542325	1	1	GOODWIN, KAELA M CCC-SLP	4/27/2023	235Z00000X	NA	Other	037	SPEECH 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
79242	Fee-for-Service	1952479594	1952479594	1	1	GREENBERG, JARED M MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	125660	-	NOT APPLICABLE	0	In state provider	None	2330 BEVERLY BOULEVARD	None	LOS ANGELES	CA	90057	2220	19	06037	34.0681396	-118.2738016	Los Angeles County
79247	Fee-for-Service	1649505504	1649505504	1	1	GENERATIONAL CHANGES, INC	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1313 P STREET	STE 200 ROOMS 200-205	FRESNO	CA	93721	1827	10	06019	36.74152383	-119.7876318	Fresno County
79276	Fee-for-Service	1154412096	1154412096	1	1	GARDINER, BARRY N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	16217	02	General Surgery	0	In state provider	None	5201 NORRIS CANYON RD	STE 120	SAN RAMON	CA	94583	5410	07	06013	37.77779028	-121.9600626	Contra Costa County
79281	Fee-for-Service	1528597192	1528597192	1	1	GONZALEZ, EVETTE A LMFT	8/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
79295	Fee-for-Service	1770099939	1770099939	1	1	GAMARRA, NICOLE CCC-SLP	3/4/2019	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
79299	Fee-for-Service	1568400455	1568400455	1	1	GATEWAY MEDICAL GROUP OF	10/1/1993	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SAN DIEGO INC	610 EUCLID AVE	STE 302	NATIONAL CITY	CA	91950	2953	37	06073	32.68419388	-117.0829524	San Diego County
79316	Fee-for-Service	1093011942	1093011942	1	2	GEORGE M. SALIB, M.D. INC.	9/26/2023	207WX0009X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	24422 AVENIDA DE LA CARL	110	LAGUNA HILLS	CA	92653	3634	30	06059	33.56726005	-117.705397	Orange County
79357	Fee-for-Service	1366426421	1366426421	1	1	GREEN, GARTH A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	51547	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
79385	Fee-for-Service	1881037810	1881037810	1	1	GAMBOA, OLIVIA G MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132306	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
79487	Fee-for-Service	1700382397	1700382397	1	1	GILL, AMITPAUL MD	7/1/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	173767	10	Gastroenterology (M.D. only)	0	In state provider	None	7095 N CHESTNUT AVE	STE 101	FRESNO	CA	93720	0360	10	06019	36.83995818	-119.7370077	Fresno County
79533	Fee-for-Service	1609270065	1609270065	1	1	GOOD SAMARITAN HOSPICE AND	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	725 S GLENDALE AVE	SUITE M	GLENDALE	CA	91205	4151	19	06037	34.13774391	-118.2513154	Los Angeles County
79566	Fee-for-Service	1356646590	1356646590	1	2	GROSSMAN, ERIC MD	2/16/2022	2086S0120X	NA	General Surgery	026	PHYSICIANS	157157	None	None	0	In state provider	None	1400 E CHURCH ST	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
79583	Fee-for-Service	1962680421	1962680421	1	17	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 565	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
79602	Fee-for-Service	1093011942	1093011942	1	2	GEORGE M. SALIB, M.D. INC.	9/26/2023	207WX0009X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	24422 AVENIDA DE LA CARL	110	LAGUNA HILLS	CA	92653	3634	30	06059	33.56726005	-117.705397	Orange County
79611	Fee-for-Service	1245334770	1245334770	1	1	GOODARZIAN, FARIBA MD	12/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84761	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
79651	Fee-for-Service	1427658335	1427658335	1	1	GREAT CARE HOSPICE AND	12/20/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	14545 FRIAR ST	SUITE 229	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
79667	Fee-for-Service	1174898696	1174898696	1	1	GIRE, JACOB D MD	10/20/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	138783	20	Orthopedic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
79710	Fee-for-Service	1407940224	1407940224	1	4	GASTROENTEROLOGY ASSOCIATES	12/16/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF THE EAST BAY MEDICAL	2363 MARINERS SQUARE DR	STE 155	ALAMEDA	CA	94501	6400	01	06001	37.78921286	-122.2766629	Alameda County
79751	Fee-for-Service	1245289164	1245289164	1	1	GACH, BRUCE M MD	4/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	21896	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
79774	Fee-for-Service	1700382397	1700382397	1	1	GILL, AMITPAUL MD	7/1/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	173767	41	Internal Medicine	0	In state provider	None	7095 N CHESTNUT AVE	STE 101	FRESNO	CA	93720	0360	10	06019	36.83995818	-119.7370077	Fresno County
79791	Fee-for-Service	1366642753	1366642753	1	1	GAMRADT, SETH C MD	12/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76926	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
79810	Fee-for-Service	1962680421	1962680421	1	3	GOLDEN VALLEY HEALTH CENTERS	4/25/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	208 WEST COOLIDGE AVE	None	MODESTO	CA	95350	0000	50	06099	37.66550267	-120.9951522	Stanislaus County
79812	Fee-for-Service	1306899604	1306899604	1	1	GOPAL, RAJ MD	4/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	37129	41	Internal Medicine	0	In state provider	None	2828 H ST	STE A	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
79820	Fee-for-Service	1609270065	1609270065	1	1	GOOD SAMARITAN HOSPICE AND	1/20/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	725 S GLENDALE AVE	SUITE M	GLENDALE	CA	91205	4151	19	06037	34.13774391	-118.2513154	Los Angeles County
79822	Fee-for-Service	1093773137	1093773137	1	1	GREENBERG, BARRY MD	1/1/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	29316	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
79828	Fee-for-Service	1346662913	1346662913	1	1	GUTHRIE, MATTHEW D	6/27/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
79842	Fee-for-Service	1346224417	1346224417	1	1	GOLDEN VALLEY HEALTH CTR	5/10/2021	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
79870	Fee-for-Service	1962680421	1962680421	1	17	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 565	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
79928	Fee-for-Service	1629215991	1629215991	1	1	GRAN, DAVID M MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62161	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
79941	Fee-for-Service	1427658335	1427658335	1	1	GREAT CARE HOSPICE AND	12/20/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	14545 FRIAR ST	SUITE 229	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
79944	Fee-for-Service	1750583787	1750583787	1	1	GWAL, KRITI MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144221	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
79957	Fee-for-Service	1174898696	1174898696	1	1	GIRE, JACOB D MD	10/20/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	138783	46	Hand Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
79962	Fee-for-Service	1255353868	1255353868	2	1	GARFIELD BEACH CVS LLC	10/27/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	475 ROHNERT PARK EXPY W	None	ROHNERT PARK	CA	94928	7907	49	06097	38.346219	-122.7202605	Sonoma County
79963	Fee-for-Service	1447397930	1447397930	1	1	GIEGERICH, LANORE LMFT	6/3/2019	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
80001	Fee-for-Service	1740484534	1740484534	1	1	GRUCHALA, NANCY 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	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
80006	Fee-for-Service	1619244480	1619244480	1	1	GARAY, DONNA C 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
80023	Fee-for-Service	1124007430	1124007430	1	1	GREENE, GILBERT E DO	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	4367	None	None	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
80031	Fee-for-Service	1043234487	1043234487	1	1	GATCHALIAN, LOURDES O	1/21/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	306 N SIESTA ST	None	ANAHEIM	CA	92801	5117	30	06059	33.83541598	-117.9615744	Orange County
80059	Fee-for-Service	1710923529	1710923529	1	1	GERGES, CHAWKI A MD INC	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66288	41	Internal Medicine	0	In state provider	None	131 S TAMARACK ST	# A	VISALIA	CA	93291	5166	54	06107	36.328851	-119.351682	Tulare County
80085	Fee-for-Service	1982760633	1982760633	1	1	GOLDSMITH, MICHELLE D MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103432	36	Psychiatry	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
80097	Fee-for-Service	1962680421	1962680421	1	3	GOLDEN VALLEY HEALTH CENTERS	4/24/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	208 WEST COOLIDGE AVE	None	MODESTO	CA	95350	0000	50	06099	37.66550267	-120.9951522	Stanislaus County
80100	Fee-for-Service	1306899604	1306899604	1	1	GOPAL, RAJ MD	4/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	37129	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2828 H ST	STE A	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
80112	Fee-for-Service	1093773137	1093773137	1	1	GREENBERG, BARRY MD	1/1/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	29316	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
80130	Fee-for-Service	1346224417	1346224417	1	1	GOLDEN VALLEY HEALTH CTR	8/18/2023	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
80138	Fee-for-Service	1073733879	1073733879	1	1	GOLDEN VALLEY HEALTH CTR	5/1/2002	207Q00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3940 SANDPIPER AVENUE	None	MERCED	CA	95340	8372	24	06047	37.33841229	-120.466546	Merced County
80170	Fee-for-Service	1639199888	1639199888	1	1	GRIFFEY, MARC S MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68748	30	Radiology	0	In state provider	None	2020 COURT ST	None	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
80171	Fee-for-Service	1467493379	1467493379	1	1	GARFIELD BEACH CVS LLC	5/17/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17136 MAGNOLIA ST	None	FOUNTAIN VALLEY	CA	92708	3348	30	06059	33.71412366	-117.9717529	Orange County
80243	Fee-for-Service	1942641139	1942641139	1	1	GUERRERO HERNANDEZ, ROSA LC	9/26/2022	1041S0200X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
80246	Fee-for-Service	1730555707	1730555707	1	1	GARFIELD BEACH CVS LLC	6/10/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3215	38	06075	37.78138632	-122.4581328	San Francisco County
80293	Fee-for-Service	1457309882	1457309882	1	1	GERSON, MICHAEL J PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	32129 LINDERO CANYON RD	STE 201	WESTLAKE VILLAGE	CA	91361	5433	19	06037	34.137924	-118.8224795	Los Angeles County
80296	Fee-for-Service	1376606863	1376606863	1	1	GOLDSTEIN, MARK J PHD	12/17/1988	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3456 CODY RD	None	SHERMAN OAKS	CA	91403	5010	19	06037	34.13313482	-118.4627215	Los Angeles County
80321	Fee-for-Service	1922208982	1922208982	1	1	GUPTA, RISHI N MD	10/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117486	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
80353	Fee-for-Service	1073535688	1073535688	2	1	GARFIELD BEACH CVS LLC	12/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 SISK RD	None	MODESTO	CA	95356	3215	50	06099	37.69516143	-121.0667611	Stanislaus County
80358	Fee-for-Service	1588420418	1588420418	1	1	GARIVALDO, BRANDON	3/6/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
80370	Fee-for-Service	1548983992	1548983992	1	1	GAVINO, CHRISTINA PT	10/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4339 E MORADA LN STE 150	150	STOCKTON	CA	95212	1634	39	06077	38.039067	-121.259493	San Joaquin County
80374	Fee-for-Service	1982760633	1982760633	1	1	GOLDSMITH, MICHELLE D MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103432	26	Psychiatry (child)	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
80385	Fee-for-Service	1962680421	1962680421	1	3	GOLDEN VALLEY HEALTH CENTERS	4/25/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	208 WEST COOLIDGE AVE	None	MODESTO	CA	95350	0000	50	06099	37.66550267	-120.9951522	Stanislaus County
80416	Fee-for-Service	1346224417	1346224417	1	1	GOLDEN VALLEY HEALTH CTR	5/3/2024	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
80422	Fee-for-Service	1548720840	1548720840	1	1	GILANI, CHRISTOPHER J MD	7/25/2022	207P00000X	NA	Other	026	PHYSICIANS	176465	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
80427	Fee-for-Service	1073733879	1073733879	1	1	GOLDEN VALLEY HEALTH CTR	5/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3940 SANDPIPER AVENUE	None	MERCED	CA	95340	8372	24	06047	37.33841229	-120.466546	Merced County
80431	Fee-for-Service	1033897574	1033897574	1	1	GAIN PHYSICAL THERAPY & WELL	4/9/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NESS PC	13700 ALTON PARKWAY	SUITE 158	IRVINE	CA	92618	1618	30	06059	33.66308011	-117.7074313	Orange County
80501	Fee-for-Service	1811372188	1811372188	1	1	GIBSON, KATHERINE L NP	12/18/2018	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
80523	Fee-for-Service	1811991847	1811991847	1	1	GATTO, MICHAEL R MD INC	7/11/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1180 N INDIAN CANYON DR	#E311	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
80525	Fee-for-Service	1134153745	1134153745	1	1	GARON, EDWARD B MD	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82474	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 MED PLAZA STE 120	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
80556	Fee-for-Service	1245390640	1245390640	1	1	GRANT, KENYON E PT	11/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25285 MADISON AVE	SUITE 103	MURRIETA	CA	92562	8981	33	06065	33.55369902	-117.1965543	Riverside County
80620	Fee-for-Service	1245577279	1245577279	1	1	GANAL, MENALIN P DO	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13851	01	General Practice	0	In state provider	None	8820 WYMARK DR	STE 200	SACRAMENTO	CA	95757	6298	34	06067	38.4021202	-121.4081886	Sacramento
80623	Fee-for-Service	1356418180	1356418180	1	1	GORZE, JILL E MD	10/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89982	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
80643	Fee-for-Service	1184957664	1184957664	1	1	GREENBERG, JOEL P PHD	9/11/2012	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
80672	Fee-for-Service	1962680421	1962680421	1	3	GOLDEN VALLEY HEALTH CENTERS	8/3/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	208 WEST COOLIDGE AVE	None	MODESTO	CA	95350	0000	50	06099	37.66550267	-120.9951522	Stanislaus County
80704	Fee-for-Service	1346224417	1346224417	1	1	GOLDEN VALLEY HEALTH CTR	11/9/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
80708	Fee-for-Service	1881878262	1881878262	1	1	GARG, SUMIT MD	5/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88101	18	Ophthalmology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
80716	Fee-for-Service	1073733879	1073733879	1	1	GOLDEN VALLEY HEALTH CTR	6/2/2021	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3940 SANDPIPER AVENUE	None	MERCED	CA	95340	8372	24	06047	37.33841229	-120.466546	Merced County
80726	Fee-for-Service	1548567498	1548567498	1	4	GENESIS HEALTHCARE PARTNERS	6/1/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	1955 CITRACADO PARKWAY	STE 302	ESCONDIDO	CA	92029	4110	37	06073	33.11301099	-117.1202081	San Diego County
80759	Fee-for-Service	1427336684	1427336684	1	1	GOYAL, BELLA MD	1/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150723	22	Pathology (M.D. only)	0	In state provider	None	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
80766	Fee-for-Service	1912119629	1912119629	1	1	GREENBERG, JASON T MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98358	05	Anesthesiology	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
80781	Fee-for-Service	1982870762	1982870762	1	1	GARFIELD BEACH CVS, LLC	8/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	316 PACIFIC COAST HWY	None	REDONDO BEACH	CA	90277	3729	19	06037	33.8376215	-118.3853584	Los Angeles County
80789	Fee-for-Service	1629324967	1629324967	1	1	GALINDO SODERSTROM, MONIQUE	7/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	L LMFT	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
80806	Fee-for-Service	1881123024	1881123024	1	1	GIOVANELLI, ALISON S PHD	3/14/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	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
80807	Fee-for-Service	1548581192	1548581192	1	1	GHODS, MICHAEL J MD	4/29/2021	207R00000X	NA	Other	026	PHYSICIANS	136424	None	None	0	In state provider	None	6535 WILSHIRE BLVD STE 2	None	LOS ANGELES	CA	90048	4963	19	06037	34.06409917	-118.3712801	Los Angeles County
80813	Fee-for-Service	1134153745	1134153745	1	1	GARON, EDWARD B MD	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82474	41	Internal Medicine	0	In state provider	None	200 MED PLAZA STE 120	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
80854	Fee-for-Service	1780916247	1780916247	1	1	GUTIERREZ, ERIN M MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110470	40	Pediatrics	0	In state provider	None	3300 WEBSTER STE	STE 1202	OAKLAND	CA	94609	3117	01	06001	37.82132826	-122.2621843	Alameda County
80856	Fee-for-Service	1417915778	1417915778	1	1	GOSNEY, WALLACE G MD INC	8/1/1996	208G00000X	NA	General Surgery	026	PHYSICIANS	19860	02	General Surgery	0	In state provider	None	591 N 13TH AVE	None	UPLAND	CA	91786	4967	36	06071	34.10081218	-117.6336095	San Bernardino County
80877	Fee-for-Service	1124034376	1124034376	1	1	GOLDMAN, LEE M MD	2/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36404	None	None	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
80885	Fee-for-Service	1215971569	1215971569	1	1	GARFIELD BEACH CVS, LLC	9/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26891 ALISO CREEK RD.	None	ALISO VIEJO	CA	92656	3392	30	06059	33.5723715	-117.7235968	Orange County
80912	Fee-for-Service	1205183951	1205183951	1	1	GWAK, TOBY C MD	11/19/2021	2085R0204X	NA	Other	026	PHYSICIANS	121928	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
80934	Fee-for-Service	1073037065	1073037065	1	1	GONG, NICOLE S PT	8/14/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
80952	Fee-for-Service	1316929896	1316929896	1	1	GOODWILL, BETH A NP	6/1/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
81002	Fee-for-Service	1073733879	1073733879	1	1	GOLDEN VALLEY HEALTH CTR	11/1/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	3940 SANDPIPER AVENUE	None	MERCED	CA	95340	8372	24	06047	37.33841229	-120.466546	Merced County
81021	Fee-for-Service	1982273967	1982273967	1	1	GENOA HEALTHCARE LLC	7/6/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 MARSHALL AVE.	SUITE 3	IMPERIAL	CA	92251	9401	13	06025	32.82850658	-115.5688272	Imperial County
81023	Fee-for-Service	1215545850	1215545850	1	1	GLENMARK NURSING CARE	10/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	2600 FOOTHILL BLVD	STE 105	LA CRESCENTA	CA	91214	4578	19	06037	34.22121465	-118.2352382	Los Angeles County
81026	Fee-for-Service	1336307537	1336307537	1	1	GOODMAN, MARGARET M MD	9/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109458	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
81050	Fee-for-Service	1588678775	1588678775	1	1	GOICOECHEA, MIGUEL A MD	12/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78023	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
81054	Fee-for-Service	1285845479	1285845479	1	1	GREGOR, SCOTT M DO	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9699	08	Family Practice	0	In state provider	None	2001 SANTA MONICA	370W,380W,860W,1070	LOS ANGELES	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles
81089	Fee-for-Service	1649214917	1649214917	1	1	GARFIELD BEACH CVS LLC	4/30/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2525 VIA CAMPO ST	None	MONTEBELLO	CA	90640	1806	19	06037	34.030485	-118.1234025	Los Angeles County
81096	Fee-for-Service	1134411317	1134411317	1	1	GRAF, JAHANARA J MD	12/21/2019	208600000X	NA	General Surgery	026	PHYSICIANS	126509	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
81106	Fee-for-Service	1134153745	1134153745	1	1	GARON, EDWARD B MD	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82474	68	Hematology	0	In state provider	None	200 MED PLAZA STE 120	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
81109	Fee-for-Service	1659414316	1659414316	1	1	GROVE, JENNIFER B OD	9/1/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1155 S DIAMOND BAR BLVD	STE J	DIAMOND BAR	CA	91765	2235	19	06037	34.00200905	-117.8106581	Los Angeles County
81143	Fee-for-Service	1417915778	1417915778	1	1	GOSNEY, WALLACE G MD INC	8/1/1996	208G00000X	NA	General Surgery	026	PHYSICIANS	19860	33	Thoracic Surgery	0	In state provider	None	591 N 13TH AVE	None	UPLAND	CA	91786	4967	36	06071	34.10081218	-117.6336095	San Bernardino County
81174	Fee-for-Service	1548567498	1548567498	1	2	GENESIS HEALTHCARE PARTNERS	5/1/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	320 SANTA FE DRIVE	SUITE 305	ENCINITAS	CA	92024	2526	37	06073	33.038847	-117.285579	San Diego County
81195	Fee-for-Service	1346573243	1346573243	1	1	GINDLESPERGER, MAGGIE F PSYD	3/17/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2577 SAMARITAN DR	STE 705	SAN JOSE	CA	95124	4105	43	06085	37.25246494	-121.9501879	Santa Clara County
81196	Fee-for-Service	1528563343	1528563343	1	1	GOMEZ, ROBERTO MD	6/8/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	176065	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
81272	Fee-for-Service	1689629388	1689629388	1	1	GOFF, JONATHAN R MD	8/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52729	None	None	0	In state provider	None	18 BON AIR ROAD	STE 120	LARKSPUR	CA	94939	1123	21	06041	37.94413684	-122.5391261	Marin County
81311	Fee-for-Service	1215545850	1215545850	1	1	GLENMARK NURSING CARE	10/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	2600 FOOTHILL BLVD	STE 105	LA CRESCENTA	CA	91214	4578	19	06037	34.22121465	-118.2352382	Los Angeles County
81345	Fee-for-Service	1538350293	1538350293	1	2	GOMEZ GONZALEZ, ALEXIS NP	11/14/2024	163WP0807X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3000 EAST 1ST STREET	W1	LOS ANGELES	CA	90063	2807	19	06037	34.04032875	-118.2022726	Los Angeles County
81370	Fee-for-Service	1780641555	1780641555	2	1	GRIMLEY, MICHAEL	4/4/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	-	68	Hematology	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
81384	Fee-for-Service	1215932058	1215932058	1	1	GOLD, MICHAEL MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33451	40	Pediatrics	0	In state provider	None	3901 LAS POSAS RD	None	CAMARILLO	CA	93010	1501	56	06111	34.2415821	-119.0183756	Ventura County
81398	Fee-for-Service	1841730777	1841730777	1	1	GARCIA, NATALIE LMFT	2/2/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
81423	Fee-for-Service	1578657482	1578657482	1	1	GUZZETTA, VINCENT MD INC	2/8/2015	2086S0129X	NA	General Surgery	026	PHYSICIANS	29317	02	General Surgery	0	In state provider	None	6719 ALVARADO RD	STE 303	SAN DIEGO	CA	92120	5264	37	06073	32.77684978	-117.055137	San Diego County
81469	Fee-for-Service	1821601840	1821601840	1	2	GASTRO HEALTH INC	3/31/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	264 N HIGHLAND SPRINGS	STE 3B	BANNING	CA	92220	0001	33	06065	33.93063	-116.946864	Riverside County
81472	Fee-for-Service	1750644266	1750644266	1	1	GEBHARDT, KORY M MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141630	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
81489	Fee-for-Service	1447316781	1447316781	1	1	GINNE, MELINDA PHD	3/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
81492	Fee-for-Service	1982026886	1982026886	1	1	GHADIYA, MANSUKH MD INC	6/12/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	71759	01	General Practice	0	In state provider	None	2201 MT VERNON AVE	STE 211 A	BAKERSFIELD	CA	93306	3341	15	06029	35.38781796	-118.9673567	Kern County
81549	Fee-for-Service	1346286564	1346286564	1	1	GOLDBERG, RICHARD M MD	8/24/1978	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	36598	46	Hand Surgery	0	In state provider	None	2322 BUTANO DR	STE 211	SACRAMENTO	CA	95825	0657	34	06067	38.606373	-121.3814655	Sacramento County
81556	Fee-for-Service	1255840799	1255840799	1	1	GALBREATH, MICHAEL MD	2/7/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166514	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
81584	Fee-for-Service	1518516806	1518516806	1	1	GUDINO, AMBAR PSYD	1/28/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	201 S ANITA DR	SUITE 203	ORANGE	CA	92868	3312	30	06059	33.786144	-117.881161	Orange County
81587	Fee-for-Service	1932258415	1932258415	1	1	GLENDALE ENDOSCOPY CENTER	12/3/2007	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	824 N GLENDALE AVE	None	GLENDALE	CA	91206	2127	19	06037	34.15816245	-118.2402162	Los Angeles County
81592	Fee-for-Service	1619219029	1619219029	1	1	GONZALEZ, ALICIA M MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133025	None	None	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
81596	Fee-for-Service	1730543539	1730543539	1	1	GHAFOURI, SANAZ N MD	9/28/2022	207RH0000X	NA	Hematology	026	PHYSICIANS	154519	None	None	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
81624	Fee-for-Service	1801418793	1801418793	1	1	GOLDING CARE HOSPICE INC	6/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1240 N VAN BUREN ST	STE 202	ANAHEIM	CA	92807	1602	30	06059	33.86067714	-117.8312118	Orange County
81627	Fee-for-Service	1699397273	1699397273	1	1	GUDUR, MANASA MD	10/4/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184797	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
81634	Fee-for-Service	1760913701	1760913701	1	1	GREENIDGE, QUEZIAH MD	5/17/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
81643	Fee-for-Service	1881900710	1881900710	1	2	GMC PROFESSIONAL HOSPICE	4/3/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1 N INDIAN HILL BLVD	STE 205	CLAREMONT	CA	91711	4769	19	06037	34.094259	-117.7193385	Los Angeles County
81647	Fee-for-Service	1922466895	1922466895	1	1	GUERRIERI, DENNIS J OD INC	5/31/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	231 C ST	None	DAVIS	CA	95616	4521	57	06113	38.54382636	-121.7435602	Yolo County
81658	Fee-for-Service	1780641555	1780641555	2	1	GRIMLEY, MICHAEL	4/4/2024	2080P0207X	NA	Hematology	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
81661	Fee-for-Service	1487800108	1487800108	1	1	GULATI, GAURAV MD	8/29/2022	207RR0500X	NA	Other	026	PHYSICIANS	178821	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
81666	Fee-for-Service	1801092440	1801092440	2	1	GUTIERREZ, JULIO A MD	11/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107985	None	None	0	In state provider	None	675 CAMINO DEL LOS MARES	None	SAN CLEMENTE	CA	92673	6266	30	06059	33.45710369	-117.6474248	Orange County
81671	Fee-for-Service	1629137542	1629137542	1	1	GANDHI, RENU D MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48798	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
81681	Fee-for-Service	1912297003	1912297003	1	1	GREEN-MURPHY, AUDREY DO	11/29/2021	2080P0207X	NA	Hematology	026	PHYSICIANS	19146	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
81687	Fee-for-Service	1356754667	1356754667	1	1	GOODWIN, NICOLE D MD	9/10/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150982	40	Pediatrics	0	In state provider	None	25170 HANCOCK AVE	SUITE 200	MURRIETA	CA	92562	5969	33	06065	33.565149	-117.1823815	Riverside County
81696	Fee-for-Service	1841351327	1841351327	1	1	GALAN, LISA C LCSW	12/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
81723	Fee-for-Service	1639788532	1639788532	1	1	GOMEZ, ROLINDA S LCSW	2/17/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5150 N 6TH ST	169	FRESNO	CA	93710	7505	10	06019	36.81127498	-119.7632093	Fresno County
81747	Fee-for-Service	1407807183	1407807183	1	1	GARREN, HIDEKI MD	1/31/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	79974	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
81749	Fee-for-Service	1831289313	1831289313	1	1	GOVINDARJAN, RANGASWAMY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	STE 528	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
81758	Fee-for-Service	1063571701	1063571701	1	1	GINETE, VERNA G CNM	6/22/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
81810	Fee-for-Service	1184831158	1184831158	1	1	GUIMARAES, CAROLINA V MD	9/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157896	30	Radiology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
81864	Fee-for-Service	1306332713	1306332713	1	1	GORDULA, ANNE GELEEN PSYD	11/26/2024	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
81866	Fee-for-Service	1073522215	1073522215	1	1	GRENKE, ALAN JOSEPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
81874	Fee-for-Service	1053672006	1053672006	1	1	GHALILI, MAZIAR M DO	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14204	41	Internal Medicine	0	In state provider	None	4312 WOODMAN AVE	STE 102	SHERMAN OAKS	CA	91423	5523	19	06037	34.148637	-118.4312035	Los Angeles County
81879	Fee-for-Service	1154345973	1154345973	1	1	GERALD E MATZKE M.D.	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2220 CANTERBURY DR	None	HAYS	KS	67601	2370	00	None	38.880486	-99.2961225	Ellis County
81910	Fee-for-Service	1801418793	1801418793	1	1	GOLDING CARE HOSPICE INC	6/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1240 N VAN BUREN ST	STE 202	ANAHEIM	CA	92807	1602	30	06059	33.86067714	-117.8312118	Orange County
81917	Fee-for-Service	1528154747	1528154747	1	1	GARFIAS, SALVADOR MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81288	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
81921	Fee-for-Service	1255372397	1255372397	1	1	GREATER BALTIMORE MEDICAL	12/3/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	6701 NORTH CHARLES ST	None	BALTIMORE	MD	21204	6808	00	None	39.390831	-76.6246635	Baltimore County
81929	Fee-for-Service	1881900710	1881900710	1	2	GMC PROFESSIONAL HOSPICE	4/3/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1 N INDIAN HILL BLVD	STE 205	CLAREMONT	CA	91711	4769	19	06037	34.094259	-117.7193385	Los Angeles County
81932	Fee-for-Service	1134259708	1134259708	1	1	GERBER, RICHARD M MD	8/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52090	41	Internal Medicine	0	In state provider	None	595 BUCKINGHAM WAY	STE 520	SAN FRANCISCO	CA	94132	1913	38	06075	37.73012679	-122.4767395	San Francisco County
81941	Fee-for-Service	1326399098	1326399098	1	1	GIBSON, VICTORIA M LMFT	2/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
81942	Fee-for-Service	1073946414	1073946414	1	1	GACHET, ELIZABETH LMFT	10/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
81971	Fee-for-Service	1225380876	1225380876	1	1	GOTTLIEB, JONATHAN K MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122886	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91773	3219	19	06037	34.20289797	-118.6294006	Los Angeles County
81983	Fee-for-Service	1578623500	1578623500	1	1	GLUCK, LYNDA DALE	2/8/2015	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1728 LAUREL CANYON BLVD	APT D	LOS ANGELES	CA	90046	2138	19	06037	34.10273627	-118.365584	Los Angeles County
82013	Fee-for-Service	1154741031	1154741031	1	1	GUPTA, TANYA MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138407	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
82022	Fee-for-Service	1235133687	1235133687	1	1	GHC OF NATIONAL CITY I LLC	2/2/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FRIENDSHIP MANOR NURSING	902 SOUTH EUCLID AVE	None	NATIONAL CITY	CA	91950	3808	37	06073	32.68175008	-117.0818924	San Diego County
82036	Fee-for-Service	1417235144	1417235144	1	1	GREENBERG, EMILY A MD	2/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125567	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
82039	Fee-for-Service	1649015942	1649015942	1	1	GOOD SAMARITAN MEDICAL GROUP	2/10/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC.	4343 MARKET ST	STE C	RIVERSIDE	CA	92501	3500	33	06065	33.97734857	-117.3791849	Riverside County
82062	Fee-for-Service	1194208744	1194208744	1	1	GUZMAN, ASHLEY B NP	5/6/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
82069	Fee-for-Service	1669874202	1669874202	1	1	GUSTAFSON, ROSANNA E LCSW	2/18/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7471 RUDELL RD	None	CORONA	CA	92881	4278	33	06065	33.8360945	-117.528093	Riverside County
82073	Fee-for-Service	1770046500	1770046500	1	1	GURDOGAN, HAFSA MD	3/20/2023	207R00000X	NA	Other	026	PHYSICIANS	179024	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
82103	Fee-for-Service	1417966615	1417966615	1	1	GHULOOM, ADEL E MD	6/18/2021	207RC0200X	NA	Other	026	PHYSICIANS	163101	None	None	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
82114	Fee-for-Service	1205129533	1205129533	1	1	GALABI, MICHAEL MD	11/13/2021	207R00000X	NA	Other	026	PHYSICIANS	170716	None	None	0	In state provider	None	1919 SANTA MONICA BLVD	STE 210	SANTA MONICA	CA	90604	1970	19	06037	34.0284492	-118.4803274	Los Angeles County
82129	Fee-for-Service	1720282429	1720282429	1	1	GBADEHAN, ADEDUTE MD	2/21/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
82151	Fee-for-Service	1548218944	1548218944	1	1	GROUP ANESTHESIA SRVCS	4/30/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL CORPORATION	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
82185	Fee-for-Service	1386172518	1386172518	1	1	GANDOMANI, BENJAMIN S MD	8/3/2021	207L00000X	NA	Other	026	PHYSICIANS	160143	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
82197	Fee-for-Service	1629796867	1629796867	1	1	GOMEZ, STEFANIE LCSW	11/10/2023	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
82211	Fee-for-Service	1255372397	1255372397	1	1	GREATER BALTIMORE MEDICAL	12/3/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	6701 NORTH CHARLES ST	None	BALTIMORE	MD	21204	6808	00	None	39.390831	-76.6246635	Baltimore County
82214	Fee-for-Service	1437218146	1437218146	1	1	GRIFFIS, KENNETH R JR MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52045	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
82234	Fee-for-Service	1114554524	1114554524	1	1	GIBBS, BRENNAN MD	8/1/2023	207P00000X	NA	Other	026	PHYSICIANS	185822	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
82261	Fee-for-Service	1609150960	1609150960	1	1	GRAVES, ANDREA M PHD	12/15/2014	No Taxonomy Provided	NA	None	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
82265	Fee-for-Service	1396092219	1396092219	1	1	GEORGE M WILSON MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	None	48.23336909	-101.2951165	Ward County
82266	Fee-for-Service	1265957518	1265957518	1	1	GANNUSCIO, DESTINEE N LMFT	5/4/2023	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
82316	Fee-for-Service	1316293392	1316293392	1	1	GOODMAN, LINDA DOULA	7/7/2023	174N00000X	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
82335	Fee-for-Service	1447303631	1447303631	1	1	GROLIG, JEFFREY W MD	12/31/1986	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	41461	25	Physical Medicine and Rehabilitation	0	In state provider	None	5000 BECHELLI LN	STE 102	REDDING	CA	96002	3553	45	06089	40.53859067	-122.354796	Shasta County
82346	Fee-for-Service	1902970221	1902970221	1	1	GUNTUR, SANDEEP MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93358	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
82384	Fee-for-Service	1174545966	1174545966	2	1	GARFIELD BEACH CVS LLC	10/5/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2191 N TUSTIN ST	None	ORANGE	CA	92865	3701	30	06059	33.82489437	-117.8360544	Orange County
82390	Fee-for-Service	1306880240	1306880240	1	1	GAINEY, PATRICK MD	6/30/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	141832	13	Neurology (M.D. only)	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
82401	Fee-for-Service	1730455353	1730455353	1	1	GOKOFFSKI, KIMBERLY K MD	6/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126939	41	Internal Medicine	0	In state provider	None	1450 SAN PABLO STREET	SUITE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
82411	Fee-for-Service	1588291496	1588291496	1	1	GASPAR, MELISSA MD	12/22/2023	2279E0002X	NA	Other	026	PHYSICIANS	191263	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
82452	Fee-for-Service	1548567498	1548567498	1	6	GENESIS HEALTHCARE PARTNERS	6/1/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	9850 GENESEE AVE	SUITE 440	SAN DIEGO	CA	92037	1212	37	06073	32.882913	-117.226341	San Diego County
82460	Fee-for-Service	1477576775	1477576775	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3520 TYLER ST	None	RIVERSIDE	CA	92503	4175	33	06065	33.906519	-117.4600125	Riverside County
82467	Fee-for-Service	1275858961	1275858961	1	1	GARG, RAVI MD	8/23/2018	208200000X	NA	General Surgery	026	PHYSICIANS	153745	24	Plastic 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
82469	Fee-for-Service	1225231590	1225231590	1	1	GOLDSICH, KATHERINE E	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96530	40	Pediatrics	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
82566	Fee-for-Service	1376976142	1376976142	1	1	GUEVARA, KARINNA LMFT	4/12/2023	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
82583	Fee-for-Service	1396047775	1396047775	1	1	GOLBARI, ABRAHAM MD INC	10/1/2001	207R00000X	NA	Other	026	PHYSICIANS	55387	None	None	0	In state provider	None	14030 CRENSHAW BLVD	None	GARDENA	CA	90249	2715	19	06037	33.9043434	-118.3264901	Los Angeles County
82593	Fee-for-Service	1114102241	1114102241	1	1	GASTALDO, GREGORY MD	6/30/1992	261Q00000X	NA	Other	026	PHYSICIANS	58872	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
82632	Fee-for-Service	1538493507	1538493507	1	2	GUMASTE, PURVA G MD	3/1/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	153725	77	Infectious Disease	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
82643	Fee-for-Service	1679754378	1679754378	1	1	GONZALES, LEARNED R MD	3/13/2008	193400000X	NA	Other	026	PHYSICIANS	76930	66	Emergency Medicine (Urgent Care)	0	In state provider	ONARY MED A PROF CORP	71-511 HWY 111	SUITE H	RANCHO MIRAGE	CA	92770	4465	33	06065	33.7750795	-116.4496953	Riverside County
82701	Fee-for-Service	1861626335	1861626335	1	1	GOLPANIAN, PEJMAN MD	9/4/2013	207L00000X	NA	Other	026	PHYSICIANS	124402	05	Anesthesiology	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2481	19	06037	34.04925	-118.2177405	Los Angeles County
82721	Fee-for-Service	1689087439	1689087439	1	1	GULAYA, KARAN MD	6/6/2023	2085R0204X	NA	Other	026	PHYSICIANS	185929	None	None	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
82733	Fee-for-Service	1619157047	1619157047	1	1	GANATA, VICTOR M MD	9/1/2009	207R00000X	NA	Other	026	PHYSICIANS	95477	41	Internal Medicine	0	In state provider	None	1600 S AZUSA AVE	STE 501	CITY OF INDUSTRY	CA	91748	8673	19	06037	33.99361941	-117.9314015	Los Angeles County
82767	Fee-for-Service	1417110065	1417110065	1	1	GALLAGHER, RYAN P MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110004	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
82866	Fee-for-Service	1710901004	1710901004	1	1	GUTIERREZ, ANACLETO OD	6/15/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2615 CAPITOL AVE	None	SACRAMENTO	CA	95816	5904	34	06067	38.571399	-121.472532	Sacramento County
82878	Fee-for-Service	1407940224	1407940224	1	2	GASTROENTEROLOGY ASSOCIATES	12/16/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF THE EAST BAY MEDICAL	365 LENNON LN	STE 230	WALNUT CREEK	CA	94598	5912	07	06013	37.92784983	-122.0301444	Contra Costa County
82904	Fee-for-Service	1093817405	1093817405	4	1	GOLDEN VALLEY HEALTH CENTERS	7/26/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	857 W CHILDS AVE	101	MERCED	CA	95341	6862	24	06047	37.2882813	-120.497688	Merced County
82926	Fee-for-Service	1679754378	1679754378	1	1	GONZALES, LEARNED R MD	3/13/2008	193400000X	NA	Other	026	PHYSICIANS	76930	29	Pulmonary Diseases (M.D. only)	0	In state provider	ONARY MED A PROF CORP	71-511 HWY 111	SUITE H	RANCHO MIRAGE	CA	92770	4465	33	06065	33.7750795	-116.4496953	Riverside County
82932	Fee-for-Service	1679788764	1679788764	1	1	GINDI, VIVIAN M MD	10/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	95838	41	Internal Medicine	0	In state provider	None	1110 N WESTERN AVE	STE 201	LOS ANGELES	CA	90029	1087	19	06037	34.091289	-118.3091505	Los Angeles County
82952	Fee-for-Service	1356886782	1356886782	1	1	GALE, MICHAEL J MD	7/7/2022	390200000X	NA	Other	026	PHYSICIANS	177044	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
82971	Fee-for-Service	1588799340	1588799340	1	1	GLASSCOCK, GREGORY F MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	57774	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
83008	Fee-for-Service	1598075806	1598075806	1	1	GHIYA, MEENA S MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147711	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
83018	Fee-for-Service	1215146576	1215146576	1	1	GARG, VINOD K MD	2/28/1994	174400000X	NA	Other	026	PHYSICIANS	49049	02	General Surgery	0	In state provider	None	250 W BONITA AVENUE	#250	POMONA	CA	91767	1850	19	06037	34.09664881	-117.751261	Los Angeles County
83021	Fee-for-Service	1619157047	1619157047	1	1	GANATA, VICTOR M MD	9/1/2009	207R00000X	NA	Other	026	PHYSICIANS	95477	40	Pediatrics	0	In state provider	None	1600 S AZUSA AVE	STE 501	CITY OF INDUSTRY	CA	91748	8673	19	06037	33.99361941	-117.9314015	Los Angeles County
83029	Fee-for-Service	1730274309	1730274309	1	1	GRANADER, NEIL MD	5/20/1996	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	44725	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2074 FOREST AVE	SUITE 2	SAN JOSE	CA	95128	4811	43	06085	37.32704107	-121.9355734	Santa Clara County
83033	Fee-for-Service	1932296357	1932296357	1	1	GURA, VICTOR MD INC	6/19/1986	207R00000X	NA	Other	026	PHYSICIANS	34872	None	None	0	In state provider	None	5901 W OLYMPIC BLVD	STE 107	LOS ANGELES	CA	90036	4659	19	06037	34.05764121	-118.3603115	Los Angeles County
83060	Fee-for-Service	1811979800	1811979800	1	1	GURSAHANI, MEENA K MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	33168	30	Radiology	0	In state provider	None	3531 FASHION WAY	None	TORRANCE	CA	90503	4807	19	06037	33.8352235	-118.348254	Los Angeles County
83067	Fee-for-Service	1982626677	1982626677	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1288 CAMINO DEL RIO N	None	SAN DIEGO	CA	92108	1511	37	06073	32.7668181	-117.150708	San Diego County
83082	Fee-for-Service	1487700738	1487700738	1	1	GAMBLE, JAMES G	4/1/1984	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	48452	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
83123	Fee-for-Service	1285618728	1285618728	1	1	GINSBERG, ROBERT ALAN MD	2/5/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	38779	07	Dermatology	0	In state provider	None	6719 ALVARADO RD	STE 207	SAN DIEGO	CA	92120	5252	37	06073	32.77684978	-117.055137	San Diego County
83158	Fee-for-Service	1558872788	1558872788	1	1	GUARDIAN FLIGHT LLC	1/9/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1722 OAKWOOD DRIVE	None	ELKO	NV	89801	8819	00	None	40.82986133	-115.726001	Elko County
83179	Fee-for-Service	1215270871	1215270871	1	1	GOUDY, BRIAN D MD	7/25/2019	2080P0203X	NA	Other	026	PHYSICIANS	134709	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
83180	Fee-for-Service	1295779858	1295779858	1	1	GILLOTT, DOUGLAS L MD	6/6/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	52767	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1180 N INDIAN CANYON DR	STE E321	PALM SPRINGS	CA	92262	4868	33	06065	33.839505	-116.5455735	Riverside County
83193	Fee-for-Service	1184786469	1184786469	1	1	GASTEL, ROSALYN M LCSW	8/29/2011	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1400 E COOLEY DRIVE	#209	COLTON	CA	92324	3939	36	06071	34.05447652	-117.305298	San Bernardino County
83209	Fee-for-Service	1831130749	1831130749	1	1	GARFIELD BEACH CVS, LLC	6/19/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	351 CARMEN DR	STE B	CAMARILLO	CA	93010	6033	56	06111	34.219179	-119.0531925	Ventura County
83217	Fee-for-Service	1558307611	1558307611	1	1	GARFIELD BEACH CVS LLC	1/14/2009	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	645 SATURN BLVD	None	SAN DIEGO	CA	92154	4732	37	06073	32.58472439	-117.0925745	San Diego County
83242	Fee-for-Service	1821248352	1821248352	1	1	GAVIN, KERRI L LCSW	12/19/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3022 SHASTA WAY	None	SANTA ROSA	CA	95403	2664	49	06097	38.470266	-122.736339	Sonoma County
83249	Fee-for-Service	1578759395	1578759395	1	1	GHAZIKHANIAN, VARAND MD	6/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121549	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
83254	Fee-for-Service	1760879498	1760879498	1	1	GRAHAM, JEFFREY D MD	11/10/2020	2080P0204X	NA	Other	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
83258	Fee-for-Service	1932857448	1932857448	1	1	GENORA HEALTH INC	10/5/2022	207ZP0007X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	4880 HUNTINGTON DR S	None	LOS ANGELES	CA	90032	1934	19	06037	34.08636456	-118.17746	Los Angeles County
83260	Fee-for-Service	1679598890	1679598890	1	1	GALLO, RICHARD L MD	6/24/1999	207N00000X	NA	Dermatology	026	PHYSICIANS	50273	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
83265	Fee-for-Service	1760459754	1760459754	1	2	GOLDSTEIN, GERALD S MD	2/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	29720	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
83273	Fee-for-Service	1669549523	1669549523	1	1	GREEN, RICHARD M MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69544	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
83275	Fee-for-Service	1730269879	1730269879	1	1	GENE C LAWRENCE MD INC	1/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	29177	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	355 PLACENTIA AVE	STE 202	NEWPORT BEACH	CA	92663	3302	30	06059	33.62672719	-117.9312941	Orange County
83300	Fee-for-Service	1285821298	1285821298	1	1	GOLDEN VALLEY USD	11/15/2005	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	37479 AVENUE 12	None	MADERA	CA	93636	8726	20	06039	36.92308652	-119.867391	Madera County
83307	Fee-for-Service	1457926065	1457926065	1	1	GOLDEN HEIGHTS OPERATIONS	4/8/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	35 ESCUELA DRIVE	None	DALY CITY	CA	94015	4003	41	06081	37.67482398	-122.4778067	San Mateo County
83312	Fee-for-Service	1073944930	1073944930	1	1	GARVIN, SHEA L LMFT	10/11/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	99770	-	NOT APPLICABLE	0	In state provider	None	500 B JEFFERSON BLVD	STE 195	WEST SACRAMENTO	CA	95605	2349	57	06113	38.58758543	-121.5270475	Yolo County
83318	Fee-for-Service	1043257066	1043257066	1	1	GURUSHANTHAIAH,KAERTI M	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68300	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MED PLAZA STE 430	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
83340	Fee-for-Service	1669416939	1669416939	1	1	GARFIELD BEACH CVS, LLC	9/30/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20839 W ROSECOE BLVD	None	WINNETKA	CA	91306	2001	19	06037	34.21999146	-118.5875595	Los Angeles County
83353	Fee-for-Service	1306352349	1306352349	1	1	GERAMI, PARVANEH NP	6/24/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
83389	Fee-for-Service	1770193773	1770193773	1	1	GOLDSTEIN, JOSHUA A PSYD	4/14/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	420 S BEVERLY DR	STE 100-8	BEVERLY HILLS	CA	90212	4426	19	06037	34.05860174	-118.3978013	Los Angeles County
83396	Fee-for-Service	1447295340	1447295340	1	1	GARFIELD BEACH CVS, LLC	2/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12280 PERRIS BLVD	None	MORENO VALLEY	CA	92557	7418	33	06065	33.942069	-117.2263615	Riverside County
83430	Fee-for-Service	1730634908	1730634908	1	1	GU, DAVID MD	9/13/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
83434	Fee-for-Service	1740290709	1740290709	1	1	GRIFFIN, WILLIAM L MD	5/17/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	38967	None	None	0	In state provider	None	3152 N MILLBROOK AVE	STE. B	FRESNO	CA	93703	1400	10	06019	36.779166	-119.7634925	Fresno County
83466	Fee-for-Service	1487721494	1487721494	1	1	GARCIA, ALEX F MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60542	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
83494	Fee-for-Service	1255508354	1255508354	1	1	GIEBEL, STEPHEN J 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
83501	Fee-for-Service	1184684672	1184684672	1	1	GROSSMAN, KENNETH R MD	9/26/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50711	18	Ophthalmology	0	In state provider	INC	580 COLLINS DR	None	MERCED	CA	95348	3121	24	06047	37.32266954	-120.4774245	Merced County
83509	Fee-for-Service	1356159008	1356159008	1	1	GARG, PRIYANKA PT	2/24/2025	No Taxonomy Provided	NA	None	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
83523	Fee-for-Service	1366683948	1366683948	1	1	GHARAVI, NIMA M MD	3/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110302	07	Dermatology	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
83557	Fee-for-Service	1265641930	1265641930	1	1	GUPTA, ROOPALI B MD	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122370	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
83587	Fee-for-Service	1164615811	1164615811	1	1	GAULT, LANCE G DO	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	10128	01	General Practice	0	In state provider	None	7300 NORTH FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
83590	Fee-for-Service	1285821298	1285821298	1	1	GOLDEN VALLEY USD	1/1/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	37479 AVENUE 12	None	MADERA	CA	93636	8726	20	06039	36.92308652	-119.867391	Madera County
83631	Fee-for-Service	1780739771	1780739771	1	1	GOEBEL, MARGARET A M	2/14/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
83676	Fee-for-Service	1376601393	1376601393	1	1	GREEN, WM MICHAEL MD	1/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
83719	Fee-for-Service	1518134154	1518134154	1	1	GAMMON, BRYAN MD	10/26/2020	207ND0900X	NA	Dermatology	026	PHYSICIANS	118101	07	Dermatology	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
83732	Fee-for-Service	1891789194	1891789194	1	1	GOURON, MAX MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	49690	01	General Practice	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
83734	Fee-for-Service	1508108986	1508108986	1	1	GHARAGOZLOU, BARSAM MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143860	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
83747	Fee-for-Service	1710058623	1710058623	1	1	GREEN, DANIEL A MD	1/31/1990	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	68784	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
83752	Fee-for-Service	1689616880	1689616880	1	1	GARFIELD BEACH CVS LLC	10/23/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3981 IRVINE BLVD	None	IRVINE	CA	92602	2400	30	06059	33.72261953	-117.7725183	Orange County
83756	Fee-for-Service	1487867503	1487867503	1	1	GOLDEN VALLEY HEALTH CTR	7/31/1991	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	WEST MODESTO MEDICAL CTR	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
83788	Fee-for-Service	1982741583	1982741583	1	1	GROSS, MEGAN F MD	4/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84264	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
83790	Fee-for-Service	1962680421	1962680421	1	20	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 560	MODESTO	CA	95350	4573	50	06099	37.666233	-120.993933	Stanislaus County
83802	Fee-for-Service	1942306865	1942306865	1	1	GIBRALTAR CONV HOSP	1/1/1979	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2720 NEVADA AVE	None	EL MONTE	CA	91733	2318	19	06037	34.06102335	-118.0367709	Los Angeles County
83806	Fee-for-Service	1417392291	1417392291	1	1	GOTIMER, KRISTIN F DO	10/19/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	15307	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
83809	Fee-for-Service	1447451539	1447451539	1	1	GOSWANMI, AMITABH U DO	8/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9044	05	Anesthesiology	0	In state provider	None	7147 N CEDAR AVE	None	FRESNO	CA	93720	3311	10	06019	36.84023418	-119.7563052	Fresno County
83818	Fee-for-Service	1609305077	1609305077	1	1	GENESIS OB ASSOCIATES PC	8/25/2017	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
83844	Fee-for-Service	1265641930	1265641930	1	1	GUPTA, ROOPALI B MD	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122370	38	Geriatrics	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
83873	Fee-for-Service	1306861430	1306861430	1	1	GRIMES, GARY T MD	12/20/2010	207L00000X	NA	Other	026	PHYSICIANS	28362	05	Anesthesiology	0	In state provider	None	1720 CESAR CHAVEZ AVE	None	LOS ANGELES	CA	90033	5033	19	06037	34.04925	-118.2177405	Los Angeles County
83904	Fee-for-Service	1821601840	1821601840	1	1	GASTRO HEALTH INC	9/14/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	26021 BUSINESS CENTER DR	None	REDLANDS	CA	92374	4553	36	06071	34.06518096	-117.2367214	San Bernardino County
83928	Fee-for-Service	1992728299	1992728299	2	1	GARFIELD BEACH CVS LLC	10/5/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2355 W KETTLEMAN LN	None	LODI	CA	95242	4120	39	06077	38.117592	-121.3033725	San Joaquin County
83972	Fee-for-Service	1528450624	1528450624	1	1	GHAFFARI, SANAZ MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126704	05	Anesthesiology	0	In state provider	None	1328 22ND STREET	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
83986	Fee-for-Service	1487681631	1487681631	1	1	GRANCELL VILLAGE OF THE	11/16/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES JEWISH HOME	7150 TAMPA AVE	None	RESEDA	CA	91335	3700	19	06037	34.2001266	-118.5534932	Los Angeles County
84008	Fee-for-Service	1518134154	1518134154	1	1	GAMMON, BRYAN MD	10/26/2020	207ND0900X	NA	Dermatology	026	PHYSICIANS	118101	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
84019	Fee-for-Service	1356646590	1356646590	1	1	GROSSMAN, ERIC MD	6/10/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	157157	None	None	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	42	06083	34.42887662	-119.7237878	Santa Barbara County
84036	Fee-for-Service	1710058623	1710058623	1	1	GREEN, DANIEL A MD	1/31/1990	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	68784	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
84044	Fee-for-Service	1487867503	1487867503	1	1	GOLDEN VALLEY HEALTH CTR	7/31/1991	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	WEST MODESTO MEDICAL CTR	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
84053	Fee-for-Service	1033226758	1033226758	1	1	GERSHFIELD, DAVID N MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74994	13	Neurology (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
84079	Fee-for-Service	1962680421	1962680421	1	5	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1525 MCHENRY AVENUE	SUITE 330	MODESTO	CA	95350	4567	50	06099	37.66642219	-120.9939896	Stanislaus County
84082	Fee-for-Service	1164562112	1164562112	1	1	GABIOLA, JULIETA M MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	51233	01	General Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84130	Fee-for-Service	1598813800	1598813800	1	1	GARRATT, RICHARD OD INC	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SAN DIMAS OPTOMETRY	120 W BONITA AVE	STE A	SAN DIMAS	CA	91773	3011	19	06037	34.1066037	-117.8080463	Los Angeles County
84136	Fee-for-Service	1417929191	1417929191	1	1	GIL, ORNA MD	11/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53195	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 VALE TERRACE	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
84181	Fee-for-Service	1619685013	1619685013	1	1	GU, JOEY PT	3/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
84196	Fee-for-Service	1437646288	1437646288	1	1	GONZALEZ, JOSE A MD	6/3/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	176718	None	None	0	In state provider	None	655 EUCLID AVE	STE 401	NATIONAL CITY	CA	91950	2978	37	06073	32.68353398	-117.082625	San Diego County
84213	Fee-for-Service	1235602954	1235602954	1	1	GOLDEN CALIFORNIA HEALTHCARE	1/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1355 ELLIS ST	None	SAN FRANCISCO	CA	94115	4215	38	06075	37.78281575	-122.4286471	San Francisco County
84222	Fee-for-Service	1780796342	1780796342	1	1	GOMEZ, ALLEN M	12/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88737	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1428	19	06037	33.808185	-118.1850575	Los Angeles County
84235	Fee-for-Service	1144308735	1144308735	1	1	GARCIA, EDWIN G MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49803	13	Neurology (M.D. only)	0	In state provider	None	1505 W ROSS RD	None	EL CENTRO	CA	92243	9585	13	06025	32.78190481	-115.6640317	Imperial County
84242	Fee-for-Service	1114986304	1114986304	1	1	GUEYIKIAN, ARA MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
84244	Fee-for-Service	1265632194	1265632194	1	1	GARCIA, MIKI S MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95690	07	Dermatology	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
84245	Fee-for-Service	1073673778	1073673778	1	1	GARCIA, HEIDI A LMFT	3/16/2020	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
84292	Fee-for-Service	1215954706	1215954706	1	1	GARRETY, KAREN L OD	12/7/2017	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	435 N A STREET	None	OXNARD	CA	93030	4903	56	06111	34.20620899	-119.1785279	Ventura County
84312	Fee-for-Service	1164528741	1164528741	1	1	GELLENS, ANDREW J MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	71477	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8851 CENTER DR	STE 210	LA MESA	CA	91942	3045	37	06073	32.78189749	-117.0075062	San Diego County
84329	Fee-for-Service	1477546745	1477546745	1	1	GREGORY WELLE	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1133 COLLEGE AVE	STE C143	MANHATTAN	KS	66502	2751	00	None	39.192381	-96.5996865	Riley County
84339	Fee-for-Service	1861414641	1861414641	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6635 FALLBROOK AVE	None	WEST HILLS	CA	91307	3520	19	06037	34.19037	-118.626714	Los Angeles County
84360	Fee-for-Service	1184216897	1184216897	1	1	GARFIELD BEACH CVS LLC	7/29/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 PARK PLZ	STE 155	SAN DIEGO	CA	92101	8272	37	06073	32.70679459	-117.1545932	San Diego County
84363	Fee-for-Service	1104037274	1104037274	1	1	GRZYWACZ, FRANK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	599 W STATE ST	STE 200	DOYLESTOWN	PA	18901	2567	00	None	40.30462831	-75.14382843	Bucks County
84365	Fee-for-Service	1962680421	1962680421	1	20	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 560	MODESTO	CA	95350	4573	50	06099	37.666233	-120.993933	Stanislaus County
84383	Fee-for-Service	1609898394	1609898394	2	1	GARFIELD BEACH CVS LLC	6/5/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5555 PHILADELPHIA ST	None	CHINO	CA	91710	2481	36	06071	34.03353348	-117.6819255	San Bernardino County
84401	Fee-for-Service	1235598756	1235598756	1	1	GARCIA, SHANA PSYD	3/21/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1620 S GRAND AVE	None	GLENDORA	CA	91740	5433	19	06037	34.10974369	-117.872489	Los Angeles County
84415	Fee-for-Service	1477612752	1477612752	1	1	GILL, KANWALJIT S MD	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53800	06	Cardiovascular Disease (M.D. only)	0	In state provider	HEART CTR OF ANTELOPE	43807 10TH ST W	STE D	LANCASTER	CA	93534	4805	19	06037	34.6788	-118.1479295	Los Angeles County
84437	Fee-for-Service	1982659421	1982659421	1	1	GLATZ, ROBERT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1441 N BECKLEY AVE	None	DALLAS	TX	75203	1201	00	None	32.76063	-96.8257485	Dallas County
84453	Fee-for-Service	1497312136	1497312136	1	1	GOOD REMEDY HEALTHCARE INC	10/21/2024	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	22939 HAWTHORNE BLVD	304	TORRANCE	CA	90505	3682	19	06037	33.81871755	-118.35123	Los Angeles County
84505	Fee-for-Service	1063731966	1063731966	1	1	GORDON, NATHANIEL A MD	4/19/2016	207RP1001X	NA	Pulmonology	026	PHYSICIANS	118793	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1485 RIVER PARK DR	SUITE 200	SACRAMENTO	CA	95815	4530	34	06067	38.599614	-121.438728	Sacramento County
84553	Fee-for-Service	1598899718	1598899718	1	1	GILBERT D ROYS MD INC	5/20/1980	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ANAHEIM SURG ASSOC MED	1211 W LA PALMA AVE	STE 705	ANAHEIM	CA	92801	2814	30	06059	33.84718298	-117.933758	Orange County
84556	Fee-for-Service	1104440163	1104440163	1	1	GIANG, JASON LCSW	2/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
84561	Fee-for-Service	1235623976	1235623976	1	1	GHULAM, MAHJOOBAH M DO	8/17/2023	207L00000X	NA	Other	026	PHYSICIANS	17811	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
84575	Fee-for-Service	1508991050	1508991050	1	1	GAIKWAD, SHILPA J MD	6/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	66755	01	General Practice	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
84584	Fee-for-Service	1528146354	1528146354	1	1	GOLDMAN, RIMA MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	45806	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
84585	Fee-for-Service	1124050679	1124050679	1	1	GARBUTT, BETTY Y CNMW	9/1/2000	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	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
84594	Fee-for-Service	1407813066	1407813066	1	1	GREATER LONG BEACH	7/1/1994	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ENDOSCOPY CTR	2880 ATLANTIC AVE	STE 180	LONG BEACH	CA	90806	1736	19	06037	33.809382	-118.185001	Los Angeles County
84600	Fee-for-Service	1164528741	1164528741	1	1	GELLENS, ANDREW J MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	71477	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8851 CENTER DR	STE 210	LA MESA	CA	91942	3045	37	06073	32.78189749	-117.0075062	San Diego County
84628	Fee-for-Service	1528278678	1528278678	1	1	GRIDLEY, LAURA D MD	10/26/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	82705	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
84653	Fee-for-Service	1962680421	1962680421	1	5	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1525 MCHENRY AVENUE	SUITE 330	MODESTO	CA	95350	4567	50	06099	37.66642219	-120.9939896	Stanislaus County
84657	Fee-for-Service	1154395424	1154395424	1	1	GOLUB, RICHARD 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	6320 W UNION HILLS DR	STE 230	GLENDALE	AZ	85308	7235	00	None	33.655023	-112.198311	Maricopa County
84666	Fee-for-Service	1548567498	1548567498	1	5	GENESIS HEALTHCARE PARTNERS	6/1/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	4033 THIRD AVE	SUITE 400	SAN DIEGO	CA	92103	2140	37	06073	32.75053781	-117.1627168	San Diego County
84667	Fee-for-Service	1508210311	1508210311	1	1	GRAY, SARAH M MD	6/25/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	151631	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
84670	Fee-for-Service	1427801919	1427801919	1	1	GILL, SURINDER	3/1/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
84675	Fee-for-Service	1922009331	1922009331	1	1	GAINESVILLE HOSP DIST	2/23/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1900 HOSPITAL BLVD	None	GAINESVILLE	TX	76240	2002	00	None	33.64614048	-97.16259278	Cooke County
84698	Fee-for-Service	1487846887	1487846887	1	1	GANESH, SIVAGINI MD	11/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101105	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	4528	19	06037	34.06269295	-118.2030006	Los Angeles County
84703	Fee-for-Service	1902927536	1902927536	1	1	GALLIGANI, DEBORAH J LCSW	7/28/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11850 WILSHIRE BLVD	201	LOS ANGELES	CA	90025	6629	19	06037	34.04719129	-118.463657	Los Angeles County
84735	Fee-for-Service	1497364921	1497364921	1	1	GRAND HOSPICE INC	12/20/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	211 W ALAMEDA AVE	SUITE 102	GLENDALE	CA	91502	3025	19	06037	34.16890032	-118.3057575	Los Angeles County
84758	Fee-for-Service	1932140845	1932140845	1	1	GARFIELD BEACH CVS LLC	12/22/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	367 N CITRUS AVE	None	AZUSA	CA	91702	3909	19	06037	34.127919	-117.8901782	Los Angeles County
84764	Fee-for-Service	1063660066	1063660066	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30340 HAUN RD	None	MENIFEE	CA	92584	6803	33	06065	33.680277	-117.172233	Riverside County
84790	Fee-for-Service	1063731966	1063731966	1	1	GORDON, NATHANIEL A MD	4/19/2016	207RP1001X	NA	Pulmonology	026	PHYSICIANS	118793	41	Internal Medicine	0	In state provider	None	1485 RIVER PARK DR	SUITE 200	SACRAMENTO	CA	95815	4530	34	06067	38.599614	-121.438728	Sacramento County
84866	Fee-for-Service	1427605856	1427605856	1	1	GALLEGOS, MIGUEL A LMFT	8/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
84917	Fee-for-Service	1891833695	1891833695	1	1	GOLDBERG, DAMIEN F MD	1/31/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	87954	18	Ophthalmology	0	In state provider	None	23600 TELO AVE	SUITE 100	TORRANCE	CA	90505	4035	19	06037	33.81215054	-118.3384029	Los Angeles County
84918	Fee-for-Service	1679932727	1679932727	1	1	GEIBEL, LINDSEY LMFT	9/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10730 PORTAL ROAD	None	ATASCADERO	CA	93422	4604	40	06079	35.47337265	-120.6987671	San Luis Obispo County
84933	Fee-for-Service	1538137914	1538137914	1	1	GARY NACE MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	880 MADISON AVE	None	MEMPHIS	TN	38103	3409	00	None	35.14044298	-90.03202962	Shelby County
84952	Fee-for-Service	1316991508	1316991508	1	1	GROVE, MATTHEW A DC	4/1/2016	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	2721 OLIVE HWY	SUITE 4	OROVILLE	CA	95966	6103	04	06007	39.50452062	-121.5420592	Butte County
84962	Fee-for-Service	1922009331	1922009331	1	1	GAINESVILLE HOSP DIST	2/23/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1900 HOSPITAL BLVD	None	GAINESVILLE	TX	76240	2002	00	None	33.64614048	-97.16259278	Cooke County
84989	Fee-for-Service	1487846887	1487846887	1	1	GANESH, SIVAGINI MD	11/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101105	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	4528	19	06037	34.06269295	-118.2030006	Los Angeles County
85020	Fee-for-Service	1497364921	1497364921	1	1	GRAND HOSPICE INC	12/20/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	211 W ALAMEDA AVE	SUITE 102	GLENDALE	CA	91502	3025	19	06037	34.16890032	-118.3057575	Los Angeles County
85041	Fee-for-Service	1386715134	1386715134	1	1	GHORISHI, ZAHRA MD	12/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75845	40	Pediatrics	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
85043	Fee-for-Service	1518202308	1518202308	1	1	GARCIA, MARTIN A MD INC	11/25/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	35253	24	Plastic Surgery	0	In state provider	None	5451 LA PALMA AVE	STE 32	LA PALMA	CA	90623	1731	30	06059	33.84643146	-118.038843	Orange County
85055	Fee-for-Service	1659316651	1659316651	1	1	GARFIELD BEACH CVS, LLC	10/10/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	28221 CROWN VALLEY PKWY	None	LAGUNA NIGUEL	CA	92677	1427	30	06059	33.55275192	-117.6868284	Orange County
85131	Fee-for-Service	1932584612	1932584612	1	1	GEHRZ, JOSEPH A MD	9/1/2022	207P00000X	NA	Other	026	PHYSICIANS	144011	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
85151	Fee-for-Service	1083659981	1083659981	1	1	GARFIELD BEACH CVS LLC	4/21/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 E PLAZA BLVD	None	NATIONAL CITY	CA	91950	3609	37	06073	32.67711518	-117.0933814	San Diego County
85187	Fee-for-Service	1619003035	1619003035	1	1	GRELOTTI, DAVID J MD	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133738	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
85193	Fee-for-Service	1871980102	1871980102	1	1	GREWAL, SEAN S MD	11/20/2018	208M00000X	NA	Other	026	PHYSICIANS	147942	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
85196	Fee-for-Service	1346672623	1346672623	1	1	GRACIOUS HOME HEALTH INC	9/6/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6314 VAN NUYS BLVD	SUITE 208	VAN NUYS	CA	91401	2625	19	06037	34.18518362	-118.4487146	Los Angeles County
85208	Fee-for-Service	1770026429	1770026429	1	1	GRANADOS-WEBER, IRMA LMFT	3/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11870 PIERCE ST	SUITE 150	RIVERSIDE	CA	92505	4402	33	06065	33.90095662	-117.4936969	Riverside County
85221	Fee-for-Service	1013196575	1013196575	1	1	GENTRY, MICHAEL D MD	10/28/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	75740	30	Radiology	0	In state provider	None	400 N PEPPER AVE	None	SAN BERNARDINO	CA	92324	1819	36	06071	34.073505	-117.3505995	San Bernardino
85222	Fee-for-Service	1306026133	1306026133	1	1	GIANELLA, DANIEL L MD	4/1/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	93464	None	None	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5606	34	06067	38.571237	-121.469958	Sacramento County
85273	Fee-for-Service	1295226272	1295226272	1	1	GUTIERREZ, ANDREW	3/21/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1402 PICO AVE	UNIT # A-44	EL CENTRO	CA	92243	1377	13	06025	32.8056843	-115.5680983	Imperial County
85316	Fee-for-Service	1770993370	1770993370	1	3	GATEWAY MEDICAL SERVICES, IN	1/25/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	NIC INC	3082 MCMURRAY	None	ANDERSON	CA	96007	3544	45	06089	40.45499506	-122.2929002	Shasta County
85336	Fee-for-Service	1275578171	1275578171	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	455 ENCINITAS BLVD	None	ENCINITAS	CA	92024	3728	37	06073	33.04687469	-117.2819119	San Diego County
85414	Fee-for-Service	1275656860	1275656860	1	1	GIRAUDO, SUZANNE M PSYD	5/18/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
85431	Fee-for-Service	1073635348	1073635348	2	1	GONDA, JEREMY M MD	5/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	236 WEST SIXTH STREET	None	RENO	NV	89503	4550	00	None	39.53151304	-119.8186228	Washoe County
85470	Fee-for-Service	1083672232	1083672232	1	1	GEORGHIOU, PAUL F MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40200	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 LAS TABLAS RD	None	TEMPLETON	CA	93465	8749	40	06079	35.55454574	-120.7266334	San Luis Obispo County
85473	Fee-for-Service	1558468942	1558468942	1	1	GANESH, NARESH J MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50454	41	Internal Medicine	0	In state provider	GANESH MEDICAL CORP	15982 TUSCOLA RD	STE A	APPLE VALLEY	CA	92307	2111	36	06071	34.54161767	-117.2692848	San Bernardino County
85478	Fee-for-Service	1124482823	1124482823	1	1	GENUALDI, MICHAEL MD	7/26/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	151396	38	Geriatrics	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
85533	Fee-for-Service	1922233998	1922233998	1	1	GONZALES, JACQUELINE LCSW	7/21/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 EAST AVENUE	K-4	LANCASTER	CA	93535	4661	19	06037	34.66041296	-118.1254254	Los Angeles County
85545	Fee-for-Service	1003085911	1003085911	1	1	GARCIA, FIRMO C MD INC	3/17/2008	193400000X	NA	Other	026	PHYSICIANS	70469	40	Pediatrics	0	In state provider	None	44140 20TH ST WEST	STE 105	LANCASTER	CA	93534	4045	19	06037	34.684956	-118.1655715	Los Angeles County
85557	Fee-for-Service	1881912129	1881912129	1	1	GREGORY, BLAKE E MD	5/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119282	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
85564	Fee-for-Service	1578386967	1578386967	1	1	GERSING, ALEXANDRA MD	11/5/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
85578	Fee-for-Service	1831310051	1831310051	1	1	GHAZVINI, MINA M	10/12/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
85605	Fee-for-Service	1770993370	1770993370	1	3	GATEWAY MEDICAL SERVICES, IN	1/25/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	NIC INC	3082 MCMURRAY	None	ANDERSON	CA	96007	3544	45	06089	40.45499506	-122.2929002	Shasta County
85620	Fee-for-Service	1477058824	1477058824	1	1	GAITHER CASTELLANOS, THOMAS	3/20/2024	208800000X	NA	Other	026	PHYSICIANS	166338	None	None	0	In state provider	W MD	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
85622	Fee-for-Service	1174291116	1174291116	1	1	GRUMAN, SARAH BIRTH DOULA	9/18/2024	174N00000X	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
85676	Fee-for-Service	1720240658	1720240658	1	1	GRIFFITH, ADAM M MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134798	14	Neurological Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
85678	Fee-for-Service	1063446920	1063446920	1	1	GROVE, THOMAS M MD	5/31/1988	207L00000X	NA	Other	026	PHYSICIANS	47393	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
85717	Fee-for-Service	1942452834	1942452834	1	1	GARFIELD BEACH CVS, LLC	9/21/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21590 E VALLEY BLVD	None	CITY OF INDUSTRY	CA	91789	5241	19	06037	34.02672601	-117.8361247	Los Angeles County
85742	Fee-for-Service	1013561919	1013561919	1	1	GPSTREATMENT DOT COM LLC	5/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	10200 SEPULVEDA BLVD STE	None	MISSION HILLS	CA	91345	2692	19	06037	34.25572562	-118.4673156	Los Angeles County
85762	Fee-for-Service	1124482823	1124482823	1	1	GENUALDI, MICHAEL MD	7/26/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	151396	41	Internal Medicine	0	In state provider	None	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	01	06001	37.84779018	-122.2868874	Alameda County
85763	Fee-for-Service	1558468942	1558468942	1	1	GANESH, NARESH J MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50454	66	Emergency Medicine (Urgent Care)	0	In state provider	GANESH MEDICAL CORP	15982 TUSCOLA RD	STE A	APPLE VALLEY	CA	92307	2111	36	06071	34.54161767	-117.2692848	San Bernardino County
85770	Fee-for-Service	1134200272	1134200272	1	1	GONZALEZ, MIGUEL C MD	10/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76653	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
85792	Fee-for-Service	1225770316	1225770316	1	1	GUTHRIE, KAREN D 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	19	06037	0	0	None
85799	Fee-for-Service	1033312624	1033312624	1	1	GILARDI, PARUL MD	11/30/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89037	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
85816	Fee-for-Service	1922233998	1922233998	1	1	GONZALES, JACQUELINE LCSW	3/22/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	60803	-	NOT APPLICABLE	0	In state provider	None	311 EAST AVENUE	K-4	LANCASTER	CA	93535	4661	19	06037	34.66041296	-118.1254254	Los Angeles County
85832	Fee-for-Service	1801226543	1801226543	2	1	GENEX LABORATORY PROFESSIONA	6/26/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	L CORPORATION	3151 AIRWAY AVE	M1	COSTA MESA	CA	92626	4626	30	06059	33.67783408	-117.8720921	Orange County
85874	Fee-for-Service	1316662091	1316662091	1	1	GUZMAN, EDDIE AU	1/10/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W. PROVIDENCE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
85912	Fee-for-Service	1740416833	1740416833	1	1	GOLDFARB, GEORGIA A MD	4/20/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43687	40	Pediatrics	0	In state provider	None	18425 BURBANK BLVD	STE 719	TARZANA	CA	91356	6914	19	06037	34.17226853	-118.5348151	Los Angeles County
85915	Fee-for-Service	1831719996	1831719996	1	1	GRAY, CHUE M	7/30/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1829 PORTELLO WAY	None	LINCOLN	CA	95648	8911	31	06061	38.87883233	-121.3190573	Placer County
85937	Fee-for-Service	1730380916	1730380916	1	1	GONZAGA, MARIA MD	12/3/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	120277	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	24411 HEALTH CENTER DR	STE 640	LAGUNA HILLS	CA	92653	3633	30	06059	33.6087201	-117.7076948	Orange County
86008	Fee-for-Service	1861011876	1861011876	1	1	GARCIA, MONIKA E MD	10/31/2023	208M00000X	NA	Other	026	PHYSICIANS	186464	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
86020	Fee-for-Service	1528042587	1528042587	1	1	GANDARA, DAVID R MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	37929	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
86023	Fee-for-Service	1700865045	1700865045	1	1	GLEASON, LISA A MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65766	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
86098	Fee-for-Service	1720099823	1720099823	1	1	GONSALVES, GARY D MD	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78816	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
86140	Fee-for-Service	1083607428	1083607428	1	1	GONZALES, LEARNED R MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76930	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
86141	Fee-for-Service	1396816369	1396816369	1	1	GOLDSTEIN, MARK A DO	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7462	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
86153	Fee-for-Service	1770993370	1770993370	1	2	GATEWAY MEDICAL SERVICES, IN	7/19/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NIC, REDDING	1310 CHURN CREEK RD	STE E5	REDDING	CA	96003	4004	45	06089	40.58819665	-122.3510235	Shasta County
86156	Fee-for-Service	1467497354	1467497354	1	1	GARFIELD BEACH CVS, LLC	2/28/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7393 JACKSON DR	None	SAN DIEGO	CA	92119	2316	37	06073	32.8026463	-117.0448544	San Diego County
86169	Fee-for-Service	1184656928	1184656928	1	1	GOMER, WILSON D MD	4/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50690	41	Internal Medicine	0	In state provider	None	1800 WESTERN AVE	STE 103	SAN BERNARDINO	CA	92411	1352	36	06071	34.1315778	-117.3182453	San Bernardino County
86202	Fee-for-Service	1831719996	1831719996	1	1	GRAY, CHUE M	7/30/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1829 PORTELLO WAY	None	LINCOLN	CA	95648	8911	31	06061	38.87883233	-121.3190573	Placer County
86257	Fee-for-Service	1982772588	1982772588	1	1	GENRAL, JIM	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12040 NE 128TH	None	KIRKLAND	WA	98034	3013	00	None	47.71493427	-122.1792761	King County
86284	Fee-for-Service	1205879202	1205879202	1	1	GIBSON, XUNDA A MD	3/23/2023	207R00000X	NA	Other	026	PHYSICIANS	83389	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
86300	Fee-for-Service	1033131669	1033131669	2	1	GARFIELD BEACH CVS LLC	3/27/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20801 VENTURA BLVD	None	WOODLAND HILLS	CA	91364	2319	19	06037	34.16785904	-118.5848358	Los Angeles County
86304	Fee-for-Service	1518045608	1518045608	1	1	GRAS, JOANNE DO	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6815	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
86327	Fee-for-Service	1740223940	1740223940	1	1	GARFIELD BEACH CVS, LLC	5/11/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27983 SECO CANYON RD	None	SANTA CLARITA	CA	91350	3872	19	06037	34.459425	-118.5344255	Los Angeles County
86373	Fee-for-Service	1881871283	1881871283	1	1	GEACH, JONATHAN B MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98157	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
86382	Fee-for-Service	1699867523	1699867523	1	1	GUIDRY, CHERYL D NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3900 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	2013	19	06037	33.78982251	-118.1462265	Los Angeles County
86391	Fee-for-Service	1992333835	1992333835	1	1	GAW, CHARLENE MD	7/12/2024	207P00000X	NA	Other	026	PHYSICIANS	181240	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
86446	Fee-for-Service	1295727360	1295727360	1	1	GLINN AND GIORDANO PHYSICAL	9/27/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY, INC.	200 CHINA GRADE LOOP	None	BAKERSFIELD	CA	93308	1735	15	06029	35.42698208	-119.0197707	Kern County
86456	Fee-for-Service	1922344225	1922344225	1	1	GRAHAM, RUTH M PT	1/23/2020	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
86465	Fee-for-Service	1982642724	1982642724	1	1	GABRIEL, MARK J DO	2/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	6346	None	None	0	In state provider	None	9851 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.918192	-117.4547295	Riverside County
86503	Fee-for-Service	1841232865	1841232865	1	1	GIES, LARRY W DC	12/31/1987	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1585 BUTTE HOUSE RD	STE A	YUBA CITY	CA	95993	2200	51	06101	39.14802201	-121.643823	Sutter County
86531	Fee-for-Service	1568840635	1568840635	1	1	GIRGIS, AGATHON MD	8/28/2020	208M00000X	NA	Other	026	PHYSICIANS	153179	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
86554	Fee-for-Service	1962532721	1962532721	1	1	GRANTHAM, AMANDA B MD	12/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54102	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	None	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
86593	Fee-for-Service	1518045608	1518045608	1	1	GRAS, JOANNE DO	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6815	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
86638	Fee-for-Service	1275731366	1275731366	1	1	GREENE, TAMBRA M LCSW	12/1/2017	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
86660	Fee-for-Service	1972681872	1972681872	1	1	GALUSTIAN, JANE C MD	10/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	70331	18	Ophthalmology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
86661	Fee-for-Service	1972537736	1972537736	1	1	GHADIYA, MANSUKH R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71759	08	Family Practice	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
86691	Fee-for-Service	1780020727	1780020727	1	1	GELGAND, RACHAEL A LMFT	6/11/2021	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
86698	Fee-for-Service	1558820670	1558820670	1	1	GHAUS, SOPHIA MD	9/1/2022	208M00000X	NA	Other	026	PHYSICIANS	179606	None	None	0	In state provider	None	2121 PINE ST	None	SAN FRANCISCO	CA	94115	2829	38	06075	37.78824776	-122.4311213	San Francisco County
86709	Fee-for-Service	1295801660	1295801660	1	1	GINIECZKI, JILL G MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67029	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
86753	Fee-for-Service	1285616904	1285616904	1	1	GANDOUR-EDWARDS, REGINA	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	57772	22	Pathology (M.D. only)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
86815	Fee-for-Service	1275940710	1275940710	1	1	GITTENS, ALENA Y PSYD	2/21/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
86822	Fee-for-Service	1073245874	1073245874	1	1	GILLES MEDICAL CORPORATION	2/17/2023	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	320 SANTA FE DR	305	ENCINITAS	CA	92024	5140	37	06073	33.038847	-117.285579	San Diego County
86891	Fee-for-Service	1104111483	1104111483	1	1	GOLDEN PACIFIC HOME HEALTH	11/26/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1151 HARBOR BAY PARKWAY	SUITE 122	ALAMEDA	CA	94502	6568	01	06001	37.7267857	-122.2311856	Alameda County
86913	Fee-for-Service	1467508879	1467508879	1	1	GLADIN, AMY M	1/30/2013	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
86941	Fee-for-Service	1336129915	1336129915	1	1	GLASSER, SCOTT A MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	89046	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
86961	Fee-for-Service	1083949309	1083949309	1	1	GLATT MEDICAL LIMITED	7/14/2011	207RA0401X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PARTNERSHIP	1860 EL CAMINO REAL	STE 301	BURLINGAME	CA	94010	3114	41	06081	37.59615729	-122.3846379	San Mateo County
86962	Fee-for-Service	1497970115	1497970115	1	3	GROVER, RAHUL INC	9/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	52335	40	Pediatrics	0	In state provider	None	910 VIA DE LA PAZ	SUITE 207	PACIFIC PALISADES	CA	90272	3545	19	06037	34.04731974	-118.5270397	Los Angeles County
87087	Fee-for-Service	1831156066	1831156066	1	1	GOMARA, ROBERTO 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	3200 SW 60TH CT	STE 204	MIAMI	FL	33155	4070	00	None	25.74153817	-80.29306992	Miami-Dade County
87096	Fee-for-Service	1801863105	1801863105	1	1	GUERRA, ERIC 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	80 HUMPHREYS CTR	STE 202	MEMPHIS	TN	38120	2353	00	None	35.12840452	-89.85727502	Shelby County
87127	Fee-for-Service	1295257897	1295257897	1	1	GLYNN, ANN CRNA	8/2/2023	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
87166	Fee-for-Service	1356789523	1356789523	1	1	GBADEBO, SARAH A LMFT	5/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
87167	Fee-for-Service	1548344526	1548344526	1	1	GELMAN, MARC A MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54202	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
87181	Fee-for-Service	1558945337	1558945337	1	1	GLOM SUBSTANCE ABUSE PROGRAM	8/29/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	13386 MARENGO RD	None	GALT	CA	95632	8429	34	06067	38.26647	-121.2836535	Sacramento County
87202	Fee-for-Service	1871996694	1871996694	1	1	GUSTAFSON, CARISSA L PSYD	5/16/2024	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
87250	Fee-for-Service	1457674160	1457674160	1	1	GARFIELD BEACH CVS LLC	11/18/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8400 BRADSHAW RD	None	ELK GROVE	CA	95624	1420	34	06067	38.452203	-121.335435	Sacramento County
87291	Fee-for-Service	1033198742	1033198742	1	1	GERLACH, TRAVIS W MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92284	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
87324	Fee-for-Service	1518415611	1518415611	1	1	GILBERT, SHARI MFT	9/21/2018	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
87333	Fee-for-Service	1508959552	1508959552	2	1	GARCIA, GAIL JEAN	10/26/2023	1041C0700X	NA	Mental Health Outpatient Services	087	LICENSED PROFESSIONALS	25316	-	NOT APPLICABLE	0	In state provider	None	590 RIO LINDA AVE	None	CHICO	CA	95926	1817	04	06007	39.75427022	-121.8482553	Butte County
87337	Fee-for-Service	1639171069	1639171069	1	1	GROZDEVA, MARIANA MD	8/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85386	41	Internal Medicine	0	In state provider	None	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	1104	15	06029	35.36605632	-119.0531502	Kern County
87391	Fee-for-Service	1306806880	1306806880	1	2	GLINES, MELINDA E MD	8/17/2023	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	83936	-	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
87403	Fee-for-Service	1104259399	1104259399	1	1	GUZMAN GUTIERREZ, MARIA LCS	11/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
87406	Fee-for-Service	1376552802	1376552802	1	1	GARBOUSHIAN, SEVAN S MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7703	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
87414	Fee-for-Service	1396767471	1396767471	1	1	GALSTYAN, KEVIN G MD	12/9/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87868	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
87426	Fee-for-Service	1144669912	1144669912	1	1	GHOLSON, JAMES J MD	8/3/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	168852	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
87443	Fee-for-Service	1508959552	1508959552	2	2	GARCIA, GAIL JEAN	10/26/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1294 E FIRST AVE	120	CHICO	CA	95926	1572	04	06007	39.75048481	-121.8251162	Butte County
87449	Fee-for-Service	1972308088	1972308088	1	1	GENSCH, REBECCA	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	34	06067	0	0	None
87465	Fee-for-Service	1730523929	1730523929	1	1	GAMEROS-GARCIA, SUSAN LMFT	4/21/2021	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
87473	Fee-for-Service	1396388906	1396388906	1	2	GUN, SHEK ON OD	10/9/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	528 E 1ST ST	STE B	TUSTIN	CA	92780	3346	30	06059	33.7456137	-117.8182291	Orange County
87520	Fee-for-Service	1205888245	1205888245	1	1	GALLIGAN, DONALD J DO	2/28/1990	207L00000X	NA	Other	026	PHYSICIANS	5372	05	Anesthesiology	0	In state provider	None	1301 N ROSE DR	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
87565	Fee-for-Service	1144573288	1144573288	1	1	GUO-XIANG, GUO MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116079	41	Internal Medicine	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
87591	Fee-for-Service	1316393010	1316393010	1	1	GOLDEN VALLEY HEALTH CENTERS	12/12/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1920 MEMORIAL DRIVE	None	CERES	CA	95307	1827	50	06099	37.600146	-120.961042	Stanislaus County
87608	Fee-for-Service	1962834150	1962834150	1	1	GILLIGAN, KATHLEEN M CNP	5/27/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
87690	Fee-for-Service	1609934538	1609934538	1	1	GANDHI, NIKHIL R MD	7/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81799	41	Internal Medicine	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92103	2303	37	06073	32.72663119	-117.1611714	San Diego County
87693	Fee-for-Service	1376552802	1376552802	1	1	GARBOUSHIAN, SEVAN S MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7703	08	Family Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
87729	Fee-for-Service	1245559731	1245559731	1	1	GLIBICKY, MARINA MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110968	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
87733	Fee-for-Service	1043252240	1043252240	1	1	GARFIELD BEACH CVS, LLC	9/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2521 EAST BLUFF DRV	None	NEWPORT BEACH	CA	92660	3504	30	06059	33.64016658	-117.8750431	Orange County
87740	Fee-for-Service	1508976580	1508976580	1	1	GINSBURG, MARVIN L MD	6/15/1976	207R00000X	NA	Other	026	PHYSICIANS	10816	41	Internal Medicine	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
87748	Fee-for-Service	1144261058	1144261058	1	1	GARFIELD BEACH CVS, LLC	3/21/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6265 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3917	37	06073	32.76317925	-117.0640882	San Diego County
87758	Fee-for-Service	1528092418	1528092418	1	1	GUTIERREZ, MIGUEL A MD	10/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91383	07	Dermatology	0	In state provider	None	200 MED PLAZA STE 450	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
87782	Fee-for-Service	1760942247	1760942247	1	1	GALLAGHER, SHEA MD	4/25/2023	390200000X	NA	Other	026	PHYSICIANS	182200	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
87785	Fee-for-Service	1124790118	1124790118	1	1	GARCIA, EMMANUEL	8/13/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
87810	Fee-for-Service	1467474999	1467474999	1	1	GREGERSEN, HOWARD J MD	3/31/1993	207R00000X	NA	Other	026	PHYSICIANS	52744	41	Internal Medicine	0	In state provider	None	300 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1316	42	06083	34.4458497	-119.779596	Santa Barbara County
87830	Fee-for-Service	1013119734	1013119734	1	1	GUNDRUM, EDWARD E II DO	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8979	05	Anesthesiology	0	In state provider	None	1720 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
87832	Fee-for-Service	1053452789	1053452789	1	1	GREG & MARCEE HIRST	12/3/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	GREEN TREE HOUSE	368 GREENTREE RD	None	NORCO	CA	92860	1722	33	06065	33.9416242	-117.529316	Riverside County
87863	Fee-for-Service	1194876359	1194876359	1	36	GOOD SHEPHERD LUTHERAN	7/26/1995	320900000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOME-FAIRHAVEN ICF/DDH	540 FAIRHAVEN AVE	None	PORTERVILLE	CA	93257	2126	54	06107	36.07843159	-119.0291415	Tulare County
87880	Fee-for-Service	1316393010	1316393010	1	1	GOLDEN VALLEY HEALTH CENTERS	5/1/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1920 MEMORIAL DRIVE	None	CERES	CA	95307	1827	50	06099	37.600146	-120.961042	Stanislaus County
87882	Fee-for-Service	1194213769	1194213769	1	1	GOULD, SETH	7/27/2023	207R00000X	NA	Other	026	PHYSICIANS	164995	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
87903	Fee-for-Service	1194877993	1194877993	1	1	GUTIERREZ-CONTRERAS, V	9/26/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73105	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
87929	Fee-for-Service	1235355702	1235355702	1	1	GRIGGS, MATHEW 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	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
87933	Fee-for-Service	1700945409	1700945409	1	1	GROSS, ELIZABETH A PHD	6/5/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	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
87942	Fee-for-Service	1235277377	1235277377	1	1	GUPTA, ACHAL MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97550	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
88003	Fee-for-Service	1003553892	1003553892	1	1	GONZALEZ, CELINE M MD	3/31/2025	207LC0200X	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
88020	Fee-for-Service	1144427774	1144427774	1	1	GONZALES, PAOLA LMFT	6/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8291 UTICA AVE	212	RANCHO CUCAMONGA	CA	91730	7614	36	06071	34.10254043	-117.5711583	San Bernardino County
88037	Fee-for-Service	1568498061	1568498061	1	1	GIERAT, SHELLEY A 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
88132	Fee-for-Service	1316099773	1316099773	1	1	GURBANI, NARENDRA G MD	11/26/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41402	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
88133	Fee-for-Service	1700018314	1700018314	1	1	GROSSMAN, DANIEL A MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60282	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
88139	Fee-for-Service	1235391640	1235391640	1	1	GOGNA, MUDITA MD	10/16/2020	207K00000X	NA	Other	026	PHYSICIANS	158169	None	None	0	In state provider	None	785 HANA	102	FOLSOM	CA	95630	3885	34	06067	38.667861	-121.1452605	Sacramento County
88160	Fee-for-Service	1669433306	1669433306	1	1	GUPTA, VARUN MD INC	7/23/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	66812	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
88168	Fee-for-Service	1316393010	1316393010	1	1	GOLDEN VALLEY HEALTH CENTERS	12/12/2016	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1920 MEMORIAL DRIVE	None	CERES	CA	95307	1827	50	06099	37.600146	-120.961042	Stanislaus County
88190	Fee-for-Service	1194877993	1194877993	1	1	GUTIERREZ-CONTRERAS, V	9/26/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	73105	05	Anesthesiology	0	In state provider	MD	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
88192	Fee-for-Service	1962869669	1962869669	1	1	GALINATO, LAUREN LMFT	9/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
88204	Fee-for-Service	1548777089	1548777089	1	1	GROSS, HEATHER E CCC-SLP	7/13/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2836 W SUNSET BLVD	None	LOS ANGELES	CA	90026	9002	19	06037	34.08237374	-118.2726063	Los Angeles County
88222	Fee-for-Service	1801970892	1801970892	1	1	GONZALEZ, ROBERTO MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55065	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
88229	Fee-for-Service	1235277377	1235277377	1	1	GUPTA, ACHAL MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97550	84	Surgery-Head and Neck	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
88254	Fee-for-Service	1245863703	1245863703	1	1	GALLARDO-STEWART, TRISTANNE	2/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 YUBA ST.	STE 204	REDDING	CA	96001	1005	45	06089	40.58361502	-122.3895595	Shasta County
88274	Fee-for-Service	1548521883	1548521883	1	1	GUPTA, SUPRIYA MD	11/15/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163071	30	Radiology	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
88324	Fee-for-Service	1659315919	1659315919	1	1	GARFIELD BEACH CVS LLC	1/3/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1101 HIDDEN VALLEY PKWY	None	NORCO	CA	92860	3901	33	06065	33.89846762	-117.5441969	Riverside County
88326	Fee-for-Service	1881836641	1881836641	1	1	GODHWANI, NITA MD	1/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106820	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
88336	Fee-for-Service	1629226659	1629226659	1	1	GARCIA, MARIO J	5/17/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
88341	Fee-for-Service	1740216936	1740216936	1	1	GOLDEN SAN GABRIEL	4/1/1996	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC VISION	140 W VALLEY BLVD	STE 115	SAN GABRIEL	CA	91776	3784	19	06037	34.07958215	-118.1021957	Los Angeles County
88364	Fee-for-Service	1720553332	1720553332	1	1	GIBBS, ELISE L PHD	10/19/2018	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
88385	Fee-for-Service	1881852366	1881852366	1	1	GONZALES, JOHN A MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117305	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
88426	Fee-for-Service	1932467487	1932467487	2	1	GALEN INPATIENT PHYSICIANS P	1/28/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	95654	2199	10	06019	36.60784193	-119.4520057	Fresno County
88436	Fee-for-Service	1215000823	1215000823	1	1	GREEN, JASON A MD	1/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76931	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
88447	Fee-for-Service	1669433306	1669433306	1	1	GUPTA, VARUN MD INC	7/23/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	66812	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
88457	Fee-for-Service	1316393010	1316393010	1	1	GOLDEN VALLEY HEALTH CENTERS	8/14/2018	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1920 MEMORIAL DRIVE	None	CERES	CA	95307	1827	50	06099	37.600146	-120.961042	Stanislaus County
88571	Fee-for-Service	1134418023	1134418023	1	1	GABEL, EILON MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124744	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
88587	Fee-for-Service	1467530964	1467530964	1	1	GUTHIKONDA, MRUDULA K MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91987	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
88602	Fee-for-Service	1952657702	1952657702	1	1	GADADOSS, PADMAJA CNP	11/19/2021	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
88634	Fee-for-Service	1376703033	1376703033	1	2	GOMEZ GONZALEZ, MILEIDYS MD	11/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117697	36	Psychiatry	0	In state provider	None	3000 EAST 1ST STREET	W1	LOS ANGELES	CA	90063	2807	19	06037	34.04032875	-118.2022726	Los Angeles County
88646	Fee-for-Service	1417044876	1417044876	1	1	GILL, SUNITHA M MD	4/21/2020	207R00000X	NA	Other	026	PHYSICIANS	84262	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
88662	Fee-for-Service	1144205964	1144205964	2	1	GIRARD, MICHAEL L MD	6/12/2018	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
88686	Fee-for-Service	1275898314	1275898314	1	1	GOGINENI, HRISHIKESH C MD	10/1/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	154074	20	Orthopedic Surgery	0	In state provider	None	2131 ELKS DR	SUITE 200	SAN BERNARDINO	CA	92404	5544	36	06071	34.13470788	-117.262434	San Bernardino County
88703	Fee-for-Service	1346256336	1346256336	1	1	GARSON, LESLIE M MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	58611	05	Anesthesiology	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
88716	Fee-for-Service	1225180912	1225180912	1	1	GIESSLER, ELISABETH OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	910 MAPLE STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
88736	Fee-for-Service	1689937344	1689937344	1	1	GONZALEZ, ERNESTO M MD	8/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137019	40	Pediatrics	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
88737	Fee-for-Service	1669433306	1669433306	1	1	GUPTA, VARUN MD INC	7/23/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	66812	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
88756	Fee-for-Service	1073660353	1073660353	1	1	GLENOAKS PODITARY GROUP	11/30/1990	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	844 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2134	19	06037	34.16065425	-118.2746063	Los Angeles County
88759	Fee-for-Service	1407301377	1407301377	1	1	GLASSBURG, NATALIE LMFT	6/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1819 CLIFF DR	F	SANTA BARBARA	CA	93109	1650	42	06083	34.40137954	-119.7214154	Santa Barbara County
88771	Fee-for-Service	1154480812	1154480812	1	1	GUO, ANDREW H MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81353	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
88785	Fee-for-Service	1992889976	1992889976	1	1	GANSEL, JOHN A MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	61907	20	Orthopedic Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
88808	Fee-for-Service	1699122630	1699122630	1	1	GREEN, TEDEAN K MD	9/2/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	171629	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
88822	Fee-for-Service	1649603499	1649603499	1	1	GHAZIZADEH, SHABNAM MD	10/18/2022	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	155697	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
88847	Fee-for-Service	1285262253	1285262253	1	1	GIDUMAL, SUNDER S MD	5/7/2025	No Taxonomy Provided	NA	None	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
88849	Fee-for-Service	1932601689	1932601689	1	1	GOHATA, ALYSSA LCSW	3/11/2025	No Taxonomy Provided	NA	None	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
88883	Fee-for-Service	1699047530	1699047530	1	1	GLASGOW, KRISTEN F OD	1/28/2019	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1104 PEAR TREE LN	None	NAPA	CA	94558	6446	28	06055	38.32088172	-122.2945763	Napa County
88890	Fee-for-Service	1922661024	1922661024	1	1	GARNICA ALBOR, MARIA G MD	6/17/2022	390200000X	NA	Other	026	PHYSICIANS	176765	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
88922	Fee-for-Service	1376703033	1376703033	1	2	GOMEZ GONZALEZ, MILEIDYS MD	11/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117697	08	Family Practice	0	In state provider	None	3000 EAST 1ST STREET	W1	LOS ANGELES	CA	90063	2807	19	06037	34.04032875	-118.2022726	Los Angeles County
88934	Fee-for-Service	1659531994	1659531994	1	1	GAVINO, ARIEL M MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118822	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
88996	Fee-for-Service	1750649471	1750649471	1	1	GUNNISON, KATHRYN M MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124321	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
89001	Fee-for-Service	1205873247	1205873247	1	1	GOUGH, 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	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	4802	00	None	43.654374	-116.694738	Canyon County
89002	Fee-for-Service	1740320811	1740320811	1	1	GORDON, PATRICIA S MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53353	30	Radiology	0	In state provider	None	150 N ROBERTSON BLVD	STE 160	BEVERLY HILLS	CA	90211	2197	19	06037	34.06812722	-118.3837146	Los Angeles County
89008	Fee-for-Service	1962680421	1962680421	1	19	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 535	MODESTO	CA	95350	4572	50	06099	37.666233	-120.993933	Stanislaus County
89024	Fee-for-Service	1811213697	1811213697	1	1	GULATI, SHUCHI MD	9/1/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	179177	None	None	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
89092	Fee-for-Service	1053324541	1053324541	1	1	GOMEZ-NARANJO, PATRICIA	8/1/1998	2084P0800X	NA	Psychiatry	026	PHYSICIANS	55544	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
89104	Fee-for-Service	1386604528	1386604528	1	1	GOULD, BETTE L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	50 CABRILLO HWY N	STE 4	HALF MOON BAY	CA	94019	6105	41	06081	37.46940881	-122.4343269	San Mateo County
89144	Fee-for-Service	1053071191	1053071191	1	1	GARRETT, ADAM NP	10/18/2023	363LF0000X	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
89195	Fee-for-Service	1447308341	1447308341	1	1	GUTIERREZ, DEBRA L MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75375	08	Family Practice	0	In state provider	None	731 S HIGHLAND AVE	None	FULLERTON	CA	92832	2753	30	06059	33.863598	-117.928718	Orange County
89206	Fee-for-Service	1740813799	1740813799	1	1	GINA MENDEZ A LICENSED CLINI	7/19/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CAL SOCIAL WORKER P.C.	28581 OLD TOWN FRONT ST	201	TEMECULA	CA	92590	2724	33	06065	33.49421281	-117.149836	Riverside County
89210	Fee-for-Service	1356945281	1356945281	1	1	GORDON, AMBER LCSW	7/24/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER 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
89211	Fee-for-Service	1932198249	1932198249	1	1	GREEN, ROBERT M MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73342	24	Plastic Surgery	0	In state provider	None	2324 23RD STREET	None	EUREKA	CA	95501	3231	12	06023	40.78684447	-124.143066	Humboldt County
89220	Fee-for-Service	1831359108	1831359108	1	1	GHAI, VIKAS MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123861	78	Neoplastic Diseases/Oncology	0	In state provider	None	2620 CHESTER AVE	None	BAKERSFIELD	CA	93301	2015	15	06029	35.383563	-119.018681	Kern County
89245	Fee-for-Service	1225875057	1225875057	1	1	GALICINAO, GARY 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
89254	Fee-for-Service	1255846093	1255846093	1	1	GOLDMAN, KIM PSYD	5/2/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	171 WINGFOOT WAY	None	APTOS	CA	95003	5429	44	06087	36.96263801	-121.8821884	Santa Cruz County
89295	Fee-for-Service	1962680421	1962680421	1	19	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 535	MODESTO	CA	95350	4572	50	06099	37.666233	-120.993933	Stanislaus County
89308	Fee-for-Service	1811902505	1811902505	1	1	GOPINATH, ARASU MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	IMC IP	5121 COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
89310	Fee-for-Service	1245261791	1245261791	1	1	GAMEZ, CORINNA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69057	36	Psychiatry	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
89367	Fee-for-Service	1396392247	1396392247	1	1	GOOD FAITH HOSPICE	10/10/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	315 W VERDUGO AVE	STE 103	BURBANK	CA	91502	2484	19	06037	34.17082135	-118.314366	Los Angeles County
89382	Fee-for-Service	1053324541	1053324541	1	1	GOMEZ-NARANJO, PATRICIA	8/1/1998	2084P0800X	NA	Psychiatry	026	PHYSICIANS	55544	26	Psychiatry (child)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
89392	Fee-for-Service	1407940224	1407940224	1	3	GASTROENTEROLOGY ASSOCIATES	12/16/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF THE EAST BAY MEDICAL	2400 BALFOUR RD	STE 230	BRENTWOOD	CA	94513	4957	07	06013	37.92519383	-121.734461	Contra Costa County
89445	Fee-for-Service	1518012079	1518012079	1	1	GROSS, DAVID M MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	29788	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
89471	Fee-for-Service	1699041566	1699041566	1	3	GARDNER FAMILY HEALTH	6/11/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3490 THE ALAMEDA	None	SANTA CLARA	CA	95050	4333	43	06085	37.35380924	-121.9418703	Santa Clara County
89493	Fee-for-Service	1932578028	1932578028	1	4	GASTROINTESTINAL AND LIVER C	5/1/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	ONSULTANTS INC.	5455 GARDEN GROVE BLVD	230	WESTMINSTER	CA	92683	1891	30	06059	33.77309896	-118.0351106	Orange County
89508	Fee-for-Service	1831359108	1831359108	1	1	GHAI, VIKAS MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123861	68	Hematology	0	In state provider	None	2620 CHESTER AVE	None	BAKERSFIELD	CA	93301	2015	15	06029	35.383563	-119.018681	Kern County
89538	Fee-for-Service	1306002761	1306002761	1	1	GHANDEHARI, JAVID MD	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127144	01	General Practice	0	In state provider	None	15525 POMERADO ROAD	SUITE E6	POWAY	CA	92064	2427	37	06073	32.99479918	-117.0579468	San Diego County
89558	Fee-for-Service	1720251440	1720251440	1	1	GIBRALTAR HOME HEALTH SRVC	7/22/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	22141 VENTURA BLVD	SUITE 300	WOODLAND HILLS	CA	91364	5734	19	06037	34.16866225	-118.6095572	Los Angeles County
89569	Fee-for-Service	1518717982	1518717982	1	1	GONZALEZ, SHEILA NP	10/11/2024	163WG0000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2222 S MAIN ST	None	SANTA ANA	CA	92707	3220	30	06059	33.717168	-117.867929	Orange County
89573	Fee-for-Service	1487660635	1487660635	1	1	GRAF, JONATHAN D MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68479	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
89578	Fee-for-Service	1659667293	1659667293	1	1	GRACE, MIRA MD	2/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127197	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
89588	Fee-for-Service	1942360367	1942360367	1	1	GOUWNES, HANS	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
89598	Fee-for-Service	1730718909	1730718909	1	1	GRIER, DANIEL A MD	8/19/2024	207L00000X	NA	Other	026	PHYSICIANS	188878	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
89632	Fee-for-Service	1548999071	1548999071	1	1	GUINOO, RYAN C CRNA	11/15/2022	163W00000X	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
89651	Fee-for-Service	1366634156	1366634156	1	1	GUAN, YI MD	1/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102084	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
89654	Fee-for-Service	1396392247	1396392247	1	1	GOOD FAITH HOSPICE	10/10/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	315 W VERDUGO AVE	STE 103	BURBANK	CA	91502	2484	19	06037	34.17082135	-118.314366	Los Angeles County
89728	Fee-for-Service	1285836619	1285836619	1	1	GEIGER, GEOFFREY MD	3/8/2024	2085R0001X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	10226 LAKEWOOD BLVD	None	DOWNEY	CA	90241	2874	19	06037	33.9465855	-118.1175703	Los Angeles County
89730	Fee-for-Service	1215322433	1215322433	1	1	GARG, DAVE K MD	6/17/2021	207R00000X	NA	Other	026	PHYSICIANS	145372	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
89732	Fee-for-Service	1275574253	1275574253	1	1	GROSSMAN, JAY R MD	2/1/1982	207N00000X	NA	Dermatology	026	PHYSICIANS	27789	07	Dermatology	0	In state provider	None	3231 WARING CT	STE M	OCEANSIDE	CA	92056	4510	37	06073	33.18776771	-117.2893136	San Diego County
89733	Fee-for-Service	1518012079	1518012079	1	1	GROSS, DAVID M MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	29788	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
89743	Fee-for-Service	1174042329	1174042329	1	1	GUEST, KIRSTEN LPCC	2/10/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
89754	Fee-for-Service	1922095132	1922095132	1	1	GO, MARIA R MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79468	41	Internal Medicine	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
89760	Fee-for-Service	1699041566	1699041566	1	3	GARDNER FAMILY HEALTH	6/11/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3490 THE ALAMEDA	None	SANTA CLARA	CA	95050	4333	43	06085	37.35380924	-121.9418703	Santa Clara County
89816	Fee-for-Service	1578083929	1578083929	1	1	GHEVARIYA, SARA DO	5/6/2024	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	22799	15	Obstetrics (D.O. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
89836	Fee-for-Service	1609334499	1609334499	1	1	GIUS, LAUREN K	10/8/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11100 COLOMA RD	None	RANCHO CORDOVA	CA	95670	2804	34	06067	38.616606	-121.271949	Sacramento County
89839	Fee-for-Service	1245239326	1245239326	1	1	GREGORY KRYNSKI,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
89851	Fee-for-Service	1184003840	1184003840	1	1	GUAIQUIL, PATRICIO DO	4/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17418	None	None	0	In state provider	None	10225 AUSTIN DR	STE 101	SPRING VALLEY	CA	91978	1521	37	06073	32.73081646	-116.9707735	San Diego County
89872	Fee-for-Service	1093052706	1093052706	1	1	GUARDIAN ANGELS MEDICAL	8/29/2014	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLY	222 I STREET	SUITE B	LOS BANOS	CA	93635	4132	24	06047	37.06321772	-120.852957	Merced County
89933	Fee-for-Service	1134680499	1134680499	1	1	GEMMELL, CONNOR C MD	8/9/2022	390200000X	NA	Other	026	PHYSICIANS	176828	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
89954	Fee-for-Service	1497897656	1497897656	1	1	GEANTA, ALICE C	6/24/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	320 STORKE ROAD,	SUITE 101	SANTA BARBARA	CA	93117	0001	42	06083	34.42750357	-119.8695671	Santa Barbara
89994	Fee-for-Service	1649243130	1649243130	1	1	GARGYA, SUKUMAR C 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
90054	Fee-for-Service	1447301833	1447301833	1	1	GIRGIS, BAHAA B MD INC	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64665	41	Internal Medicine	0	In state provider	None	9194 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3802	33	06065	33.92351463	-117.4408298	Riverside County
90091	Fee-for-Service	1003304833	1003304833	1	1	GHOBRIAL, MINA K MD	1/9/2024	207P00000X	NA	Other	026	PHYSICIANS	192546	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
90096	Fee-for-Service	1912269408	1912269408	1	2	GRIFFIN, CAROL E DO	9/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16542	15	Obstetrics (D.O. only)	0	In state provider	None	2505 LUCAS STREET	SUITE B	EUREKA	CA	95501	4436	12	06023	40.79130448	-124.139304	Humboldt County
90103	Fee-for-Service	1336227917	1336227917	1	1	GUERRERO, LUZ D MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67073	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
90198	Fee-for-Service	1831562495	1831562495	1	1	GONZALEZ, JASMINE LCSW	8/1/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
90212	Fee-for-Service	1134533177	1134533177	1	1	GREEN, ALEXANDRA E MD	8/1/2018	207P00000X	NA	Other	026	PHYSICIANS	155331	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
90235	Fee-for-Service	1699169599	1699169599	1	1	GRANSTEIN, JUSTIN H MD	8/2/2021	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	172111	None	None	0	In state provider	None	101 CITY DR S	STE 313	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
90238	Fee-for-Service	1922097203	1922097203	1	1	GATYNYA, PAVEL V MD	3/24/2008	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
90241	Fee-for-Service	1922243401	1922243401	1	1	GUPTA, MONIKA A MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91519	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
90247	Fee-for-Service	1932612025	1932612025	1	1	GILLISPIE, MARK S MD	9/1/2022	207P00000X	NA	Other	026	PHYSICIANS	178118	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
90272	Fee-for-Service	1720288681	1720288681	1	1	GIBSON, JOHN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
90334	Fee-for-Service	1043344864	1043344864	1	1	GADSON, CHARITA N	5/22/2023	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
90338	Fee-for-Service	1396745659	1396745659	1	1	GRANDT, VICTOR K DPM	1/9/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	308 S JOHNSON ST	None	VISALIA	CA	93291	6136	54	06107	36.327753	-119.298636	Tulare County
90365	Fee-for-Service	1619279213	1619279213	1	1	GAZARIAN, AIK MD	4/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114703	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
90377	Fee-for-Service	1851461248	1851461248	1	1	GASMAN, MICHAEL A MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	67965	05	Anesthesiology	0	In state provider	None	2365 DREAM ST	None	REDDING	CA	96001	5938	45	06089	40.56504371	-122.413748	Shasta County
90403	Fee-for-Service	1023594546	1023594546	1	1	GONZALES, JULIEANN NP	6/5/2019	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
90417	Fee-for-Service	1356503775	1356503775	1	1	GEANNETTE, CHRISTIAN S MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130478	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	6075	19	06037	34.06373445	-118.443537	Los Angeles County
90440	Fee-for-Service	1497970115	1497970115	1	2	GROVER, RAHUL INC	3/17/2008	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	65 N MADISON AVE	STE 304	PASADENA	CA	91101	2050	19	06037	34.14705803	-118.1384317	Los Angeles County
90496	Fee-for-Service	1548243033	1548243033	1	1	GRAVES, GREGORY M MD	12/31/1979	208600000X	NA	General Surgery	026	PHYSICIANS	30037	02	General Surgery	0	In state provider	None	2800 L ST	STE 200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
90497	Fee-for-Service	1447243506	1447243506	1	1	GORDON, LINDA M MD	3/28/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	72164	30	Radiology	0	In state provider	None	3012 SUMMIT ST	FL 3	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
90505	Fee-for-Service	1982305611	1982305611	1	1	GITONGA, PETRONILLA MUKUBA	3/23/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7393 RIVER GLEN DR	None	JURUPA VALLEY	CA	92509	3457	33	06065	34.00809672	-117.4440475	Riverside County
90547	Fee-for-Service	1154638740	1154638740	1	1	GAUNTLETT, KIMBERLY A PSYD	3/14/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	657 CONNIE ST	None	SANTA ROSA	CA	95407	6267	49	06097	38.40606	-122.709978	Sonoma County
90555	Fee-for-Service	1760426464	1760426464	1	1	GOLDBERG, STEVEN M MD	3/1/1989	207P00000X	NA	Other	026	PHYSICIANS	31613	None	None	0	In state provider	None	13361 LARAMORE LN	None	GARDEN GROVE	CA	92843	2224	30	06059	33.77348478	-117.8965289	Orange County
90623	Fee-for-Service	1679078620	1679078620	1	1	GRAY, ZACHARY A MD	5/20/2021	207R00000X	NA	Other	026	PHYSICIANS	163938	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
90631	Fee-for-Service	1679037691	1679037691	1	1	GRESHAM, ADAM RCP	2/24/2019	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
90719	Fee-for-Service	1437791043	1437791043	1	1	GOLDEN AGE HOSPICE INC	2/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8315 FOOTHILL BLVD	B	SUNLAND	CA	91040	2877	19	06037	34.2597215	-118.313874	Los Angeles County
90740	Fee-for-Service	1407472483	1407472483	1	1	GILBERT, CHERYL L LMFT	4/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2023 RANCHO CORTE	None	VISTA	CA	92084	2585	37	06073	33.23138118	-117.2441158	San Diego County
90742	Fee-for-Service	1962580589	1962580589	1	1	GRANICH, RUSS D MD	6/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	50400	41	Internal Medicine	0	In state provider	None	1001 SNEATH LN	STE 204	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
90744	Fee-for-Service	1962680421	1962680421	1	2	GOLDEN VALLEY HEALTH CENTERS	11/27/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	209 KERR AVE	None	MODESTO	CA	95354	3808	50	06099	37.63667913	-120.9714031	Stanislaus County
90758	Fee-for-Service	1710941729	1710941729	1	1	GOETZ, LAURA H MD	6/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86535	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
90793	Fee-for-Service	1982305611	1982305611	1	1	GITONGA, PETRONILLA MUKUBA	3/23/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7393 RIVER GLEN DR	None	JURUPA VALLEY	CA	92509	3457	33	06065	34.00809672	-117.4440475	Riverside County
90850	Fee-for-Service	1295917060	1295917060	1	1	GILBERT, LAURA M LMFT	6/12/2020	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
90878	Fee-for-Service	1518228642	1518228642	1	1	GARCIA, MICHELLE G PSYD	3/17/2021	103TF0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SY.D.	715 N. CENTRAL AVE.	108	GLENDALE	CA	91203	4262	19	06037	34.15695962	-118.2580155	Los Angeles County
90892	Fee-for-Service	1558306449	1558306449	1	1	GARFIELD BEACH CVS, LLC	2/19/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1382 N. MOORPARK ROAD	None	THOUSAND OAKS	CA	91360	5224	56	06111	34.19773926	-118.8697889	Ventura County
90898	Fee-for-Service	1659818425	1659818425	1	1	GARFIELD BEACH CVS LLC	3/13/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3033 HUNTINGTON DR	None	PASADENA	CA	91107	5516	19	06037	34.12762758	-118.0893449	Los Angeles County
90919	Fee-for-Service	1255918769	1255918769	1	1	GONDY, KEERTHI	4/30/2025	No Taxonomy Provided	NA	None	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
90954	Fee-for-Service	1083636690	1083636690	2	1	GARFIELD BEACH CVS LLC	5/24/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1057 EASTSHORE HWY	None	ALBANY	CA	94710	1011	01	06001	37.88252873	-122.3078464	Alameda County
90957	Fee-for-Service	1841463346	1841463346	1	1	GRAHAM, LESLIE E MD	1/1/1994	207P00000X	NA	Other	026	PHYSICIANS	76651	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
91008	Fee-for-Service	1437791043	1437791043	1	1	GOLDEN AGE HOSPICE INC	2/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8315 FOOTHILL BLVD	B	SUNLAND	CA	91040	2877	19	06037	34.2597215	-118.313874	Los Angeles County
91011	Fee-for-Service	1326065046	1326065046	1	1	GIZZI, ELIO L MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54952	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
91033	Fee-for-Service	1962680421	1962680421	1	2	GOLDEN VALLEY HEALTH CENTERS	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	209 KERR AVE	None	MODESTO	CA	95354	3808	50	06099	37.63667913	-120.9714031	Stanislaus County
91036	Fee-for-Service	1700335742	1700335742	1	1	GARCIA, ADRIANA LMFT	4/4/2022	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
91041	Fee-for-Service	1447482096	1447482096	1	1	GILL, AMMARA T MD	10/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154333	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
91051	Fee-for-Service	1013088830	1013088830	1	1	GRAHAM, VIRGIL L MD	5/20/2009	282N00000X	NA	Hospitals	026	PHYSICIANS	59523	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
91066	Fee-for-Service	1528358215	1528358215	1	1	GIN, BRIAN C MD	5/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124293	40	Pediatrics	0	In state provider	None	2200 OFARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
91100	Fee-for-Service	1902667900	1902667900	1	1	GONZALEZ, AMANDA	4/5/2024	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
91122	Fee-for-Service	1164414017	1164414017	1	1	GANELLEN,EDWARD 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	1160 E 3900 S	STE 2000	SALT LAKE CITY	UT	84124	0000	00	None	40.68703647	-111.85785	Salt Lake County
91146	Fee-for-Service	1225688138	1225688138	1	1	GARFIELD BEACH CVS LLC	1/23/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 WILSHIRE BLVD	None	SANTA MONICA	CA	90401	0000	19	06037	34.02003788	-118.4971275	Los Angeles County
91155	Fee-for-Service	1720147317	1720147317	1	1	GALINDO, SONIA MD	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52524	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
91170	Fee-for-Service	1508884008	1508884008	1	1	GHAZAL, ELIZABETH A MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73945	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
91171	Fee-for-Service	1750784245	1750784245	1	1	GRODZICKI, LINDSEY N LMFT	10/18/2021	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
91185	Fee-for-Service	1972766848	1972766848	1	1	GRAY, CAROLYNN PSYD	5/6/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
91194	Fee-for-Service	1366514655	1366514655	1	1	GONZALEZ, EDGARDO M MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	53693	08	Family Practice	0	In state provider	None	6301 BEACH BLVD	STE 111	BUENA PARK	CA	90621	4030	30	06059	33.86880928	-117.9983013	Orange County
91221	Fee-for-Service	1558042358	1558042358	1	1	GALEN INPATIENT PHYSICIANS P	9/18/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
91269	Fee-for-Service	1013221233	1013221233	1	1	GIRARDEY, BRIGETTE LMFT	3/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
91322	Fee-for-Service	1962680421	1962680421	1	2	GOLDEN VALLEY HEALTH CENTERS	5/22/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	209 KERR AVE	None	MODESTO	CA	95354	3808	50	06099	37.63667913	-120.9714031	Stanislaus County
91327	Fee-for-Service	1447482096	1447482096	1	1	GILL, AMMARA T MD	10/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154333	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
91328	Fee-for-Service	1376587642	1376587642	1	1	GARFIELD BEACH CVS LLC	1/19/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12101 CENTRAL AVE	None	CHINO	CA	91710	2421	36	06071	34.03321759	-117.6893711	San Bernardino County
91338	Fee-for-Service	1255727459	1255727459	1	1	GUPTA, ANU MD	6/26/2020	390200000X	NA	Other	026	PHYSICIANS	153274	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
91358	Fee-for-Service	1477594380	1477594380	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	645 E PALOMAR ST	None	CHULA VISTA	CA	91911	6974	37	06073	32.61446195	-117.0260102	San Diego County
91363	Fee-for-Service	1104879014	1104879014	1	1	GOLTZ, DAVID H	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85091	None	None	0	In state provider	None	1341 S ELISEO DR	None	GREENBRAE	CA	94904	2000	21	06041	37.9449045	-122.537105	Marin County
91395	Fee-for-Service	1326019332	1326019332	1	1	GEORGE POLANCO DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE GENESYS PARKWAY	None	GRAND BLANC	MI	48439	8065	00	None	42.89245321	-83.64137612	Genesee County
91413	Fee-for-Service	1285697862	1285697862	1	1	GRIFFIN, WARREN 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	2478 13TH ST SE	None	SALEM	OR	97302	2546	00	None	44.917146	-123.0289425	Marion County
91422	Fee-for-Service	1902448368	1902448368	1	1	GREAT VALLEY HOME HEALTH LLC	12/8/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2730 NAGLEE RD	SUITE 200	TRACY	CA	95304	7309	39	06077	37.75668399	-121.4628701	San Joaquin County
91479	Fee-for-Service	1366514655	1366514655	1	1	GONZALEZ, EDGARDO M MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	53693	41	Internal Medicine	0	In state provider	None	6301 BEACH BLVD	STE 111	BUENA PARK	CA	90621	4030	30	06059	33.86880928	-117.9983013	Orange County
91491	Fee-for-Service	1578520904	1578520904	1	1	GLEN FORREST HUFF, 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
91500	Fee-for-Service	1457471567	1457471567	1	1	GRUBER, TANJA A MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89115	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
91502	Fee-for-Service	1871511139	1871511139	1	1	GOLLOBER, MARCIA J MD	7/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64012	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
91531	Fee-for-Service	1831271790	1831271790	1	1	GOMEZ, ESTEBAN M MD	12/15/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40128	01	General Practice	0	In state provider	None	5101 FLORENCE AVE	STE 7	BELL	CA	90201	3801	19	06037	33.96904913	-118.1757922	Los Angeles County
91534	Fee-for-Service	1083810857	1083810857	1	1	GLADMAN, AARON C MD	12/3/2007	207P00000X	NA	Other	026	PHYSICIANS	96594	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
91537	Fee-for-Service	1487230447	1487230447	1	1	GROS, ENIOLA C MD	4/4/2024	207P00000X	NA	Other	026	PHYSICIANS	None	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
91559	Fee-for-Service	1497924823	1497924823	1	1	GREAT EXPECTATIONS SERVICES	6/19/2003	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	305 CARLSON CT	None	VISTA	CA	92083	5137	37	06073	33.192549	-117.287193	San Diego County
91569	Fee-for-Service	1528324043	1528324043	1	1	GALAN, TIMOTHY MD	9/20/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	127406	20	Orthopedic Surgery	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
91590	Fee-for-Service	1699730416	1699730416	1	1	GROPPER, MICHAEL A MD	10/1/1995	207LC0200X	NA	Other	026	PHYSICIANS	71217	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
91616	Fee-for-Service	1447482096	1447482096	1	1	GILL, AMMARA T MD	10/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154333	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
91632	Fee-for-Service	1710929179	1710929179	1	1	GARBIN, GREGORY S	5/31/1990	207L00000X	NA	Other	026	PHYSICIANS	63967	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
91659	Fee-for-Service	1962554360	1962554360	1	1	GEHRIG, TED 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
91690	Fee-for-Service	1730322462	1730322462	1	1	GIBB, ELIZABETH R MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107119	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
91691	Fee-for-Service	1275985582	1275985582	1	1	GUILLEN MEZA, MARICELA	11/4/2024	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
91699	Fee-for-Service	1568571206	1568571206	1	1	GUNDUPALLI, ANITHA MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55904	41	Internal Medicine	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
91704	Fee-for-Service	1619093853	1619093853	1	1	GUIMET, MOISES	6/14/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	12001 W WASHINGTON BLVD	None	LOS ANGELES	CA	90066	5801	19	06037	33.99760695	-118.4228296	Los Angeles County
91735	Fee-for-Service	1952781379	1952781379	1	1	GYORFFY, JANELLE MD	12/29/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	185220	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
91772	Fee-for-Service	1881661536	1881661536	1	1	GUILLINTA, PAULO MD	9/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74999	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	480 4TH AVE	STE 401	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
91787	Fee-for-Service	1083762983	1083762983	1	1	GENOVESE, MATTHEW A MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66908	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
91815	Fee-for-Service	1386739605	1386739605	1	1	GREEN, DOUGLAS W MD	10/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90305	02	General Surgery	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
91832	Fee-for-Service	1922532720	1922532720	1	1	GROHMANN, ALEXANDER MD	1/1/2020	207P00000X	NA	Other	026	PHYSICIANS	158886	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
91857	Fee-for-Service	1003113705	1003113705	1	1	GRANADA REHABILITATION &	4/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER LP	2885 HARRIS ST	None	EUREKA	CA	95503	4808	12	06023	40.78053262	-124.1353699	Humboldt County
91874	Fee-for-Service	1669545901	1669545901	1	1	GOLDBERG, CORY S MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97840	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
91885	Fee-for-Service	1942449558	1942449558	1	1	GADDI, ANTHONY P MD	3/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115847	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
91892	Fee-for-Service	1790799849	1790799849	1	1	GUIDICI, SUSAN E CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6880 PALM AVE	None	SEBASTOPOL	CA	95472	4270	49	06097	38.39599965	-122.8192479	Sonoma County
91908	Fee-for-Service	1750301644	1750301644	1	1	GARCIA, MARIA C MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61586	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
91917	Fee-for-Service	1487745808	1487745808	1	1	GRUBA, MICHAEL J MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108707	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
91919	Fee-for-Service	1649358227	1649358227	1	1	GUNTER, JENNIFER MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52149	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
91930	Fee-for-Service	1922048974	1922048974	1	1	GUNN, JOHN L MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83492	18	Ophthalmology	0	In state provider	None	14914 SHERMAN WAY	None	VAN NUYS	CA	91405	2113	19	06037	34.20110364	-118.458051	Los Angeles County
91938	Fee-for-Service	1366090466	1366090466	1	1	GOLDEN AGE HOSPICE CARE INC	2/21/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5311 TOPANGA CANYON	STE 305	WOODLAND HILLS	CA	91364	1754	19	06037	34.166313	-118.6059365	Los Angeles County
91962	Fee-for-Service	1316992811	1316992811	1	1	GELBMAN, ANDREW	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
91966	Fee-for-Service	1588192181	1588192181	1	1	GHAFFARI, AMIR A MD	4/9/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
91967	Fee-for-Service	1083761142	1083761142	1	1	GEORGE, TRACY I MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62223	22	Pathology (M.D. only)	0	In state provider	None	134 NELSON ST	STE A	ARROYO GRANDE	CA	93420	3386	40	06079	35.12233737	-120.576558	San Luis Obispo County
91975	Fee-for-Service	1730322462	1730322462	1	1	GIBB, ELIZABETH R MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107119	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
92033	Fee-for-Service	1164930640	1164930640	1	1	GAMBETTI, ALICIA NP	4/15/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
92058	Fee-for-Service	1881661536	1881661536	1	1	GUILLINTA, PAULO MD	9/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74999	41	Internal Medicine	0	In state provider	None	480 4TH AVE	STE 401	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
92125	Fee-for-Service	1548259229	1548259229	1	1	GOES, NELSON B MD	8/28/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
92153	Fee-for-Service	1427508241	1427508241	1	1	GOMEZ, ULYSSES MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145425	01	General Practice	0	In state provider	None	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	49	06097	38.26876442	-122.6598332	Sonoma County
92163	Fee-for-Service	1669545901	1669545901	1	1	GOLDBERG, CORY S MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97840	24	Plastic 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
92208	Fee-for-Service	1659344232	1659344232	1	1	GELLER, MICHELLE MD	2/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79993	41	Internal Medicine	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
92215	Fee-for-Service	1831532092	1831532092	1	1	GRAHAM, JESSICA L PT	8/13/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	500 LIGHTHOUSE AVE.	SUITE B	MONTEREY	CA	93940	1423	27	06053	36.61269281	-121.9009435	Monterey County
92222	Fee-for-Service	1386160703	1386160703	1	1	GHC OF AUBURN LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11600 EDUCATION ST	None	AUBURN	CA	95603	2468	31	06061	38.94384696	-121.1061469	Placer County
92225	Fee-for-Service	1366090466	1366090466	1	1	GOLDEN AGE HOSPICE CARE INC	2/21/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5311 TOPANGA CANYON	STE 305	WOODLAND HILLS	CA	91364	1754	19	06037	34.166313	-118.6059365	Los Angeles County
92252	Fee-for-Service	1588192181	1588192181	1	1	GHAFFARI, AMIR A MD	4/9/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	100 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
92261	Fee-for-Service	1508240458	1508240458	1	1	GILL, LIZA MD	7/2/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	159076	07	Dermatology	0	In state provider	None	200 UCLA MEDICAL PLZ	BLDG 465	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
92306	Fee-for-Service	1790888998	1790888998	1	1	GIBSON, AMANDA D LCSW	7/11/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2617 K ST	SUITE 125	SACRAMENTO	CA	95816	5133	34	06067	38.573595	-121.4715825	Sacramento County
92314	Fee-for-Service	1578101978	1578101978	1	1	GOLDEN LIFE HOME HEALTH INC	5/12/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7301 TOPANGA CANYON BLVD	#355	CANOGA PARK	CA	91303	7301	19	06037	34.203222	-118.605988	Los Angeles County
92327	Fee-for-Service	1144284373	1144284373	2	7	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	587 RIO LINDO AVE	None	CHICO	CA	95926	1816	04	06007	39.75444405	-121.848431	Butte County
92362	Fee-for-Service	1629874367	1629874367	1	1	GUTIERREZ, CARINA A DOULA	5/5/2025	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	34	06067	0	0	None
92384	Fee-for-Service	1407247505	1407247505	1	1	GUADIAN, NIDIA A NP	1/19/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4950 SUNSET BLVD	None	LOS ANGELES	CA	90027	5822	19	06037	34.09812092	-118.2980246	Los Angeles County
92387	Fee-for-Service	1922439116	1922439116	1	1	GARFIELD BEACH CVS LLC	6/18/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5837 S CENTRAL AVE	None	LOS ANGELES	CA	90001	1127	19	06037	33.988806	-118.256486	Los Angeles County
92485	Fee-for-Service	1477574937	1477574937	1	1	GERSTBACHER, DANA M MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92080	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
92504	Fee-for-Service	1598840191	1598840191	1	1	GARY B WATTS MD	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3535 S I 35 E	None	DENTON	TX	76210	6850	00	None	33.177906	-97.091271	Denton County
92505	Fee-for-Service	1811347040	1811347040	1	1	GRIGGS, RYAN P DO	8/9/2022	208800000X	NA	Other	026	PHYSICIANS	19362	None	None	0	In state provider	None	355 ABBOTT ST STE 201	STE 201	SALINAS	CA	93901	4483	27	06053	36.66552031	-121.6439174	Monterey County
92509	Fee-for-Service	1700370442	1700370442	1	1	GILL, ADITYA MD	9/2/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	177955	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
92516	Fee-for-Service	1801858451	1801858451	1	1	GILMORE, MICHAEL J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66073	08	Family Practice	0	In state provider	None	1320 MARICOPA HWY	STE A	OJAI	CA	93023	3154	56	06111	34.44248874	-119.2654707	Ventura County
92525	Fee-for-Service	1750312021	1750312021	1	1	GOLDMAN,JANET M MD	7/11/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63338	None	None	0	In state provider	None	300 PASTEUR DR	# A200	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
92547	Fee-for-Service	1508240458	1508240458	1	1	GILL, LIZA MD	7/2/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	159076	41	Internal Medicine	0	In state provider	None	200 UCLA MEDICAL PLZ	BLDG 465	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
92572	Fee-for-Service	1518463777	1518463777	1	1	GASPARIAN, GREGORY G MD	8/21/2024	207L00000X	NA	Other	026	PHYSICIANS	163641	05	Anesthesiology	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
92594	Fee-for-Service	1629625439	1629625439	1	1	GILGER, MARISSA M AU	2/8/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
92607	Fee-for-Service	1396884326	1396884326	1	1	GREGORY, GINA M DO	1/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10718	08	Family Practice	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
92616	Fee-for-Service	1144284373	1144284373	2	7	GARRETSON, CHARLES A MD	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	41	Internal Medicine	0	In state provider	None	587 RIO LINDO AVE	None	CHICO	CA	95926	1816	04	06007	39.75444405	-121.848431	Butte County
92620	Fee-for-Service	1104589506	1104589506	1	1	GRANT SERENITY HOMES	9/10/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OF SF VALLEY	6928 PEACH AVE	None	VAN NUYS	CA	91406	5230	19	06037	34.19650389	-118.4683603	Los Angeles County
92631	Fee-for-Service	1235456781	1235456781	1	1	GERSTEIN, BENJAMIN A	12/27/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
92644	Fee-for-Service	1801868112	1801868112	1	1	GRAHAM, STEPHEN L MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	33123	45	Nephrology (Renal-Kidney)	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
92674	Fee-for-Service	1912942095	1912942095	1	1	GALICIA, ANTHONY R MD	12/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74340	25	Physical Medicine and Rehabilitation	0	In state provider	None	631 E ALVIN DR	None	SALINAS	CA	93906	3056	27	06053	36.7035675	-121.6319376	Monterey County
92685	Fee-for-Service	1649605635	1649605635	1	1	GRAHAM, WILLIE J	11/18/2013	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
92704	Fee-for-Service	1487701264	1487701264	1	1	GIRI, VASANTA V MD	2/23/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	34106	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
92781	Fee-for-Service	1679598866	1679598866	1	1	GALENS,STEPHEN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PULMONARY CRITICAL CARE	50505 SCHOENHERR ROAD	STE 290	SHELBY TOWNSHIP	MI	48315	3141	00	None	42.6672	-82.998144	Macomb County
92795	Fee-for-Service	1376868323	1376868323	1	1	GARCIA, STEVEN M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129885	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
92820	Fee-for-Service	1962680421	1962680421	1	1	GOLDEN VALLEY HEALTH CENTERS	4/3/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2101 TENAYA DR	None	MODESTO	CA	95354	3930	50	06099	37.6324545	-120.956463	Stanislaus County
92859	Fee-for-Service	1497962286	1497962286	1	1	GUPTA, PUNEET MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135387	41	Internal Medicine	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
92895	Fee-for-Service	1396884326	1396884326	1	1	GREGORY, GINA M DO	1/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10718	01	General Practice	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
92928	Fee-for-Service	1578902052	1578902052	1	1	GRASSINGER, MARK W LCSW	6/25/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
92929	Fee-for-Service	1801868112	1801868112	1	1	GRAHAM, STEPHEN L MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	33123	41	Internal Medicine	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
92944	Fee-for-Service	1689640179	1689640179	1	1	GREGG, LAURIE C MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	75115	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2277 FAIR OAKS BLVD	STE 355	SACRAMENTO	CA	95825	5595	34	06067	38.575404	-121.4121195	Sacramento County
92949	Fee-for-Service	1689094492	1689094492	1	1	GOMBAR, SAURABH MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138842	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
92955	Fee-for-Service	1124106828	1124106828	1	1	GYLLING, SCOTT F MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	47700	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
93021	Fee-for-Service	1902828502	1902828502	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3245 SPORTS ARENA BLVD	None	SAN DIEGO	CA	92110	4529	37	06073	32.751621	-117.2113875	San Diego County
93061	Fee-for-Service	1760740385	1760740385	1	1	GRABENAUER, LEAH M MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120577	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
93076	Fee-for-Service	1699987040	1699987040	1	1	GUERRERO, PATRICK E DO	7/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10352	20	Orthopedic Surgery	0	In state provider	None	1801 COLORADO AVE	STE 250	TURLOCK	CA	95382	2710	50	06099	37.50941613	-120.8353105	Stanislaus County
93079	Fee-for-Service	1760952683	1760952683	1	1	GRAYSON, NICOLE C LMFT	3/18/2024	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
93087	Fee-for-Service	1275772386	1275772386	1	1	GOMEZ, GIANCARLO MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114938	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
93088	Fee-for-Service	1588667109	1588667109	1	1	GEORGETTA BIDWELL 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	4502 W INDIAN SCHOOL RD	None	PHOENIX	AZ	85031	2800	00	None	33.495489	-112.1565735	Maricopa County
93108	Fee-for-Service	1962680421	1962680421	1	1	GOLDEN VALLEY HEALTH CENTERS	4/3/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2101 TENAYA DR	None	MODESTO	CA	95354	3930	50	06099	37.6324545	-120.956463	Stanislaus County
93126	Fee-for-Service	1821010463	1821010463	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7530 ORANGETHORPE AVE	None	BUENA PARK	CA	90621	3429	30	06059	33.85894048	-118.001682	Orange County
93189	Fee-for-Service	1215382197	1215382197	1	1	GILL, MANPREET K MD	6/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160364	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
93205	Fee-for-Service	1326063355	1326063355	1	1	GINIEWICZ, ELAINE M PSY	9/19/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
93206	Fee-for-Service	1467864363	1467864363	1	1	GUPTA, SHILPI MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145036	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
93207	Fee-for-Service	1699728410	1699728410	1	1	GHODSIAN, SHAHRIAR MD	3/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	72696	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1100 LAS TABLAS ROAD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
93277	Fee-for-Service	1598109704	1598109704	1	1	GUPTA, PRITIKA MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143406	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
93283	Fee-for-Service	1548674187	1548674187	1	1	GILLESPIE, KAYLA OT	12/14/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
93327	Fee-for-Service	1588600878	1588600878	1	1	GERMAN, MICHAEL S.	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	43102	67	Endocrinology	0	In state provider	5TH FLR.	400 PARNASSUS AVE	APT 591	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
93344	Fee-for-Service	1366738692	1366738692	1	1	GEMIL, HATIM O MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
93371	Fee-for-Service	1770993370	1770993370	1	1	GATEWAY MEDICAL SERVICES, IN	1/14/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9461 DESCHUTES RD	UNIT 4	PALO CEDRO	CA	96073	9761	45	06089	40.562523	-122.238633	Shasta County
93397	Fee-for-Service	1962680421	1962680421	1	1	GOLDEN VALLEY HEALTH CENTERS	3/30/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2101 TENAYA DR	None	MODESTO	CA	95354	3930	50	06099	37.6324545	-120.956463	Stanislaus County
93405	Fee-for-Service	1730345158	1730345158	1	1	GANGALE, SARAH B PSYD	1/4/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	26742	-	NOT APPLICABLE	0	In state provider	None	815 BUENA VISTA WEST	None	SAN FRANCISCO	CA	94117	4108	38	06075	37.76921703	-122.4429461	San Francisco County
93406	Fee-for-Service	1750469458	1750469458	1	1	GENTEMANN, REBECCA L MD	9/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82845	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
93462	Fee-for-Service	1366658411	1366658411	1	1	GUPTA, RAJNISH A MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92250	07	Dermatology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
93464	Fee-for-Service	1871877746	1871877746	1	1	GARCIA-IXCOL, JULIA LMFT	7/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
93489	Fee-for-Service	1053325530	1053325530	1	1	GARVER, DAVID R MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	46828	None	None	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
93514	Fee-for-Service	1164558235	1164558235	1	1	GREENE, VALINDA L PHD	10/1/1996	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5360 JACKSON DR	STE 112	LA MESA	CA	91942	3012	37	06073	32.77680573	-117.0176327	San Diego County
93518	Fee-for-Service	1861808644	1861808644	1	1	GRAICHEN, CARLA C MD	9/14/2022	207P00000X	NA	Other	026	PHYSICIANS	181051	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
93530	Fee-for-Service	1295864890	1295864890	1	1	GAYED, OSAMA	9/8/1994	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	500 W WILLOW ST	STE 7	LONG BEACH	CA	90806	2831	19	06037	33.80431447	-118.198602	Los Angeles County
93537	Fee-for-Service	1780837559	1780837559	1	1	GOLD, SUSAN L PHD	5/24/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15767	-	NOT APPLICABLE	0	In state provider	None	1904 RICHLAND AVE	None	CERES	CA	95307	9440	50	06099	37.60031128	-120.9658226	Stanislaus County
93547	Fee-for-Service	1528021235	1528021235	1	1	GREGOR, PETER W MD	4/1/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	39417	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
93575	Fee-for-Service	1942836952	1942836952	1	1	GALI, HELENA E MD	4/4/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	187514	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
93595	Fee-for-Service	1851082267	1851082267	1	1	GASTROENTEROLOGY MEDICAL PRA	8/28/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	R HEALTH CLINIC	6927 BROCKTON AVE	SUITE 2A	RIVERSIDE	CA	92506	3805	33	06065	33.948063	-117.396776	Riverside County
93615	Fee-for-Service	1588600878	1588600878	1	1	GERMAN, MICHAEL S.	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	43102	41	Internal Medicine	0	In state provider	5TH FLR.	400 PARNASSUS AVE	APT 591	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
93618	Fee-for-Service	1215933957	1215933957	1	1	GREENBURG M JEFFREY	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	16601 N 40TH STE STE 205	None	PHOENIX	AZ	85072	0000	00	None	33.635331	-112.144977	Maricopa County
93650	Fee-for-Service	1851975585	1851975585	1	1	GREAT LIFE HOME HEALTH INC.	5/8/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	STE 608	ENCINO	CA	91436	4732	19	06037	34.15524484	-118.4756687	Los Angeles County
93656	Fee-for-Service	1578132916	1578132916	1	1	GREENE, LAURA A PT	10/30/2021	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
93684	Fee-for-Service	1962680421	1962680421	1	1	GOLDEN VALLEY HEALTH CENTERS	4/3/2008	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2101 TENAYA DR	None	MODESTO	CA	95354	3930	50	06099	37.6324545	-120.956463	Stanislaus County
93705	Fee-for-Service	1457395550	1457395550	2	1	GARG, SHIKHA MD	11/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	82372	None	None	0	In state provider	None	2170 E BIDWELL ST	STE 100	FOLSOM	CA	95630	6453	34	06067	38.667321	-121.1435865	Sacramento County
93719	Fee-for-Service	1912996851	1912996851	1	1	GELBARD, MARTIN MD	5/23/2019	208800000X	NA	Other	026	PHYSICIANS	35061	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
93726	Fee-for-Service	1073073086	1073073086	1	1	GHEMIGIAN, KHRISTINE MD	8/20/2024	207L00000X	NA	Other	026	PHYSICIANS	184756	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
93745	Fee-for-Service	1073008801	1073008801	1	1	GUNN, ERIKA	9/28/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	5500 MING AVE	100	BAKERSFIELD	CA	93309	4619	15	06029	35.33787572	-119.0620525	Kern County
93749	Fee-for-Service	1477713048	1477713048	1	1	GOBER, BRIANNE C MD	8/19/2021	163WG0000X	NA	Other	026	PHYSICIANS	145392	None	None	0	In state provider	None	8665 LA MESA	None	LA MESA	CA	91942	9503	37	06073	32.76948516	-117.0108365	San Diego County
93828	Fee-for-Service	1184946527	1184946527	1	1	GARFIELD BEACH CVS LLC	6/25/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1205 S OXNARD BLVD	None	OXNARD	CA	93030	7419	56	06111	34.18880251	-119.1762815	Ventura County
93840	Fee-for-Service	1528021235	1528021235	1	1	GREGOR, PETER W MD	4/1/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	39417	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
93914	Fee-for-Service	1639282395	1639282395	1	1	GABAEFF, STEVEN C MD	1/13/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	32170	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
93922	Fee-for-Service	1386306876	1386306876	1	1	GRACE MENTAL HEALTH RESOURCE	1/16/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	S, INC	50 IRON POINT CIR STE 14	None	FOLSOM	CA	95630	8594	34	06067	38.644128	-121.1423175	Sacramento County
93947	Fee-for-Service	1912085796	1912085796	1	1	GRAY, ELIZABETH MD	7/15/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	53217	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
93972	Fee-for-Service	1962680421	1962680421	1	1	GOLDEN VALLEY HEALTH CENTERS	4/23/2009	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	2101 TENAYA DR	None	MODESTO	CA	95354	3930	50	06099	37.6324545	-120.956463	Stanislaus County
93979	Fee-for-Service	1679865885	1679865885	1	1	GAUDIO, BRYAN S DO	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13440	01	General Practice	0	In state provider	None	150 N ROBERTSON BLVD	SUITE 300	BEVERLY HILLS	CA	90211	2145	19	06037	34.06812722	-118.3837146	Los Angeles County
94016	Fee-for-Service	1841822962	1841822962	1	1	GARFIELD BEACH CVS LLC	6/9/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	420 BROADWAY	None	SANTA MONICA	CA	90401	2314	19	06037	34.01560772	-118.49293	Los Angeles County
94053	Fee-for-Service	1235350703	1235350703	1	1	GOLDEN YEARS SERVICES	12/13/2000	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	GOLDEN YEARS ADULT DAY	60 E LIVE OAK AVE	None	ARCADIA	CA	91006	5237	19	06037	34.1076152	-118.0281847	Los Angeles County
94059	Fee-for-Service	1164003711	1164003711	1	1	GRACE MEDICAL TRANSPORTATION	5/21/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	336 OAKWOOD CT	None	CORONA	CA	92879	8070	33	06065	33.89377028	-117.5040936	Riverside County
94074	Fee-for-Service	1164093753	1164093753	1	1	GHIGIARELLI, DARCIE L NP	6/7/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
94078	Fee-for-Service	1245402338	1245402338	1	1	GROPPO, ELI R MD	8/22/2011	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	102807	None	None	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
94079	Fee-for-Service	1063515468	1063515468	1	1	GARDNER, FLOYD C MD	10/9/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	33476	30	Radiology	0	In state provider	None	605 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1102	19	06037	34.06890387	-118.1229537	Los Angeles County
94091	Fee-for-Service	1982090668	1982090668	1	1	GUZMAN HERRERA, CARLOS R MD	11/30/2021	208600000X	NA	General Surgery	026	PHYSICIANS	175007	None	None	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
94104	Fee-for-Service	1659410827	1659410827	1	1	GRIN, RADMILA MD	4/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91986	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
94121	Fee-for-Service	1275929077	1275929077	1	1	GE, JIN MD	6/14/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	146805	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
94179	Fee-for-Service	1649358714	1649358714	1	1	GUPTA, RAVINDER K MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61932	01	General Practice	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
94192	Fee-for-Service	1255490199	1255490199	1	1	GEIGER, ERIK J MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	84929	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
94196	Fee-for-Service	1639282395	1639282395	1	1	GABAEFF, STEVEN C MD	1/13/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	32170	01	General Practice	0	In state provider	None	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
94199	Fee-for-Service	1821516360	1821516360	1	1	GUTIERREZ, MICHELLE E LCSW	8/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
94242	Fee-for-Service	1457706137	1457706137	1	1	GARCHA, DAMANVIR S MD	3/12/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172501	None	None	0	In state provider	None	2230 STOCKTON BLVD	STE 2800	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
94275	Fee-for-Service	1710996277	1710996277	1	1	GOEHNER, PAUL MD	4/4/2016	207L00000X	NA	Other	026	PHYSICIANS	58275	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
94276	Fee-for-Service	1649459413	1649459413	1	1	GRAFF, SUSAN J LMFT	5/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	288 W 9TH ST	None	UPLAND	CA	91786	5949	36	06071	34.0960435	-117.6548445	San Bernardino County
94295	Fee-for-Service	1902941867	1902941867	1	1	GIARDINI, NICHOLAS A MD	1/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	61115	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
94314	Fee-for-Service	1265775282	1265775282	1	1	GARNICA GARCIA, FATIMA	4/23/2024	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
94340	Fee-for-Service	1912529645	1912529645	1	1	GENCARE PHARMACY INC	2/9/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15761 TUSTIN VILLAGE WAY	STE 108	TUSTIN	CA	92780	8328	30	06059	33.73473905	-117.8359136	Orange County
94343	Fee-for-Service	1952323735	1952323735	2	1	GARFIELD BEACH CVS LLC	8/2/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5600 WHITTIER BLVD	None	COMMERCE	CA	90022	4106	19	06037	34.01885268	-118.1500912	Los Angeles County
94371	Fee-for-Service	1942224712	1942224712	1	1	GUPTA, ANURAG MD	6/1/2000	207W00000X	NA	Ophthalmology	026	PHYSICIANS	69634	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
94397	Fee-for-Service	1952728412	1952728412	1	1	GAPUZ INCORPORATED	5/25/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	409 WOODSTOCK DR	None	STOCKTON	CA	95207	5833	39	06077	38.00022109	-121.3011644	San Joaquin County
94421	Fee-for-Service	1992823959	1992823959	1	1	GUALTIERI, CHRISTOPHER J MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73020	18	Ophthalmology	0	In state provider	APC	3969 FOURTH AVE	STE 300	SAN DIEGO	CA	92103	3165	37	06073	32.74948151	-117.1615826	San Diego County
94423	Fee-for-Service	1619038601	1619038601	1	1	GRAY,FRANK 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	310 SUNNYVIEW LANE	None	KALISPELL	MT	59901	3129	00	None	48.214773	-114.3236925	Flathead County
94425	Fee-for-Service	1407350663	1407350663	1	1	GRAVESANDY VASSALL, MOREMI	7/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177163	36	Psychiatry	0	In state provider	MD	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
94447	Fee-for-Service	1053911842	1053911842	1	1	GUERRET, MICHAEL OD	12/13/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4130 N VIKING WAY	None	LONG BEACH	CA	90808	1402	19	06037	33.83301608	-118.1262565	Los Angeles County
94457	Fee-for-Service	1518902311	1518902311	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	311 W PACIFIC COAST HWY	STE C	WILMINGTON	CA	90744	2583	19	06037	33.79102937	-118.2663637	Los Angeles County
94465	Fee-for-Service	1649358714	1649358714	1	1	GUPTA, RAVINDER K MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61932	41	Internal Medicine	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
94513	Fee-for-Service	1265664270	1265664270	1	1	GEGENWARTH, MAURA CCC-SLP	7/8/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 GREGORY LANE	SUITE 280	PLEASANT HILL	CA	94523	3339	07	06013	37.94794183	-122.0649162	Contra Costa County
94537	Fee-for-Service	1346396645	1346396645	1	1	GUERRA, JOSE J DO	3/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	8135	01	General Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
94543	Fee-for-Service	1194251249	1194251249	1	1	GROOT, SEBASTIAN O DO	11/14/2019	390200000X	NA	Other	026	PHYSICIANS	16750	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
94551	Fee-for-Service	1427322908	1427322908	1	1	GUERRA, IRENE PHD	1/14/2016	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
94576	Fee-for-Service	1164920849	1164920849	1	1	GOMEZ, LARRY NP	7/8/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
94598	Fee-for-Service	1487765301	1487765301	1	1	GUNNELL, JOHN C MD	6/25/2012	207RH0003X	NA	Oncology	026	PHYSICIANS	17573	78	Neoplastic Diseases/Oncology	0	In state provider	None	435 ARDEN AVE	STE 520	GLENDALE	CA	91203	1138	19	06037	34.15848148	-118.2628845	Los Angeles County
94607	Fee-for-Service	1467496737	1467496737	1	1	GARFIELD BEACH CVS, LLC	7/31/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2760 FLECTCHER PKY	None	EL CAJON	CA	92020	2110	37	06073	32.80015674	-117.0036982	San Diego County
94617	Fee-for-Service	1235794520	1235794520	1	1	GUPTA, ERIC MD	2/28/2024	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
94626	Fee-for-Service	1811740780	1811740780	1	1	GALEANA, DIANA NP	9/6/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	420 S BRISTOL ST	None	SANTA ANA	CA	92703	4527	30	06059	33.74216489	-117.8852849	Orange County
94661	Fee-for-Service	1396786208	1396786208	1	1	GARFIELD BEACH CVS LLC	12/13/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	33499 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2064	36	06071	34.03382713	-117.0737457	San Bernardino County
94671	Fee-for-Service	1396142527	1396142527	1	1	GOMEZ, GUILLERMO LAC	1/22/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	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
94709	Fee-for-Service	1992823959	1992823959	1	1	GUALTIERI, CHRISTOPHER J MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73020	66	Emergency Medicine (Urgent Care)	0	In state provider	APC	3969 FOURTH AVE	STE 300	SAN DIEGO	CA	92103	3165	37	06073	32.74948151	-117.1615826	San Diego County
94821	Fee-for-Service	1164824538	1164824538	1	1	GINSBURG-LAVER, STUART LMFT	4/8/2025	No Taxonomy Provided	NA	None	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
94874	Fee-for-Service	1770534638	1770534638	1	1	GLINA, JOHN CHARLES MD	6/18/1998	207L00000X	NA	Other	026	PHYSICIANS	74645	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
94878	Fee-for-Service	1154723542	1154723542	1	1	GIL, RYAN PT	4/29/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7033 N FRESNO ST STE 202	None	FRESNO	CA	93720	2976	10	06019	36.838044	-119.7813175	Fresno County
94885	Fee-for-Service	1487765301	1487765301	1	1	GUNNELL, JOHN C MD	6/25/2012	207RH0003X	NA	Oncology	026	PHYSICIANS	17573	68	Hematology	0	In state provider	None	435 ARDEN AVE	STE 520	GLENDALE	CA	91203	1138	19	06037	34.15848148	-118.2628845	Los Angeles County
94895	Fee-for-Service	1275885691	1275885691	1	1	GOLDEN HEART MEDICAL	4/17/2014	193200000X	NA	Other	026	PHYSICIANS	80802	06	Cardiovascular Disease (M.D. only)	0	In state provider	CORPORATION	8729 VALLEY BLVD	UNIT A	ROSEMEAD	CA	91770	1743	19	06037	34.0806454	-118.0795045	Los Angeles County
94955	Fee-for-Service	1649272832	1649272832	1	1	GORSULOWSKY, DAVID C MD	11/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	42190	07	Dermatology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
94969	Fee-for-Service	1457363947	1457363947	1	1	GOLDEN, DAVID MD	7/10/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79763	20	Orthopedic Surgery	0	In state provider	None	8635 W 3RD ST	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
94980	Fee-for-Service	1922387729	1922387729	2	1	GARFIELD BEACH CVS LLC	5/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	990 AVENIDA VISTA HERMOS	None	SAN CLEMENTE	CA	92673	6360	30	06059	33.46323292	-117.6058071	Orange County
94993	Fee-for-Service	1659327112	1659327112	1	1	GROVE, IRA K MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51338	66	Emergency Medicine (Urgent Care)	0	In state provider	None	502 W HOLT AVE	None	POMONA	CA	91768	3604	19	06037	34.06219961	-117.7571033	Los Angeles County
95061	Fee-for-Service	1275011074	1275011074	1	1	GATHINGS, KATHLEEN T RCP	8/16/2018	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
95064	Fee-for-Service	1104236298	1104236298	1	1	GANATRA, NIKITA MD	8/23/2019	207P00000X	NA	Other	026	PHYSICIANS	162855	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6696	19	06037	34.05682871	-118.360716	Los Angeles County
95068	Fee-for-Service	1992749048	1992749048	1	1	GOMEZ, MYRON J. MD	5/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	33	Thoracic Surgery	1	Border provider	None	75 PRINGLE WAY	STE 1002	RENO	NV	89502	1475	00	None	39.52621891	-119.7944075	Washoe County
95095	Fee-for-Service	1811955438	1811955438	1	1	GUPTA, NALIN MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	74196	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	STE A808	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
95110	Fee-for-Service	1265457436	1265457436	1	1	GARVEY, DENISE S MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55477	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	STE 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
95129	Fee-for-Service	1730732512	1730732512	1	1	GJIKA, LLUKAN	2/14/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5013 CRESTVIEW DRIVE	None	CARMICHAEL	CA	95608	0828	34	06067	38.656809	-121.320891	Sacramento County
95130	Fee-for-Service	1528143575	1528143575	1	1	GEE, WARREN L MD	6/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97099	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
95148	Fee-for-Service	1942268792	1942268792	1	1	GODIL, FOUZIA MD	11/1/1995	207R00000X	NA	Other	026	PHYSICIANS	52997	41	Internal Medicine	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
95158	Fee-for-Service	1497799746	1497799746	1	1	GARFIELD BEACH CVS, LLC	3/12/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12071 MT. VERNON AVE	None	GRAND TERRACE	CA	92313	5173	36	06071	34.03435291	-117.3135935	San Bernardino County
95160	Fee-for-Service	1306029459	1306029459	1	1	GEBREKRISTOS, BISRAT H	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88733	40	Pediatrics	0	In state provider	MD	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
95173	Fee-for-Service	1487765301	1487765301	1	1	GUNNELL, JOHN C MD	6/25/2012	207RH0003X	NA	Oncology	026	PHYSICIANS	17573	41	Internal Medicine	0	In state provider	None	435 ARDEN AVE	STE 520	GLENDALE	CA	91203	1138	19	06037	34.15848148	-118.2628845	Los Angeles County
95263	Fee-for-Service	1699041566	1699041566	1	4	GARDNER FAMILY HEALTH	6/11/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	580 CHARLES STREET	None	SAN JOSE	CA	95112	1424	43	06085	37.36538758	-121.8963003	Santa Clara County
95278	Fee-for-Service	1972609998	1972609998	1	1	GARDEN PARK	2/4/1994	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5025 MARSHBURN CIR	None	YORBA LINDA	CA	92886	3926	30	06059	33.88791284	-117.8249044	Orange County
95355	Fee-for-Service	1992749048	1992749048	1	1	GOMEZ, MYRON J. MD	5/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	75 PRINGLE WAY	STE 1002	RENO	NV	89502	1475	00	None	39.52621891	-119.7944075	Washoe County
95398	Fee-for-Service	1265457436	1265457436	1	1	GARVEY, DENISE S MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55477	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVE	STE 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
95417	Fee-for-Service	1730732512	1730732512	1	1	GJIKA, LLUKAN	2/14/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5013 CRESTVIEW DRIVE	None	CARMICHAEL	CA	95608	0828	34	06067	38.656809	-121.320891	Sacramento County
95431	Fee-for-Service	1942268792	1942268792	1	1	GODIL, FOUZIA MD	11/1/1995	207R00000X	NA	Other	026	PHYSICIANS	52997	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
95465	Fee-for-Service	1891226403	1891226403	1	1	GOH, MINDY J DO	7/2/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16840	08	Family Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
95482	Fee-for-Service	1376204669	1376204669	1	1	GAURAV, JIVITESH MD	10/23/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
95494	Fee-for-Service	1700352606	1700352606	1	1	GRAY, GABRIELLE LCSW	7/28/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
95503	Fee-for-Service	1528402948	1528402948	1	1	GASTELUM, NICHOLAS S MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132726	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
95511	Fee-for-Service	1720064488	1720064488	1	1	GATPOLINTAN, JESUS R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65656	None	None	0	In state provider	None	890 SUNSET DR	STE A2	HOLLISTER	CA	95023	5652	35	06069	36.83514342	-121.3877091	San Benito County
95526	Fee-for-Service	1144293739	1144293739	1	1	GILLAN, EILEEN MD	1/25/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	60405	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
95534	Fee-for-Service	1811249543	1811249543	1	1	GLICKMAN, SETH R MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122923	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
95543	Fee-for-Service	1588650667	1588650667	1	1	GILBERT, JOHN M	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	53352	67	Endocrinology	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
95551	Fee-for-Service	1699041566	1699041566	1	4	GARDNER FAMILY HEALTH	6/11/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	580 CHARLES STREET	None	SAN JOSE	CA	95112	1424	43	06085	37.36538758	-121.8963003	Santa Clara County
95559	Fee-for-Service	1346640984	1346640984	1	1	GUADIAN, HUGO NP	4/4/2016	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
95568	Fee-for-Service	1417984600	1417984600	1	1	GREENSPUN, RICHARD H MD	6/8/1995	207R00000X	NA	Other	026	PHYSICIANS	25213	41	Internal Medicine	0	In state provider	None	2825 SANTA MONICA BLVD	STE 301	SANTA MONICA	CA	90404	2429	19	06037	34.03539456	-118.4718113	Los Angeles County
95570	Fee-for-Service	1104279280	1104279280	1	1	GUARDADO, CAROL A LCSW	4/19/2022	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
95602	Fee-for-Service	1770893117	1770893117	1	1	GONZALEZ, JOSE L	7/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114052	None	None	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
95634	Fee-for-Service	1063054831	1063054831	1	1	GLENN MEDICAL CENTER, INC	7/1/2021	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
95673	Fee-for-Service	1386688638	1386688638	1	1	GARFIELD BEACH CVS LLC	1/3/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	31575 DATE PALM DR	None	CATHEDRAL CITY	CA	92234	3138	33	06065	33.819084	-116.4582985	Riverside County
95681	Fee-for-Service	1902823354	1902823354	1	1	GIORI, NICHOLAS J MD	9/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54726	20	Orthopedic Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
95699	Fee-for-Service	1851002570	1851002570	1	1	GATHUU, LUCY NYAMBURA	1/12/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1267 BEE BALM ROAD	None	HEMET	CA	92545	8725	33	06065	33.72597592	-117.0042645	Riverside County
95700	Fee-for-Service	1467429191	1467429191	1	1	GOLLAPUDI, RAGHAVA R MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73392	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
95727	Fee-for-Service	1255582631	1255582631	1	1	GUEVARRA, JOSE I	5/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149200	05	Anesthesiology	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
95843	Fee-for-Service	1215912522	1215912522	1	1	GANGULY,GAUTAM MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69058	13	Neurology (M.D. only)	0	In state provider	None	12291 WASHINGTON BLVD	STE 303	WHITTIER	CA	90606	2550	19	06037	33.96734104	-118.0508773	Los Angeles County
95879	Fee-for-Service	1770864977	1770864977	1	1	GUZMAN, JENNIFER D CCC-SLP	6/7/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
95880	Fee-for-Service	1528080314	1528080314	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3030 HARBOR BLVD	STE A	COSTA MESA	CA	92626	2562	30	06059	33.681159	-117.919194	Orange County
95900	Fee-for-Service	1831893957	1831893957	1	1	G-AIMS TRANSPORTATION	7/6/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	31708 BLUE HERON LN	None	AUBERRY	CA	93602	9600	10	06019	37.04763975	-119.5079963	Fresno County
95901	Fee-for-Service	1932362894	1932362894	1	1	GROZAVU, SERGIU MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113643	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
95909	Fee-for-Service	1730315532	1730315532	1	1	GORDON, DEBBIE NP	9/12/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
95913	Fee-for-Service	1023196698	1023196698	1	1	GUPTA, SUMEER K MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95057	84	Surgery-Head and Neck	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
95920	Fee-for-Service	1063054831	1063054831	1	1	GLENN MEDICAL CENTER, INC	7/1/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
95925	Fee-for-Service	1144452186	1144452186	1	1	GONZALEZ, LORENA MD	9/25/2019	208600000X	NA	General Surgery	026	PHYSICIANS	162154	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
95926	Fee-for-Service	1114000569	1114000569	1	1	GARCIA, ALEJANDRO R MD	11/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	63931	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 N BRENT ST	STE 301	VENTURA	CA	93003	2836	56	06111	34.27345057	-119.2569821	Ventura County
95945	Fee-for-Service	1942650171	1942650171	1	1	GORDON, MELISSA	6/21/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6242 MULAN ST	None	CORONA	CA	92880	0790	33	06065	33.97445955	-117.571179	Riverside County
95970	Fee-for-Service	1669138400	1669138400	1	1	GRAHAM, JEFFREY P CRNA	11/19/2021	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
95973	Fee-for-Service	1154442416	1154442416	1	1	GUPTA, NEIL MD	7/30/2007	207R00000X	NA	Other	026	PHYSICIANS	94062	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
95977	Fee-for-Service	1932312675	1932312675	1	1	GEORGE S TABOR MD INC	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	14903	None	None	0	In state provider	None	3808 W RIVERSIDE DR	#404	BURBANK	CA	91505	5301	19	06037	34.15252315	-118.3412174	Los Angeles County
95980	Fee-for-Service	1851002570	1851002570	1	1	GATHUU, LUCY NYAMBURA	1/12/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1267 BEE BALM ROAD	None	HEMET	CA	92545	8725	33	06065	33.72597592	-117.0042645	Riverside County
95983	Fee-for-Service	1457859399	1457859399	1	1	GUEVARRA, ALEJREN T CNP	7/24/2018	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1040 ELM AVE	STE 300	LONG BEACH	CA	90813	3267	19	06037	33.779799	-118.1879535	Los Angeles County
95988	Fee-for-Service	1467429191	1467429191	1	1	GOLLAPUDI, RAGHAVA R MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73392	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
96013	Fee-for-Service	1689364721	1689364721	1	3	GEM MEDICAL GROUP CORPORATIO	2/6/2024	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	525 GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
96020	Fee-for-Service	1336301340	1336301340	1	1	GREENFIELD, TANYA PSYD	11/16/2023	103TC0700X	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
96034	Fee-for-Service	1891887139	1891887139	1	1	GUTIERREZ, LAURA E PHD	4/10/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
96036	Fee-for-Service	1861409385	1861409385	1	1	GILL, KANWAR R MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92249	41	Internal Medicine	0	In state provider	None	1409 EAST BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
96049	Fee-for-Service	1639787278	1639787278	1	1	GANA HOSPICE INC	10/7/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	200 W GLENOAKS BLVD	STE 103	GLENDALE	CA	91202	3609	19	06037	34.15957045	-118.2582206	Los Angeles County
96125	Fee-for-Service	1861735862	1861735862	1	1	GRUBB, HILARY M MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132310	36	Psychiatry	0	In state provider	None	250 BON AIR ROAD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
96131	Fee-for-Service	1811172190	1811172190	1	1	GREAT EYES OPTOMETRY INC	1/12/2010	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	343 S BROADWAY	None	LOS ANGELES	CA	90013	1207	19	06037	34.05003869	-118.2489313	Los Angeles County
96145	Fee-for-Service	1588147508	1588147508	1	1	GERMAN, ZAE J	8/25/2024	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
96149	Fee-for-Service	1336231679	1336231679	1	1	GARFIELD BEACH CVS LLC	3/23/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	846 W AVENUE K	None	LANCASTER	CA	93534	6022	19	06037	34.67485047	-118.1471535	Los Angeles County
96201	Fee-for-Service	1255731915	1255731915	1	1	GAROFALO, MARY D CNP	6/3/2022	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
96205	Fee-for-Service	1376188359	1376188359	1	1	GUARDIAN ANGEL HOME CARE OF	4/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SACRAMENTO LLC	1451 RIVER PARK DRIVE	STE 225	SACRAMENTO	CA	95815	4507	34	06067	38.598651	-121.439673	Sacramento County
96212	Fee-for-Service	1518196591	1518196591	1	1	GONZALEZ, MARIA LCSW	8/2/2024	1041C0700X	NA	Mental Health Outpatient Services	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
96234	Fee-for-Service	1942650171	1942650171	1	1	GORDON, MELISSA	6/21/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6242 MULAN ST	None	CORONA	CA	92880	0790	33	06065	33.97445955	-117.571179	Riverside County
96273	Fee-for-Service	1598297111	1598297111	1	1	GREEN, RUBIN D MD	8/28/2020	207P00000X	NA	Other	026	PHYSICIANS	166667	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
96287	Fee-for-Service	1316176035	1316176035	1	1	GOSWAMI, SANJEEV K MD INC	11/6/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1801 EAST MARCH LN	STE C300	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
96300	Fee-for-Service	1497867717	1497867717	1	1	GABAYAN, ARASH J MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87475	30	Radiology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
96309	Fee-for-Service	1073154068	1073154068	1	1	GARCIA, SARAH M LCSW	10/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
96334	Fee-for-Service	1639787278	1639787278	1	1	GANA HOSPICE INC	10/7/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	200 W GLENOAKS BLVD	STE 103	GLENDALE	CA	91202	3609	19	06037	34.15957045	-118.2582206	Los Angeles County
96345	Fee-for-Service	1104095819	1104095819	1	1	GONZALES, ELENA V PHD	3/21/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
96363	Fee-for-Service	1477597748	1477597748	2	1	GARFIELD BEACH CVS, LLC	4/3/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1655 S. CENTER CITY	None	ESCONDIDO	CA	82025	6068	37	06073	33.10364319	-117.0759656	San Diego County
96389	Fee-for-Service	1386688125	1386688125	1	1	GARFIELD EMERGENCY	10/22/2003	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL ASSOCIATES, INC	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
96395	Fee-for-Service	1487302170	1487302170	1	1	GONZALEZ, MARCO A CNP	4/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
96403	Fee-for-Service	1649787326	1649787326	1	1	GARRISON, SPENCER J CRNA	12/16/2020	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
96416	Fee-for-Service	1326011131	1326011131	1	1	GENTZ, BRENDA 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
96437	Fee-for-Service	1295809861	1295809861	1	1	GEIDERMAN, JOEL M MD	2/28/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38819	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
96455	Fee-for-Service	1922635143	1922635143	1	1	GRABER, STEPHEN MD	8/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178635	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
96498	Fee-for-Service	1194724583	1194724583	1	1	GHOLIZADEH, MARYAM MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83935	40	Pediatrics	0	In state provider	None	1120 W LAVETA AVE	STE 100	ORANGE	CA	92868	0000	30	06059	33.78029455	-117.864369	Orange County
96509	Fee-for-Service	1336436583	1336436583	1	1	GANJEHEI, LEILA MD	10/13/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	129350	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
96521	Fee-for-Service	1831381904	1831381904	1	1	GUIDED ALLIANCE PHARMACY INC	2/20/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27111 ALISO CREEK RD	STE 185A	ALISO VIEJO	CA	92656	3365	30	06059	33.56887286	-117.7232725	Orange County
96524	Fee-for-Service	1003053943	1003053943	1	1	GAGE MEDICAL CLINIC INC	4/1/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	985 W VERNON AVE	None	LOS ANGELES	CA	90037	3038	19	06037	34.00370943	-118.2912135	Los Angeles County
96535	Fee-for-Service	1215985205	1215985205	1	1	GRIFFIN, GERALD D MD	9/30/1986	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	37105	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
96627	Fee-for-Service	1134148174	1134148174	1	1	GEARY, DAVID P MD	6/21/2000	207LP2900X	NA	Other	026	PHYSICIANS	46829	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
96698	Fee-for-Service	1871569335	1871569335	1	1	GE, NENGJIE MD PC	8/16/2009	174400000X	NA	Other	026	PHYSICIANS	70942	18	Ophthalmology	0	In state provider	None	16300 SAND CANYON AVE	#608	IRVINE	CA	92618	3706	30	06059	33.66115075	-117.7742405	Orange County
96740	Fee-for-Service	1093898629	1093898629	2	1	GARFIELD BEACH CVS LLC	11/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	747 GRAND AVE	None	DIAMOND BAR	CA	91765	8400	19	06037	34.00501009	-117.8203725	Los Angeles County
96762	Fee-for-Service	1477654747	1477654747	1	1	GILL, JEFFRY M	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77828	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
96773	Fee-for-Service	1982235594	1982235594	1	1	GRAJEDA, CHERIE P	2/25/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6473 THUNDER BAY TRL	None	RIVERSIDE	CA	92509	0147	33	06065	33.97185099	-117.4531347	Riverside County
96777	Fee-for-Service	1407113400	1407113400	1	1	GARCIA, CHRISTINE MD	8/28/2020	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	123044	09	Gynecology (D.O. only)	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
96793	Fee-for-Service	1023038031	1023038031	1	1	GRIFFIN, THOMAS E MD	4/13/2021	207R00000X	NA	Other	026	PHYSICIANS	37512	None	None	0	In state provider	None	7202 MILLBROOK	105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
96794	Fee-for-Service	1013183581	1013183581	1	1	GABRIELS CARE HOMES INC	10/7/1999	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2216 ALPINE DR	None	LODI	CA	95240	6703	39	06077	38.10556626	-121.2742336	San Joaquin County
96809	Fee-for-Service	1912931361	1912931361	1	1	GIANOTTI, ALAN J MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54636	41	Internal Medicine	0	In state provider	None	SFIA INT'L TERMINAL	None	SAN FRANCISCO	CA	94128	0000	38	06075	0	0	None
96825	Fee-for-Service	1134389117	1134389117	1	1	GEBIS, ELIZABETH M MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108978	36	Psychiatry	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
96826	Fee-for-Service	1215985205	1215985205	1	1	GRIFFIN, GERALD D MD	9/30/1986	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	37105	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
96838	Fee-for-Service	1194923235	1194923235	1	1	GUBENS, MATTHEW A MD	7/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98645	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
96844	Fee-for-Service	1376871624	1376871624	1	1	GARCIA, MARIA T PT	10/28/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2251 COUNTRY CLUB LN	None	SELMA	CA	93662	3859	10	06019	36.5662241	-119.5996308	Fresno County
96845	Fee-for-Service	1891081485	1891081485	1	1	GONZALEZ, LIZA M	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11290	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
96854	Fee-for-Service	1750355392	1750355392	1	1	GROSSKLAUS, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	875 N GREENFIELD RD	STE 101	GILBERT	AZ	85234	5044	00	None	33.366132	-111.737889	Maricopa County
96866	Fee-for-Service	1548751852	1548751852	1	1	GHASEMZADEH, REZVANEH MD	6/16/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163802	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
96964	Fee-for-Service	1306881214	1306881214	1	1	GARFIELD BEACH CVS LLC	1/3/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	435 EAST ARROW HWY	None	GLENDORA	CA	91740	5607	19	06037	34.10676653	-117.8558415	Los Angeles County
96967	Fee-for-Service	1508119215	1508119215	1	1	GATEWOOD, LONDEN LMFT	12/5/2024	172V00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W 5TH ST STE 308	None	SAN PEDRO	CA	90731	2750	19	06037	33.73971572	-118.284045	Los Angeles County
97015	Fee-for-Service	1548012735	1548012735	1	1	GONZALEZ, ADAM LMFT	7/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
97063	Fee-for-Service	1982235594	1982235594	1	1	GRAJEDA, CHERIE P	2/25/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6473 THUNDER BAY TRL	None	RIVERSIDE	CA	92509	0147	33	06065	33.97185099	-117.4531347	Riverside County
97124	Fee-for-Service	1194923235	1194923235	1	1	GUBENS, MATTHEW A MD	7/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98645	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
97142	Fee-for-Service	1417373010	1417373010	1	1	GAZI, HASHIM MD	1/23/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	166600	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
97144	Fee-for-Service	1598230617	1598230617	1	1	GUZMAN, JACQULINE LAC	4/3/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
97156	Fee-for-Service	1386751477	1386751477	1	1	GRAHAM, JUSTIN V MD	12/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	68099	77	Infectious Disease	0	In state provider	None	222 W 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
97195	Fee-for-Service	1588806665	1588806665	1	1	GARFIELD BEACH CVS, LLC	9/16/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3301 ZINFANDEL DR	None	RANCHO CORDOVA	CA	95670	6385	34	06067	38.581479	-121.28364	Sacramento County
97266	Fee-for-Service	1710987474	1710987474	1	1	GARDNER, KIRSTEN J MD	1/4/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	93580	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
97298	Fee-for-Service	1417033366	1417033366	1	1	GORDON, MALCOLM MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40447	41	Internal Medicine	0	In state provider	None	2111 UNIVERSITY AVE	None	EAST PALO ALTO	CA	94303	1715	41	06081	37.463436	-122.1418585	San Mateo County
97313	Fee-for-Service	1811356165	1811356165	1	1	GUTIERREZ, DAVID LMFT	7/5/2024	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
97329	Fee-for-Service	1205129509	1205129509	1	1	GALLEGOS, NICOLAS MD	6/29/2017	207ZP0101X	NA	Other	026	PHYSICIANS	124479	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
97335	Fee-for-Service	1003131053	1003131053	1	1	GANDOLFI, BRAD M MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142117	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
97342	Fee-for-Service	1427869221	1427869221	1	1	GUZMAN KING, GABRIELA BIRTH	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	37	06073	0	0	None
97346	Fee-for-Service	1063606689	1063606689	1	1	GUTTADAURO, JOANIE T	1/24/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
97353	Fee-for-Service	1730625336	1730625336	1	1	GOLLES, KIMBERLEE M	6/29/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
97355	Fee-for-Service	1528007119	1528007119	1	1	GIBBS, HARLAN MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59003	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
97362	Fee-for-Service	1649342478	1649342478	1	1	GO, LEONY C MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53650	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
97371	Fee-for-Service	1417418179	1417418179	1	1	GONZALEZ PEREZ, ALEJANDRO M	8/30/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176944	None	None	0	In state provider	MD	625 34TH ST	STE 100 & 200	BAKERSFIELD	CA	93301	2305	15	06029	35.39046051	-119.0092725	Kern County
97372	Fee-for-Service	1720506751	1720506751	1	1	GARFIELD BEACH CVS, LLC	6/15/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1919 S HOOVER STREET	None	LOS ANGELES	CA	90007	1322	19	06037	34.03938555	-118.2841294	Los Angeles County
97373	Fee-for-Service	1093737603	1093737603	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8101 COSUMNES RIVER BLVD	None	SACRAMENTO	CA	95823	5415	34	06067	38.459079	-121.4134785	Sacramento County
97379	Fee-for-Service	1154577823	1154577823	1	1	GENT, JUSTIN J MD	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103874	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
97387	Fee-for-Service	1770631665	1770631665	1	1	GILBERT, DEAN D MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60404	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
97396	Fee-for-Service	1154482503	1154482503	1	1	GOVINDARAJAN, PARTHASARATHY	2/8/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	30073	41	Internal Medicine	0	In state provider	MD	1711 W ROMNEYA DR	STE A	ANAHEIM	CA	92801	1804	30	06059	33.85069353	-117.9425745	Orange County
97405	Fee-for-Service	1477502144	1477502144	1	1	GOLDIN, JONATHAN G MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68396	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
97416	Fee-for-Service	1821463761	1821463761	1	1	GESMUNDO, RACHEL A OT	6/26/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
97455	Fee-for-Service	1043499452	1043499452	1	1	GARRIGUES, SIMONE	5/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
97498	Fee-for-Service	1285959932	1285959932	1	1	GAO, LING LING DO	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13363	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
97546	Fee-for-Service	1588636609	1588636609	1	1	GORMAN, LEENA G MD	6/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54375	08	Family Practice	0	In state provider	None	3612 DALE ROAD	None	MODESTO	CA	95356	0500	50	06099	37.69097901	-121.0498748	Stanislaus County
97554	Fee-for-Service	1942235874	1942235874	1	2	GARCIA, RAYNADO F MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	36032	08	Family Practice	0	In state provider	SAN JOAQUIN VALLEY MED	536 N COURT ST	None	VISALIA	CA	93291	4913	54	06107	36.334809	-119.292057	Tulare County
97573	Fee-for-Service	1003812751	1003812751	1	1	GALLO, JOHN J MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32335	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
97621	Fee-for-Service	1073055612	1073055612	1	3	GOLDEN STATE URGENT CARE PRO	12/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1038 E BROKAW ROAD	SUITE 30	SAN JOSE	CA	95131	2309	43	06085	37.3827822	-121.8982439	Santa Clara County
97643	Fee-for-Service	1548337389	1548337389	1	1	GUITRON-ZABY, LORENA D NP	12/2/2013	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1502 WEST COVINA PKWY	None	WEST COVINA	CA	91790	2703	19	06037	34.06975232	-117.9394512	Los Angeles County
97652	Fee-for-Service	1730507377	1730507377	1	1	GALVEZ CARRERA, MARIA V LCSW	6/14/2021	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
97667	Fee-for-Service	1861436115	1861436115	1	1	GARFIELD BEACH CVS LLC	10/26/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 S GAFFEY	None	SAN PEDRO	CA	90731	3029	19	06037	33.737589	-118.292323	Los Angeles County
97670	Fee-for-Service	1114034881	1114034881	1	1	GAMBLE, ROBERT C JR	12/1/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42796	08	Family Practice	0	In state provider	None	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
97679	Fee-for-Service	1720230451	1720230451	1	1	GUJRATI, MANU MD	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112446	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
97685	Fee-for-Service	1154759355	1154759355	1	1	GUTIERREZ, CANDACE T MD	4/3/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	137139	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
97736	Fee-for-Service	1477713048	1477713048	1	7	GOBER, BRIANNE C MD	7/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145392	None	None	0	In state provider	None	510 E WASHINGTON AVE	None	EL CAJON	CA	92020	5324	37	06073	32.78767749	-116.9555839	San Diego County
97744	Fee-for-Service	1205466521	1205466521	1	1	GAYLORD, KYLEIGH H DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21179	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
97750	Fee-for-Service	1790334126	1790334126	1	1	GONZALEZ, TONANTZIN M LCSW	6/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12321 MAGNOLIA AVE	SUITE D	RIVERSIDE	CA	92503	4736	33	06065	33.89046742	-117.4991751	Riverside County
97780	Fee-for-Service	1669908265	1669908265	1	1	GAU, MEGAN MD	11/22/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	153188	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
97812	Fee-for-Service	1275521494	1275521494	1	1	GUZMAN, DAVID MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151747	41	Internal Medicine	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
97831	Fee-for-Service	1275021263	1275021263	1	1	GUTIERREZ-WU, JENNIFER C MD	11/6/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
97846	Fee-for-Service	1790720969	1790720969	1	1	GREBLYA, VICTORIA MD	12/1/1996	207R00000X	NA	Other	026	PHYSICIANS	52304	41	Internal Medicine	0	In state provider	None	18800 DELAWARE ST	STE 600	HUNTINGTON BEACH	CA	92648	6017	30	06059	33.68911733	-117.9931535	Orange County
97847	Fee-for-Service	1700096807	1700096807	1	1	GONZALEZ, VERONICA L LMFT	3/18/2022	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
97880	Fee-for-Service	1477656502	1477656502	1	1	GILL, LYNN M OD	12/20/1971	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5284 STATE HIGHWAY 49 N	STE 1	MARIPOSA	CA	95338	9501	22	06043	37.49684965	-119.981419	Mariposa County
97922	Fee-for-Service	1841730397	1841730397	1	1	GERHART, VICTORIA E NP	10/22/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	250 E CAROLINE ST	STE J	SAN BERNARDINO	CA	92408	3758	36	06071	34.0615203	-117.2793274	San Bernardino County
97935	Fee-for-Service	1669558573	1669558573	1	2	GARRY, JOHN E MD	5/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39995	02	General Surgery	0	In state provider	None	6121 N THESTA	STE 202	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
97954	Fee-for-Service	1588776579	1588776579	2	1	GROSSMONT PHARMACY INC	3/8/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5565 GROSSMONT CENTER DR	BLDG 3 SUITE 150	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
97988	Fee-for-Service	1679805675	1679805675	1	1	GS TAKOWSKY PLASTIC SURGERY	1/29/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34305	24	Plastic Surgery	0	In state provider	GROUP INC	8500 WILSHIRE BLVD	STE 630	BEVERLY HILLS	CA	90211	3139	19	06037	34.06521956	-118.3764689	Los Angeles County
98004	Fee-for-Service	1255758512	1255758512	1	1	GRELLI, KIMBERLY NICOLE MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147133	40	Pediatrics	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	9411	38	06075	37.78324881	-122.4405738	San Francisco County
98012	Fee-for-Service	1568062479	1568062479	1	1	GMG HOSPICE AND	9/21/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	3429 OCEAN VIEW BLVD	SUITE F	GLENDALE	CA	91208	1584	19	06037	34.20111517	-118.2283793	Los Angeles County
98017	Fee-for-Service	1366426074	1366426074	1	1	GOLDMAN, 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	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
98046	Fee-for-Service	1952340994	1952340994	1	1	GWINNETT HOSPITAL SYSTEM	8/4/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1000 MEDICAL CENTER BLVD	None	LAWRENCEVILLE	GA	30045	7694	00	None	33.96493784	-84.0173541	Gwinnett County
98052	Fee-for-Service	1346686375	1346686375	1	1	GUADIZ, TRICIA M MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134902	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
98090	Fee-for-Service	1780828939	1780828939	1	1	GOYAL, AMIT MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107279	02	General Surgery	0	In state provider	None	1020 29TH STREET	#350	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
98135	Fee-for-Service	1184395212	1184395212	1	1	GABUCAN, LOURDES LMFT	3/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
98159	Fee-for-Service	1851465256	1851465256	1	1	GEORGIOU, STEPHEN J MD	6/28/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	81674	None	None	0	In state provider	None	502 WASHINGTON AVE	None	LOS BANOS	CA	93635	4649	24	06047	37.05600223	-120.8529485	Merced County
98173	Fee-for-Service	1295808384	1295808384	1	1	GREEN, TRINH M MD	8/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78204	08	Family Practice	0	In state provider	None	2433 CENTRAL AVE	STE A	ALAMEDA	CA	94501	4564	01	06001	37.76358675	-122.2413153	Alameda County
98197	Fee-for-Service	1861763518	1861763518	1	1	GUILFOOS, SONIA LCSW	8/13/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
98217	Fee-for-Service	1457373086	1457373086	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1601 KINGSDALE AVE	None	REDONDO BEACH	CA	90278	3928	19	06037	33.86950138	-118.3567164	Los Angeles County
98221	Fee-for-Service	1225863814	1225863814	1	1	GARDNER, JOSIAH PT	2/14/2025	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
98229	Fee-for-Service	1548567498	1548567498	1	8	GENESIS HEALTHCARE PARTNERS	6/1/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	9834 GENESEE AVE	SUITE 421	SAN DIEGO	CA	92037	1264	37	06073	32.884074	-117.225855	San Diego County
98243	Fee-for-Service	1598004624	1598004624	1	1	GONZALES, DOMINIC A LMFT	8/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
98277	Fee-for-Service	1679805675	1679805675	1	1	GS TAKOWSKY PLASTIC SURGERY	1/29/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34305	04	Otology, Laryngology, Rhinology	0	In state provider	GROUP INC	8500 WILSHIRE BLVD	STE 630	BEVERLY HILLS	CA	90211	3139	19	06037	34.06521956	-118.3764689	Los Angeles County
98286	Fee-for-Service	1174501340	1174501340	1	1	GUGENHEIM, STEPHEN M MD	10/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51162	04	Otology, Laryngology, Rhinology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
98294	Fee-for-Service	1881271716	1881271716	1	1	GARDNER, EMILY MD	7/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	192325	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
98301	Fee-for-Service	1568062479	1568062479	1	1	GMG HOSPICE AND	9/21/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	3429 OCEAN VIEW BLVD	SUITE F	GLENDALE	CA	91208	1584	19	06037	34.20111517	-118.2283793	Los Angeles County
98335	Fee-for-Service	1346686375	1346686375	1	1	GUADIZ, TRICIA M MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134902	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
98339	Fee-for-Service	1952340994	1952340994	1	1	GWINNETT HOSPITAL SYSTEM	8/4/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1000 MEDICAL CENTER BLVD	None	LAWRENCEVILLE	GA	30045	7694	00	None	33.96493784	-84.0173541	Gwinnett County
98350	Fee-for-Service	1306290242	1306290242	1	1	GUPTA, TRIPTI MD	7/9/2024	207R00000X	NA	Other	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
98353	Fee-for-Service	1235337569	1235337569	1	1	GHISELLI, NINA A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1014 B STREET	None	HAYWARD	CA	94541	4108	01	06001	37.6731209	-122.0824165	Alameda County
98367	Fee-for-Service	1043581093	1043581093	1	1	GHIO, DARIO LMFT	9/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	624 W 9TH ST STE 202	None	SAN PEDRO	CA	90731	3158	19	06037	33.73607853	-118.290789	Los Angeles County
98415	Fee-for-Service	1942937768	1942937768	1	1	GUADIZ, CONRADO J CNP	8/5/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
98438	Fee-for-Service	1376752188	1376752188	1	1	GLADDING, REBECCA L MD	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97367	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
98446	Fee-for-Service	1790886638	1790886638	1	1	GEIGER, PHILLIP G MD	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109052	05	Anesthesiology	0	In state provider	None	450 GREENFIELD AVE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
98459	Fee-for-Service	1366464067	1366464067	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 HARBOR BLVD	None	GARDEN GROVE	CA	92840	4004	30	06059	33.78659758	-117.9147708	Orange County
98465	Fee-for-Service	1942699418	1942699418	1	1	GEREN, JENNIFER PHD	11/18/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
98472	Fee-for-Service	1790777449	1790777449	1	1	GODFREY, NANCY MD	5/31/1981	207RR0500X	NA	Other	026	PHYSICIANS	37982	None	None	0	In state provider	None	10861 CHERRY ST	104	LOS ALAMITOS	CA	90720	5403	30	06059	33.80465174	-118.0680053	Orange County
98483	Fee-for-Service	1710246673	1710246673	1	1	GORDON, JAMES H MD	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127847	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
98506	Fee-for-Service	1629556675	1629556675	1	1	GUEVARA, CRYSTAL PHD	8/1/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
98510	Fee-for-Service	1528042512	1528042512	1	1	GOLDEN VALLEY HEALTH CTR	11/9/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
98534	Fee-for-Service	1144261462	1144261462	1	1	GONZALES, GILBERT S MD	11/30/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70533	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
98541	Fee-for-Service	1730125030	1730125030	1	1	GARSKE, STEVEN T PT	1/22/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1914 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2203	07	06013	37.87851556	-122.0745896	Contra Costa County
98542	Fee-for-Service	1427786862	1427786862	1	1	GRANT SERENITY HOMES OF	9/17/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	PASADENA, INC.	1745 WAGNER STREET	None	PASADENA	CA	91106	1329	19	06037	34.15355361	-118.1146203	Los Angeles County
98558	Fee-for-Service	1194925842	1194925842	1	1	GUEVARA, ADRIANA LCSW	1/27/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	157 VAN NESS AVE	2	SANTA CRUZ	CA	95060	4200	44	06087	36.96847527	-122.0373569	Santa Cruz County
98590	Fee-for-Service	1184963456	1184963456	1	1	GARCIA, NICOLE LMFT	9/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
98612	Fee-for-Service	1760297352	1760297352	1	1	GERALDO DA SILVA COUCEIRO, A	3/19/2025	2085P0229X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	NA FILIPA MD	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
98628	Fee-for-Service	1588644207	1588644207	1	1	GERKE, HENNING 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
98631	Fee-for-Service	1750361200	1750361200	1	1	GERSTENFELD, TAMMY S DO	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	5345	66	Emergency Medicine (Urgent Care)	0	In state provider	None	637 LUCAS AVE	STE 207	LOS ANGELES	CA	90017	1912	19	06037	34.05351827	-118.2646017	Los Angeles County
98634	Fee-for-Service	1023660875	1023660875	2	1	GOODLIFE RX LLC	1/5/2021	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25 N 14TH ST	STE 110	SAN JOSE	CA	95112	6208	43	06085	37.34293357	-121.8775187	Santa Clara County
98635	Fee-for-Service	1760423891	1760423891	1	1	GARCIA, PAMELA P DO	7/16/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	8132	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
98655	Fee-for-Service	1316346349	1316346349	1	1	GORMLEY, ERICA N LMFT	1/27/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1160 SUNSET BLVD	None	ROCKLIN	CA	95677	3772	31	06061	38.8125	-121.2848698	Placer County
98659	Fee-for-Service	1902830060	1902830060	1	1	GONZALEZ, AIMEE MD	6/5/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51815	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
98665	Fee-for-Service	1477828267	1477828267	1	1	GARG, RONAK B MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120497	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
98670	Fee-for-Service	1124365309	1124365309	1	1	GAMACHE, MEGHAN E NP	3/14/2018	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
98671	Fee-for-Service	1346308764	1346308764	1	1	GRUENLOH, KELLY C	8/17/2007	No Taxonomy Provided	NA	None	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
98696	Fee-for-Service	1508131590	1508131590	1	1	GOGNA, KARUN MD	7/15/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	152027	36	Psychiatry	0	In state provider	None	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
98737	Fee-for-Service	1124176953	1124176953	1	1	GLEESON, MICHAEL P MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82246	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
98739	Fee-for-Service	1821239112	1821239112	1	1	GARDNER FAMILY HEALTH	12/7/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	7526 MONTEREY ST	None	GILROY	CA	95020	5826	43	06085	37.00852861	-121.5694352	Santa Clara County
98788	Fee-for-Service	1205847746	1205847746	1	1	GOLDEN STATE EYE MEDICAL	1/14/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	30637	18	Ophthalmology	0	In state provider	GROUP INC	1001 TOWER WAY	STE 150	BAKERSFIELD	CA	93309	1586	15	06029	35.36363292	-119.0611362	Kern County
98791	Fee-for-Service	1316023831	1316023831	1	1	GUZMAN, HECTOR MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73951	05	Anesthesiology	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
98794	Fee-for-Service	1528042512	1528042512	1	1	GOLDEN VALLEY HEALTH CTR	8/31/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
98819	Fee-for-Service	1144261462	1144261462	1	1	GONZALES, GILBERT S MD	11/30/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70533	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
98823	Fee-for-Service	1801998133	1801998133	1	1	GARCIA ARISTIZABAL, LUZ ADRI	9/27/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80314	None	None	0	In state provider	ANA MD	2066 E COPPER AVE	101, 102, 104, 105	FRESNO	CA	93730	5408	10	06019	36.89569948	-119.7455119	Fresno County
98825	Fee-for-Service	1003837766	1003837766	1	1	GWYNN, DAVID R MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86237	18	Ophthalmology	0	In state provider	None	607 N CENTRAL AVE	# 105	GLENDALE	CA	91203	1804	19	06037	34.153974	-118.2579675	Los Angeles County
98830	Fee-for-Service	1033944848	1033944848	1	1	GARCIA, AARON PT	1/15/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1700 E BULLARD AVE	102	FRESNO	CA	93710	5866	10	06019	36.82318621	-119.7562623	Fresno County
98861	Fee-for-Service	1770901985	1770901985	1	1	GABRIELYAN, ARAM MD	12/13/2019	207R00000X	NA	Other	026	PHYSICIANS	151720	41	Internal Medicine	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
98918	Fee-for-Service	1750361200	1750361200	1	1	GERSTENFELD, TAMMY S DO	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	5345	01	General Practice	0	In state provider	None	637 LUCAS AVE	STE 207	LOS ANGELES	CA	90017	1912	19	06037	34.05351827	-118.2646017	Los Angeles County
98923	Fee-for-Service	1629147343	1629147343	1	1	GRANTS PASS SURGICAL	7/14/2008	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	1	Border provider	ASSOCIATES PC	1600 NW 6TH ST	STE#N	GRANTS PASS	OR	97526	1094	00	None	42.45662001	-123.3226346	Josephine County
98946	Fee-for-Service	1699032540	1699032540	1	1	GORDON, BAHAREH T MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130799	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
98978	Fee-for-Service	1992966493	1992966493	1	1	GOMEZ-LEONARDELLI, DOMINIC T	3/16/2022	171000000X	NA	Other	026	PHYSICIANS	162952	None	None	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
98986	Fee-for-Service	1770105322	1770105322	1	1	GOLDEN TOUCH HOSPICE CARE	1/7/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	11030 ARROW ROUTE	STE 211	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
99005	Fee-for-Service	1952336752	1952336752	1	1	GREEN, LYDIA M MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68297	01	General Practice	0	In state provider	None	4837 N HUNTINGTON DRIVE	None	LOS ANGELES	CA	90032	1953	19	06037	34.0860874	-118.1788432	Los Angeles County
99010	Fee-for-Service	1194760082	1194760082	1	1	GARFIELD BEACH CVS LLC	8/10/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10011 ADAMS AVE	None	HUNTINGTON BEACH	CA	92646	4904	30	06059	33.674157	-117.9533385	Orange County
99021	Fee-for-Service	1033538350	1033538350	1	1	GRAY, IGA N MD	3/29/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	174875	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
99059	Fee-for-Service	1235717273	1235717273	1	1	GONZALEZ, DANIEL M MD	7/12/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
99072	Fee-for-Service	1982195665	1982195665	1	1	GIBBONS, MEADOW CCC-SLP	10/26/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8030 SOQUEL AVE	100	SANTA CRUZ	CA	95062	2096	44	06087	36.98236333	-121.9670379	Santa Cruz County
99077	Fee-for-Service	1205847746	1205847746	1	1	GOLDEN STATE EYE MEDICAL	1/20/2017	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	1001 TOWER WAY	STE 150	BAKERSFIELD	CA	93309	1586	15	06029	35.36363292	-119.0611362	Kern County
99082	Fee-for-Service	1528042512	1528042512	1	1	GOLDEN VALLEY HEALTH CTR	11/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
99087	Fee-for-Service	1629585062	1629585062	1	1	GUERRERO, ALYSSA	10/31/2023	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
99101	Fee-for-Service	1780751644	1780751644	1	1	GARLITOS, JUANITO M MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38768	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
99132	Fee-for-Service	1033303524	1033303524	1	1	GALOVICH, JUSTIN M MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109026	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
99159	Fee-for-Service	1811921752	1811921752	1	1	GLENDORA SURGERY CENTER	10/14/2020	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	541 S PASADENA AVE	101	GLENDORA	CA	91741	6232	19	06037	34.1294999	-117.8602252	Los Angeles County
99164	Fee-for-Service	1376660704	1376660704	1	1	GAIR, ERICKA M DO	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	9980	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
99169	Fee-for-Service	1457619363	1457619363	1	1	GUTIERREZ, PATRICIA LCSW	1/31/2023	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
99237	Fee-for-Service	1457039331	1457039331	1	1	GREEN ANESTHESIA	9/22/2023	193400000X	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
99245	Fee-for-Service	1790404929	1790404929	1	1	GARFIELD BEACH CVS, L.L.C.	6/29/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	111 W MCKNIGHT WAY	None	GRASS VALLEY	CA	95949	9637	29	06057	39.19958444	-121.0610567	Nevada County
99277	Fee-for-Service	1770105322	1770105322	1	1	GOLDEN TOUCH HOSPICE CARE	1/7/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	11030 ARROW ROUTE	STE 211	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
99316	Fee-for-Service	1609811504	1609811504	1	1	GARFIELD BEACH CVS, LLC	1/27/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1645 EAST 103RD ST	None	LOS ANGELES	CA	90002	2923	19	06037	33.94476	-118.2444615	Los Angeles County
99318	Fee-for-Service	1396995833	1396995833	1	1	GANEZER, EMILIYA S NP	6/6/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2670 GAGE AVE	STE 4	HUNTINGTON PARK	CA	90255	4176	19	06037	33.98161649	-118.2228885	Los Angeles County
99356	Fee-for-Service	1881073039	1881073039	1	1	GOLDSTEIN, MAX D MD	10/24/2017	207P00000X	NA	Other	026	PHYSICIANS	145201	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
99360	Fee-for-Service	1285618736	1285618736	1	1	GOOD HOPE HOME HEALTH	6/5/1996	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	484 E FOOTHILL BLVD	None	UPLAND	CA	91786	3953	36	06071	34.10681855	-117.6444855	San Bernardino County
99365	Fee-for-Service	1205847746	1205847746	1	1	GOLDEN STATE EYE MEDICAL	1/20/2017	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1001 TOWER WAY	STE 150	BAKERSFIELD	CA	93309	1586	15	06029	35.36363292	-119.0611362	Kern County
99422	Fee-for-Service	1033303524	1033303524	1	1	GALOVICH, JUSTIN M MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109026	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
99430	Fee-for-Service	1306856299	1306856299	1	1	GOLDSTEIN, JACQUES	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8268 164TH ST	None	JAMAICA	NY	11432	1121	00	None	40.717917	-73.804086	Queens County
99453	Fee-for-Service	1003043712	1003043712	1	1	GOROKHOV, IGOR MD	2/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106075	41	Internal Medicine	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
99517	Fee-for-Service	1043574403	1043574403	1	1	GUPTA, ANUSHREE MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126104	01	General Practice	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
99521	Fee-for-Service	1922109560	1922109560	1	1	GISLA, JOHN F JR MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61317	01	General Practice	0	In state provider	None	8120 TIMBERLAKE WAY	STE 109	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
99522	Fee-for-Service	1992715155	1992715155	1	1	GONDHA, CHETAN V MD	11/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113015	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
99537	Fee-for-Service	1639371412	1639371412	1	1	GREENE, YOLONDA S LCSW	4/18/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15640	-	NOT APPLICABLE	0	In state provider	None	34 DAVI AVE	None	PITTSBURG	CA	94565	3701	07	06013	38.02382226	-121.8913364	Contra Costa County
99545	Fee-for-Service	1962425157	1962425157	1	1	GERVIN, LISA N MD	9/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65261	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
99570	Fee-for-Service	1588264782	1588264782	1	1	GREEN LIFE HOSPICE INC	5/27/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE B 103A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
99580	Fee-for-Service	1275763922	1275763922	1	1	GILLENWATER, TIMOTHY J MD	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108333	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
99593	Fee-for-Service	1417345695	1417345695	1	1	GREENBERG, HEATHER LPCC	4/24/2025	No Taxonomy Provided	NA	None	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
99607	Fee-for-Service	1679621668	1679621668	1	1	GHODSI-SHIRAZI, ANOOSHA	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90225	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
99609	Fee-for-Service	1023055431	1023055431	1	1	GEROW, FRANK T MD	1/28/2023	207XP3100X	NA	Orthopedic Surgery	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
99623	Fee-for-Service	1992712616	1992712616	1	1	GILL, VIVEK S MD	10/6/2011	207R00000X	NA	Other	026	PHYSICIANS	61054	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4383 PHELAN RD	None	PHELAN	CA	92371	7675	36	06071	34.4263017	-117.5661457	San Bernardino County
99652	Fee-for-Service	1518192541	1518192541	2	1	GARFIELD BEACH CVS LLC	12/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27818 CLINTON KEITH RD	None	MURRIETA	CA	92562	8554	33	06065	33.604191	-117.172989	Riverside County
99739	Fee-for-Service	1720465396	1720465396	1	1	GRISSOM, MURRAY J MD	7/17/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147782	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
99750	Fee-for-Service	1356864540	1356864540	1	1	GABRILLO, JOSEPHINE J NP	1/17/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1200 DISCOVERY DR	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
99767	Fee-for-Service	1790711034	1790711034	1	1	GALANG, GERARDO S MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96206	41	Internal Medicine	0	In state provider	None	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
99783	Fee-for-Service	1720098429	1720098429	1	1	GORCHOFF, DAVID B MD	12/1/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	58183	08	Family Practice	0	In state provider	None	16319 THIRD STREET	None	GUERNEVILLE	CA	95446	0000	49	06097	38.50256994	-122.9992051	Sonoma County
99791	Fee-for-Service	1598116857	1598116857	1	1	GARG, DEEPAK MD	7/1/2020	207R00000X	NA	Other	026	PHYSICIANS	161965	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
99802	Fee-for-Service	1740683002	1740683002	1	1	GARST, JAYME A CRNA	1/9/2015	No Taxonomy Provided	NA	None	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
99811	Fee-for-Service	1497709125	1497709125	1	1	GRGUREVIC, MIROSLAV MD	3/1/1994	207L00000X	NA	Other	026	PHYSICIANS	40300	05	Anesthesiology	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
99831	Fee-for-Service	1013276484	1013276484	1	1	GRIJALVA, VERONICA J MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125767	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
99837	Fee-for-Service	1841498847	1841498847	1	1	GARCIA, IVAN A MD	1/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99758	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
99854	Fee-for-Service	1588264782	1588264782	1	1	GREEN LIFE HOSPICE INC	5/27/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE B 103A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
99869	Fee-for-Service	1982145074	1982145074	1	1	GUPTA, ANJALI MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142815	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
99870	Fee-for-Service	1184011876	1184011876	1	1	GREENE, MARIE-CHRISTINE LMF	8/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
99871	Fee-for-Service	1588199392	1588199392	1	1	GJORAAS, JENNY M	3/20/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
99886	Fee-for-Service	1508398702	1508398702	1	1	GARCIA, EDUARDO MD	5/10/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159799	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
99905	Fee-for-Service	1417967480	1417967480	1	1	GOSCH, CHRISTINE E DPM	2/27/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
99911	Fee-for-Service	1992712616	1992712616	1	1	GILL, VIVEK S MD	10/6/2011	207R00000X	NA	Other	026	PHYSICIANS	61054	41	Internal Medicine	0	In state provider	None	4383 PHELAN RD	None	PHELAN	CA	92371	7675	36	06071	34.4263017	-117.5661457	San Bernardino County
99937	Fee-for-Service	1477934149	1477934149	1	1	GREENBERG, SCOTT A MD	6/26/2020	208800000X	NA	Other	026	PHYSICIANS	167540	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
99959	Fee-for-Service	1891982948	1891982948	1	1	GILL, TANYA A OD INC	4/30/2008	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1960 BROADWAY	None	OAKLAND	CA	94612	2206	01	06001	37.80861936	-122.2684225	Alameda County
100013	Fee-for-Service	1174785331	1174785331	1	1	GARFIELD BEACH CVS,LLC	10/31/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	42150 JACKSON ST. #A	None	INDIO	CA	92203	9736	33	06065	33.74338766	-116.2166041	Riverside County
100018	Fee-for-Service	1235892134	1235892134	1	1	GO, LACRISHA J CNP	12/27/2021	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
100041	Fee-for-Service	1518261676	1518261676	1	1	GRAVES, MALAIKA E MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119939	None	None	0	In state provider	None	8787 HALL ROAD	None	LAMONT	CA	93241	1953	15	06029	35.25969451	-118.908099	Kern County
100066	Fee-for-Service	1295757821	1295757821	2	1	GARFIELD BEACH CVS LLC	10/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26762 PORTOLA PKWY	None	FOOTHILL RANCH	CA	92610	1712	30	06059	33.676299	-117.6645105	Orange County
100081	Fee-for-Service	1245655216	1245655216	2	1	GARCIA, CORINE Y LMFT	1/15/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	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
100116	Fee-for-Service	1285138149	1285138149	1	1	GARCIA, ANGELICA NP	6/14/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
100176	Fee-for-Service	1124353685	1124353685	1	1	GRANT, ROSS D MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114647	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
100199	Fee-for-Service	1992712616	1992712616	1	1	GILL, VIVEK S MD	10/6/2011	207R00000X	NA	Other	026	PHYSICIANS	61054	08	Family Practice	0	In state provider	None	4383 PHELAN RD	None	PHELAN	CA	92371	7675	36	06071	34.4263017	-117.5661457	San Bernardino County
100285	Fee-for-Service	1962680421	1962680421	1	18	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 570	MODESTO	CA	95350	4574	50	06099	37.666233	-120.993933	Stanislaus County
100289	Fee-for-Service	1477529279	1477529279	1	1	GUPTA, AJAY MD	7/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	50579	45	Nephrology (Renal-Kidney)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
100290	Fee-for-Service	1376700963	1376700963	1	1	GHATORA, PREETI S MD	9/30/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	86168	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
100293	Fee-for-Service	1164463337	1164463337	1	1	GOLDBERG, DAVID PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4153 1ST AVE	None	SAN DIEGO	CA	92103	2047	37	06073	32.752953	-117.1641215	San Diego County
100307	Fee-for-Service	1992948855	1992948855	1	1	GILLIS, VICTORIA F MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113165	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100327	Fee-for-Service	1770917684	1770917684	1	1	GONZALEZ TORRES, JAIME MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137538	01	General Practice	0	In state provider	None	700 N BRAND BLVD	SUITE 1400	GLENDALE	CA	91203	4263	19	06037	34.15710327	-118.2549428	Los Angeles County
100328	Fee-for-Service	1497168348	1497168348	1	1	GEORGINA MARIE GARZA	3/8/2020	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1141 SHAW AVE	STE 203	FRESNO	CA	93711	3713	10	06019	36.80826902	-119.8120449	Fresno County
100376	Fee-for-Service	1164613808	1164613808	1	1	GOLDEN, JULIA B DO	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12171	34	Urology and Urological Surgery	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
100434	Fee-for-Service	1497919179	1497919179	1	1	GUNNALA, VISHAL MD	9/26/2016	No Taxonomy Provided	NA	None	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
100443	Fee-for-Service	1154513877	1154513877	1	1	GOMEZ, CESAR D MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100269	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
100444	Fee-for-Service	1558325837	1558325837	1	1	GUNALP, FEZA N MD	2/18/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
100472	Fee-for-Service	1336126184	1336126184	1	1	GAYNOR, LAURENCE 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	7700 S BROADWAY	None	LITTLETON	CO	80122	2602	00	None	39.576573	-104.9859	Arapahoe County
100473	Fee-for-Service	1255083093	1255083093	1	1	GALAXY PHARMACY INC	7/22/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E ANAHEIM ST	STE 106	LONG BEACH	CA	90813	5514	19	06037	33.78258054	-118.1744415	Los Angeles County
100480	Fee-for-Service	1063694834	1063694834	1	1	GRIFFITH-TATE, ELIZABETH	3/30/2023	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
100575	Fee-for-Service	1962680421	1962680421	1	18	GOLDEN VALLEY HEALTH CENTERS	2/1/2025	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 570	MODESTO	CA	95350	4574	50	06099	37.666233	-120.993933	Stanislaus County
100628	Fee-for-Service	1558358028	1558358028	1	1	GURROLA, EDWARD M II MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	62888	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
100683	Fee-for-Service	1558892018	1558892018	1	1	GIBSON, CLAIRE S MD	4/8/2020	390200000X	NA	Other	026	PHYSICIANS	160072	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
100714	Fee-for-Service	1710058698	1710058698	1	1	GEE, JOEY R DO	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7576	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
100723	Fee-for-Service	1255415378	1255415378	2	1	GDC ENTERPRISES INC	5/10/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4477 118TH ST	100	HAWTHORNE	CA	90250	2255	19	06037	33.92734752	-118.354221	Los Angeles County
100732	Fee-for-Service	1821834193	1821834193	1	1	GRIFFIN, ASHLEY NP	9/17/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
100742	Fee-for-Service	1962680421	1962680421	1	10	GOLDEN VALLEY HEALTH CENTERS	7/12/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E104	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
100758	Fee-for-Service	1962497271	1962497271	1	1	GOLDBERG, MICHAL MD	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144211	40	Pediatrics	0	In state provider	None	16899 W BERNARDO DR	None	SAN DIEGO	CA	92127	1603	37	06073	33.02108288	-117.0810562	San Diego County
100769	Fee-for-Service	1962680421	1962680421	1	13	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1199 DELBON AVENUE	SUITE 2	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
100857	Fee-for-Service	1316189426	1316189426	1	1	GONG, HUI MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119513	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
100964	Fee-for-Service	1174950505	1174950505	1	1	GOOD CHOICE HOME HEALTH INC	11/16/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1117 N HOLLYWOOD WAY	SUITE B	BURBANK	CA	91505	2528	19	06037	34.17006439	-118.3481038	Los Angeles County
100992	Fee-for-Service	1356975684	1356975684	1	1	GHC OF EL CAJON LLC	3/1/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	675 E BRADLEY AVE	None	EL CAJON	CA	92021	3110	37	06073	32.81908596	-116.9522793	San Diego County
101029	Fee-for-Service	1962680421	1962680421	1	10	GOLDEN VALLEY HEALTH CENTERS	7/12/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E104	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
101050	Fee-for-Service	1760702633	1760702633	1	1	GARDNER, KATHERINE T MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118533	01	General Practice	0	In state provider	None	3201 DATA DRIVE	None	RANCHO CORDOVA	CA	95670	7374	34	06067	38.58561	-121.2838875	Sacramento County
101053	Fee-for-Service	1093246662	1093246662	1	1	GILANI, SAYYED O MD	10/4/2022	208VP0000X	NA	Other	026	PHYSICIANS	177171	None	None	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
101057	Fee-for-Service	1962680421	1962680421	1	13	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1199 DELBON AVENUE	SUITE 2	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
101080	Fee-for-Service	1659517415	1659517415	1	1	GREENFIELD, ELIZABETH L	2/17/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	700 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
101085	Fee-for-Service	1528487501	1528487501	1	1	GERETY, PADRAIC P MD	7/18/2017	207P00000X	NA	Other	026	PHYSICIANS	148070	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
101103	Fee-for-Service	1447781596	1447781596	1	1	GHAFIL, CAMERON A MD	7/6/2020	208600000X	NA	General Surgery	026	PHYSICIANS	161684	02	General Surgery	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
101133	Fee-for-Service	1083980635	1083980635	1	1	GALLARDO, GEORGE K MD	1/10/2020	207R00000X	NA	Other	026	PHYSICIANS	127268	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
101159	Fee-for-Service	1295120616	1295120616	1	1	GREEN, DANIEL J MD	11/26/2018	208M00000X	NA	Other	026	PHYSICIANS	156601	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
101175	Fee-for-Service	1730270422	1730270422	1	1	GILBERT, GARY G MD	3/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	33574	05	Anesthesiology	0	In state provider	None	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
101201	Fee-for-Service	1710146204	1710146204	1	1	GOLDEN, DEREK J MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112177	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
101209	Fee-for-Service	1780046847	1780046847	1	1	GERSHENSON, JONATHAN P DO	9/22/2022	207U00000X	NA	Other	026	PHYSICIANS	17270	None	None	0	In state provider	None	1380 LEAD HILL RD	SUITE 100	ROSEVILLE	CA	95661	2997	31	06061	38.74953449	-121.2601832	Placer County
101219	Fee-for-Service	1518184621	1518184621	1	1	GRANITE WELLNESS CENTERS	3/5/2018	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	12125 SHALE RIDGE LN	None	AUBURN	CA	95602	8880	31	06061	38.9530355	-121.0978845	Placer County
101271	Fee-for-Service	1902104722	1902104722	1	1	GARFIELD BEACH CVS, LLC	11/6/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1771 PLEASANT GROVE BLVD	SUITE 100	ROSEVILLE	CA	95747	8720	31	06061	38.76614254	-121.357647	Placer County
101295	Fee-for-Service	1912105677	1912105677	1	1	GLASSNER, STUART J DO	7/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14656	13	Neurology (M.D. only)	0	In state provider	None	45 RIVER PARK PLACE WEST	STE 104	FRESNO	CA	93720	1565	10	06019	36.85901695	-119.7893872	Fresno County
101300	Fee-for-Service	1609380955	1609380955	1	1	GARAY, VERONICA NP	2/13/2023	363L00000X	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
101317	Fee-for-Service	1215321955	1215321955	1	1	GONZALEZ-GARCIA, CAROLINA L	10/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
101338	Fee-for-Service	1164414975	1164414975	1	1	GRANOT, ALLISON N	10/2/2007	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
101339	Fee-for-Service	1760702633	1760702633	1	1	GARDNER, KATHERINE T MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118533	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
101362	Fee-for-Service	1821292152	1821292152	1	1	GREWALL, JATINDER P MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99543	34	Urology and Urological Surgery	0	In state provider	None	7014 N WHITNEY AVE	None	FRESNO	CA	93720	0155	10	06019	36.83834474	-119.7423213	Fresno County
101403	Fee-for-Service	1063453934	1063453934	1	1	GARFIELD BEACH CVS, LLC	10/20/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11831 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	3013	19	06037	33.926688	-118.352726	Los Angeles County
101440	Fee-for-Service	1457731333	1457731333	1	1	GHARABEKI, SHARIS OD	2/24/2016	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
101465	Fee-for-Service	1619660800	1619660800	1	1	GREAT VALLEY ACADEMY	7/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	3200 TULLY ROAD	None	MODESTO	CA	95350	0811	50	06099	37.6853555	-121.0123876	Stanislaus County
101470	Fee-for-Service	1083703201	1083703201	1	1	GUO, ALEXANDER C MD	3/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74167	30	Radiology	0	In state provider	None	652 PETALUMA AVE	STE I	SEBASTOPOL	CA	95472	4266	49	06097	38.39662494	-122.8201368	Sonoma County
101501	Fee-for-Service	1205075298	1205075298	1	1	GADIYARAM, VARUNA K MD	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54291	41	Internal Medicine	0	In state provider	None	501 WASHINGTON ST	STE 600	SAN DIEGO	CA	92103	2239	37	06073	32.74986289	-117.1599343	San Diego County
101543	Fee-for-Service	1467150581	1467150581	1	1	GUZMAN ALVAREZ, STEPHANIE L	10/2/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	PCC	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
101555	Fee-for-Service	1104837657	1104837657	1	1	GORDON, KENNETH L MD INC	9/23/1996	207W00000X	NA	Ophthalmology	026	PHYSICIANS	36598	18	Ophthalmology	0	In state provider	None	2080 CENTURY PARK E	STE 800	LOS ANGELES	CA	90067	2011	19	06037	34.05887194	-118.4122914	Los Angeles County
101560	Fee-for-Service	1013172477	1013172477	1	1	GREEN, HARRY	11/29/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	2020	01	06001	37.87133398	-122.2545466	Alameda County
101595	Fee-for-Service	1457883605	1457883605	1	1	GILBERT, DEREK MD	7/24/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	173547	None	None	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
101615	Fee-for-Service	1619451754	1619451754	1	1	GARCIA, MICHELLE LCSW	9/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6000 SEPULVEDA BLVD	E10	CULVER CITY	CA	90230	6421	19	06037	33.985512	-118.393524	Los Angeles County
101633	Fee-for-Service	1841542677	1841542677	1	1	GONZALEZ, VERONICA LMFT	11/7/2022	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
101642	Fee-for-Service	1386093136	1386093136	1	1	GRIFFARD, JARED MD	11/28/2023	208600000X	NA	General Surgery	026	PHYSICIANS	-	None	None	1	Border provider	None	1707 W CHARLESTON BLVD	SUITE 160	LAS VEGAS	NV	89102	2354	00	None	36.15879353	-115.1643015	Clark County
101684	Fee-for-Service	1457506792	1457506792	1	1	GUPTA, CHARU MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121862	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
101733	Fee-for-Service	1508834359	1508834359	1	1	GREENE, 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	200 NAT WASHINGTON WAY	None	EPHRATA	WA	98823	1982	00	None	47.31503673	-119.5461579	Grant County
101734	Fee-for-Service	1073809109	1073809109	1	1	GARFIAS, GUADALUPE V LCSW	1/4/2022	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
101750	Fee-for-Service	1881951168	1881951168	1	1	GUZMAN, HECTOR M DO	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13825	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
101757	Fee-for-Service	1942356662	1942356662	1	1	GRUNVALD, EUGENIO R MD	9/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50471	10	Gastroenterology (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
101763	Fee-for-Service	1871523878	1871523878	1	1	GORDON, ROBERT A MD	12/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144967	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
101777	Fee-for-Service	1972506632	1972506632	1	1	GODIN, PAUL J MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	71662	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
101833	Fee-for-Service	1285092411	1285092411	1	1	GARCIA, GEORGE A III LMFT	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107258	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90807	4417	19	06037	33.8188341	-118.1923297	Los Angeles County
101840	Fee-for-Service	1609555796	1609555796	1	1	GEMECHIS, TESHAGRE	1/2/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TION	1058 FOXCHASE DR	168	SAN JOSE	CA	95123	1145	43	06085	37.25279026	-121.8731062	Santa Clara County
101851	Fee-for-Service	1083620066	1083620066	1	1	GROSS, BRIAN R MD	2/8/2015	156FX1100X	NA	Other	026	PHYSICIANS	37513	18	Ophthalmology	0	In state provider	None	25880 TOURNAMENT RD	STE 109	VALENCIA	CA	91355	2384	19	06037	34.39184204	-118.5626441	Los Angeles County
101872	Fee-for-Service	1245618115	1245618115	1	1	GARCIA, JENNIE M MD	11/6/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158944	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
101886	Fee-for-Service	1104050996	1104050996	1	1	GHANEIAN, ATOUSA MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3001 SAINT ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
101893	Fee-for-Service	1467708891	1467708891	1	1	GOPINATH, ANUPAMA MD	7/29/2021	207L00000X	NA	Other	026	PHYSICIANS	132900	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
101906	Fee-for-Service	1699041566	1699041566	1	2	GARDNER FAMILY HEALTH	3/12/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	195 E SAN FERNANDO ST	SUITE 100	SAN JOSE	CA	95112	3503	43	06085	37.33620916	-121.8852264	Santa Clara County
101926	Fee-for-Service	1992879407	1992879407	1	1	GORDON, DAVID W OD	9/15/1979	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	851 N HOLLYWOOD WAY	None	BURBANK	CA	91505	2814	19	06037	34.1661034	-118.3461652	Los Angeles County
101941	Fee-for-Service	1477659399	1477659399	1	1	GARDEN PARK CARE CENTER	5/16/1996	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	12681 HASTER ST	None	GARDEN GROVE	CA	92840	6040	30	06059	33.778494	-117.906197	Orange County
101953	Fee-for-Service	1871124222	1871124222	1	1	GADE, STEPHANIE A PHD	3/9/2020	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
101982	Fee-for-Service	1174920367	1174920367	1	1	GODLEY, JULIA J	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
102013	Fee-for-Service	1861662702	1861662702	1	1	GMOSER, MARK T PSYD	7/16/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7907 CHERRYSTONE AVE	None	PANORAMA CITY	CA	91402	6105	19	06037	34.2142645	-118.4372381	Los Angeles County
102025	Fee-for-Service	1841218492	1841218492	1	1	GOLDSTEIN, STEVEN I LMFT	12/21/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	14645	-	NOT APPLICABLE	0	In state provider	None	103 SHORELINE PKWY	None	SAN RAFAEL	CA	94901	5581	21	06041	37.9516451	-122.4933768	Marin County
102035	Fee-for-Service	1023036753	1023036753	1	1	GREGORY J BJERKE 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
102037	Fee-for-Service	1073500732	1073500732	1	1	GARCIA, MARIA I MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	55338	08	Family Practice	0	In state provider	None	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	49	06097	38.62729851	-122.8637785	Sonoma County
102061	Fee-for-Service	1972506632	1972506632	1	1	GODIN, PAUL J MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	71662	66	Emergency Medicine (Urgent Care)	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
102078	Fee-for-Service	1942385695	1942385695	1	1	GRAYCK, EVA N MD	1/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
102084	Fee-for-Service	1871877746	1871877746	1	2	GARCIA-IXCOL, JULIA LMFT	12/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	163 S AVENUE 24	STE 201	LOS ANGELES	CA	90031	2299	19	06037	34.073901	-118.2169855	Los Angeles County
102087	Fee-for-Service	1942389242	1942389242	1	1	GORDON, YVETTE M C MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	65095	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
102109	Fee-for-Service	1679025126	1679025126	1	1	GARCIA-BABASA, MARI LMFT	10/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
102158	Fee-for-Service	1659474112	1659474112	1	1	GHOSHEH, RIBHI K MD	2/9/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35270	47	Miscellaneous	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
102195	Fee-for-Service	1699041566	1699041566	1	2	GARDNER FAMILY HEALTH	3/12/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	195 E SAN FERNANDO ST	SUITE 100	SAN JOSE	CA	95112	3503	43	06085	37.33620916	-121.8852264	Santa Clara County
102211	Fee-for-Service	1669852059	1669852059	1	1	GEREIS, ANGIE PSYD	1/14/2025	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
102247	Fee-for-Service	1871603696	1871603696	1	1	GAN, RONG MD	7/21/2009	207L00000X	NA	Other	026	PHYSICIANS	84009	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
102294	Fee-for-Service	1588706105	1588706105	1	1	GHALY, SABRY F MD	2/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45755	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
102302	Fee-for-Service	1932463486	1932463486	1	1	GARG, SHILPI MD	5/12/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	2	Out of state provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
102310	Fee-for-Service	1306429865	1306429865	1	1	GENZOLI, MARISA LMFT	12/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
102319	Fee-for-Service	1669574968	1669574968	1	1	GARCIA, DON L MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	52231	08	Family Practice	0	In state provider	CLINICA MEDICA LA HABRA	1055 E LA HABRA BLVD	STE 3	LA HABRA	CA	90631	5597	30	06059	33.93189316	-117.9343627	Orange County
102334	Fee-for-Service	1508067075	1508067075	1	1	GEORGE, SHEFAA MD	12/12/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105745	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
102340	Fee-for-Service	1043497464	1043497464	1	1	GO, DIANA C MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141724	40	Pediatrics	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
102342	Fee-for-Service	1689005209	1689005209	1	1	GOEPPERT, ASHLEY NICOLE	2/20/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	540 CORELLO STREET	None	TURLOCK	CA	95380	4442	50	06099	37.49742109	-120.8177914	Stanislaus County
102367	Fee-for-Service	1962675462	1962675462	1	1	GRAY, JAMES P MD	9/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114939	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
102410	Fee-for-Service	1659315927	1659315927	1	1	GARFIELD BEACH CVS LLC	10/7/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6201 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	1111	19	06037	34.183332	-118.4662165	Los Angeles County
102419	Fee-for-Service	1154414225	1154414225	1	1	GRANT, KENNETH E MD	4/30/1989	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	60289	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
102447	Fee-for-Service	1639383847	1639383847	1	1	GOLDEN EMPIRE PATHOLOGY	9/18/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1830 FLOWER STREET	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
102464	Fee-for-Service	1073021119	1073021119	1	1	GARBER, LINDSEY M LCSW	9/24/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
102477	Fee-for-Service	1720166630	1720166630	1	1	GALAN JR, OSCAR C MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79196	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
102484	Fee-for-Service	1093944571	1093944571	1	1	GRIMM, KRISTA A MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	102892	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
102508	Fee-for-Service	1912269408	1912269408	1	1	GRIFFIN, CAROL E DO	4/3/2019	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	16542	-	NOT APPLICABLE	0	In state provider	None	1024 N STREET	None	EUREKA	CA	95501	2047	12	06023	40.79883077	-124.1563311	Humboldt County
102512	Fee-for-Service	1184705386	1184705386	1	1	GRIMM, PAUL C MD	11/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44616	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
102540	Fee-for-Service	1861988651	1861988651	1	1	GOSTINE, DAVID J MD	8/5/2023	207L00000X	NA	Other	026	PHYSICIANS	173887	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
102582	Fee-for-Service	1588706105	1588706105	1	1	GHALY, SABRY F MD	2/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45755	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
102623	Fee-for-Service	1629084199	1629084199	1	1	GOPEZ, NICHOLAS R MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98488	41	Internal Medicine	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
102630	Fee-for-Service	1689005209	1689005209	1	1	GOEPPERT, ASHLEY NICOLE	2/20/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	540 CORELLO STREET	None	TURLOCK	CA	95380	4442	50	06099	37.49742109	-120.8177914	Stanislaus County
102641	Fee-for-Service	1336180207	1336180207	1	1	GARFIELD BEACH CVS, LLC	2/13/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7100 BROADWAY	None	LEMON GROVE	CA	91945	1401	37	06073	32.74262551	-117.044127	San Diego County
102660	Fee-for-Service	1750684205	1750684205	1	1	GARFIELD BEACH CVS LLC	3/16/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23743 JACKSON AVE	None	MURRIETA	CA	92562	2264	33	06065	33.58527647	-117.2190705	Riverside County
102690	Fee-for-Service	1184941379	1184941379	1	1	GBEGNON, AKPENE A MD	1/5/2021	208600000X	NA	General Surgery	026	PHYSICIANS	170668	None	None	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
102706	Fee-for-Service	1568445419	1568445419	1	1	GROSSMONT HOSP	1/1/1995	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3077	37	06073	32.781483	-117.007182	San Diego County
102713	Fee-for-Service	1790244325	1790244325	1	1	GONZALEZ, THERESITA LCSW	9/12/2023	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
102715	Fee-for-Service	1255520623	1255520623	1	1	GUPTA, ANURAG MD	5/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91382	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	106 LA CASA VIA	STE 140	WALNUT CREEK	CA	94598	3084	07	06013	37.91255783	-122.0428047	Contra Costa County
102753	Fee-for-Service	1740506963	1740506963	1	1	GOPAL, ARUN MD	11/18/2021	207R00000X	NA	Other	026	PHYSICIANS	152047	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
102768	Fee-for-Service	1720122906	1720122906	1	1	GAUTHIER, JULIE A PHD	9/23/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2880 ZANKER ROAD	STE 203	SAN JOSE	CA	95134	2122	43	06085	37.39537119	-121.9293808	Santa Clara County
102781	Fee-for-Service	1396325080	1396325080	1	1	GRINCERI, JENNIFER B MD	7/2/2024	207R00000X	NA	Other	026	PHYSICIANS	182787	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
102783	Fee-for-Service	1982473443	1982473443	1	1	GLENN, MARLENE LMFT	2/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22777 LYONS AVE	#107	NEWHALL	CA	91324	3985	19	06037	34.38063512	-118.5316765	Los Angeles County
102800	Fee-for-Service	1184705386	1184705386	1	1	GRIMM, PAUL C MD	11/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44616	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
102803	Fee-for-Service	1033743901	1033743901	1	1	GENOA HEALTHCARE, LLC	11/17/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 MISSION AVE	SUITE 230, ROOM P1	OCEANSIDE	CA	92058	7103	37	06073	33.20296571	-117.3666126	San Diego County
102822	Fee-for-Service	1437218005	1437218005	1	1	GATES, DONALD G DO	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	5281	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
102828	Fee-for-Service	1215431747	1215431747	1	1	GEIBIG, JARED A MD	8/17/2023	390200000X	NA	Other	026	PHYSICIANS	164630	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
102873	Fee-for-Service	1104989649	1104989649	1	1	GOLDMAN, ROBERT D MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44889	07	Dermatology	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
102946	Fee-for-Service	1013367374	1013367374	1	1	GUPTA, NEEL A MD	7/26/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	164618	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
102954	Fee-for-Service	1124449442	1124449442	1	1	GOODRICH, JOHN E MD	11/24/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	149423	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
102981	Fee-for-Service	1306066527	1306066527	1	1	GARFIELD BEACH CVS, LLC	11/30/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3883 EAST FOOTHILL BLVD	None	PASADENA	CA	91107	2204	19	06037	34.15031053	-118.0683855	Los Angeles County
102988	Fee-for-Service	1003113622	1003113622	1	1	GREDVIG, CHANNING A 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
103006	Fee-for-Service	1033233671	1033233671	1	1	GABRIEL, SYNYI J MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13375	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
103065	Fee-for-Service	1780684910	1780684910	1	1	GUTIERREZ, DAVID MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50633	08	Family Practice	0	In state provider	None	15576 MAIN ST	None	HESPERIA	CA	92345	3482	36	06071	34.42464781	-117.322468	San Bernardino County
103073	Fee-for-Service	1093750994	1093750994	1	1	GARFIELD BEACH CVS, LLC	2/14/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5623 KANAN RD	None	AGOURA HILLS	CA	91301	3358	19	06037	34.15237396	-118.757941	Los Angeles County
103147	Fee-for-Service	1861630568	1861630568	1	1	GROSS, ZERRI LMFT	4/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
103159	Fee-for-Service	1104989649	1104989649	1	1	GOLDMAN, ROBERT D MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44889	01	General Practice	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
103178	Fee-for-Service	1700062346	1700062346	1	1	GENDY, ALFRED E MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123576	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1729 WEST AVE J	None	LANCASTER	CA	93534	2707	19	06037	34.68944953	-118.162287	Los Angeles County
103182	Fee-for-Service	1184682387	1184682387	1	1	GREENBERG, STEPHEN M MD	3/31/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	45339	None	None	0	In state provider	#107	8540 S SEPULVEDA BLVD	None	LOS ANGELES	CA	90045	3807	19	06037	33.96022076	-118.3961982	Los Angeles County
103261	Fee-for-Service	1053020453	1053020453	1	1	GHC OF ANBERRY, LLC	4/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	REHABILITATION CENTER	1685 SHAFFER ROAD	None	ATWATER	CA	95301	4456	24	06047	37.34901372	-120.5959455	Merced County
103278	Fee-for-Service	1043597974	1043597974	1	1	GUSTAVESON, JAN-ERIK CNP	12/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33205 TEMECULA PKWY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
103295	Fee-for-Service	1568552859	1568552859	1	1	GREENBERG, PETER MD	11/30/1985	174400000X	NA	Other	026	PHYSICIANS	48958	30	Radiology	0	In state provider	DEPT OF RAD/ONC #B3120-A	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
103325	Fee-for-Service	1760031413	1760031413	1	1	GONZALES, MELISSA JOY L LCSW	12/27/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
103332	Fee-for-Service	1104867019	1104867019	1	1	GARFIELD BEACH CVS LLC	4/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	150 E YORBA LINDA BLVD	None	PLACENTIA	CA	92870	3327	30	06059	33.88764049	-117.8640491	Orange County
103337	Fee-for-Service	1396985404	1396985404	1	1	GEM PHYSICIANS MEDICAL GROUP	7/12/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	4909 CENTENNIAL PLAZA WA	None	BAKERSFIELD	CA	93312	2011	15	06029	35.40410521	-119.0932287	Kern County
103359	Fee-for-Service	1134758055	1134758055	1	1	GIL, LADY PT	10/19/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
103368	Fee-for-Service	1619230042	1619230042	1	1	GARDINER, RACHEL N MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134493	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
103421	Fee-for-Service	1063787307	1063787307	1	1	GONZALEZ, BRADLEY M MD	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122305	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
103436	Fee-for-Service	1073055612	1073055612	1	1	GOLDEN STATE URGENT CARE PRO	12/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	640 BLOSSOM HILL ROAD	SUITE A	LOS GATOS	CA	95032	4564	43	06085	37.23571758	-121.9638232	Santa Clara County
103458	Fee-for-Service	1477673408	1477673408	1	1	GOTTERER, BRIAN PSYD	9/14/2024	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
103478	Fee-for-Service	1285818179	1285818179	1	1	GIARDI, LAURA E PHD	9/16/2016	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
103513	Fee-for-Service	1750709077	1750709077	1	1	GAHM, CLAIRE L MD	7/1/2023	2080P0204X	NA	Other	026	PHYSICIANS	185973	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
103534	Fee-for-Service	1902285208	1902285208	1	2	GENUINE DBT LICENSED	11/28/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1140 MANGROVE AVE	STE D	CHICO	CA	95926	3500	04	06007	39.74217522	-121.8384743	Butte County
103541	Fee-for-Service	1275189466	1275189466	1	1	GIDISH, TANYA NP	4/28/2020	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
103552	Fee-for-Service	1548686009	1548686009	1	1	GEE DELGADO, WENDY NP	9/29/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	604597	-	NOT APPLICABLE	0	In state provider	None	10850 MACARTHUR BLVD	STE 200	OAKLAND	CA	94605	5266	01	06001	37.7414325	-122.1498379	Alameda County
103621	Fee-for-Service	1316162001	1316162001	1	1	GROVER, AMY R MD	7/4/2014	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
103632	Fee-for-Service	1861547192	1861547192	1	1	GUERRA MORENO, JHON A MD	9/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55365	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
103641	Fee-for-Service	1821387879	1821387879	1	1	GIMENEZ QUEROL, CLIFFORD A	9/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131744	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
103675	Fee-for-Service	1851783146	1851783146	1	1	GUO, LIANA J	4/25/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
103699	Fee-for-Service	1215967906	1215967906	1	1	GAIDRY, JOHN E MD	10/31/1991	207R00000X	NA	Other	026	PHYSICIANS	44411	41	Internal Medicine	0	In state provider	None	4501 MISSION BAY DR	STE C	SAN DIEGO	CA	92109	4923	37	06073	32.80307971	-117.2166446	San Diego County
103708	Fee-for-Service	1740305242	1740305242	1	1	GOTT, JEFFREY L CRNA	6/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
103713	Fee-for-Service	1326205782	1326205782	1	1	GUTHMILLER, KEVIN B MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	101557	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
103725	Fee-for-Service	1770147266	1770147266	1	1	GALSTIAN, HEGHINEH	8/23/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185634	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
103768	Fee-for-Service	1780798736	1780798736	1	1	GOPALAN, SAROJA MD	9/22/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30294	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
103772	Fee-for-Service	1679985675	1679985675	1	1	GALICIA, LORELIE B MD	11/27/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144978	08	Family Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
103779	Fee-for-Service	1376895615	1376895615	1	1	GHATTAS, MEDHAT L OT	6/25/2018	225X00000X	NA	Other	019	OCCUPATIONAL 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
103800	Fee-for-Service	1144344250	1144344250	1	1	GONZALEZ, VANESSA Y LMFT	11/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
103810	Fee-for-Service	1710906375	1710906375	1	1	GREENBERG, MARK MD	3/31/1988	207L00000X	NA	Other	026	PHYSICIANS	63733	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
103830	Fee-for-Service	1477591154	1477591154	1	1	GIRGUIS, MARK S MD	5/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82528	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
103839	Fee-for-Service	1588715007	1588715007	1	1	GALLEGOS, YOLANDA L LCSW	5/26/2021	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
103866	Fee-for-Service	1154480721	1154480721	1	1	GOW, MARK W MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	53511	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
103880	Fee-for-Service	1770649261	1770649261	1	1	GHAFFARI, ARMAND MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96925	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
103891	Fee-for-Service	1598993487	1598993487	1	1	GAGLANI, SASHA C MD	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138639	40	Pediatrics	0	In state provider	None	25395 HANCOCK AVE	STE 250	MURRIETA	CA	92562	9009	33	06065	33.5591482	-117.185187	Riverside County
103922	Fee-for-Service	1861547192	1861547192	1	1	GUERRA MORENO, JHON A MD	9/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55365	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
103933	Fee-for-Service	1912525791	1912525791	1	1	GEORGINA INES LAMPHERE A PRO	10/8/2020	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	FESSIONAL PSYCHOLOGY COR	10832 LAUREL ST	STE 102	RANCHO CUCAMONGA	CA	91730	7688	36	06071	34.10486789	-117.5684863	San Bernardino County
103941	Fee-for-Service	1912424300	1912424300	1	1	GUARDIAN FLIGHT LLC	1/6/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	141 W 40TH ST	None	YUMA	AZ	85365	9641	00	None	32.654331	-114.62067	Yuma County
103943	Fee-for-Service	1821092685	1821092685	1	1	GHAFFARI, SASAN MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87173	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3080 BRISTOL STREET	SUITE 600	COSTA MESA	CA	92626	7341	30	06059	33.68480996	-117.8854767	Orange County
103990	Fee-for-Service	1215967906	1215967906	1	1	GAIDRY, JOHN E MD	10/31/1991	207R00000X	NA	Other	026	PHYSICIANS	44411	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4501 MISSION BAY DR	STE C	SAN DIEGO	CA	92109	4923	37	06073	32.80307971	-117.2166446	San Diego County
104014	Fee-for-Service	1407985534	1407985534	2	1	GARDNER FAMILY HEALTH	2/21/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	NETWORK, INC	195 E VIRGINIA ST	None	SAN JOSE	CA	95112	5844	43	06085	37.32593057	-121.8777002	Santa Clara County
104072	Fee-for-Service	1831245810	1831245810	1	1	GUPTA, PAWAN K MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53988	42	Nuclear Medicine	0	In state provider	None	8700 BEVERLY BLVD	STE 5431	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
104079	Fee-for-Service	1871721043	1871721043	1	1	GREEN, JANELLE P DPM	4/17/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	795 EAST SECOND STREET	SUITE 7	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
104089	Fee-for-Service	1700104320	1700104320	1	1	GIFFORD, ROBERT C DPM	9/11/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6405 DAY STREET	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
104096	Fee-for-Service	1407827405	1407827405	1	1	GELLIN, GERALD A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	20774	07	Dermatology	0	In state provider	None	3838 CALIFORNIA ST	RM 805	SAN FRANCISCO	CA	94118	1510	38	06075	37.78591809	-122.4575439	San Francisco County
104104	Fee-for-Service	1689037285	1689037285	1	1	GADDY, BRYAN MD	7/15/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	169103	36	Psychiatry	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
104136	Fee-for-Service	1902281009	1902281009	1	1	GALEN INPATIENT PHYSICIANS P	10/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
104182	Fee-for-Service	1457889776	1457889776	1	1	GONZALEZ, JUSTINE A OD	12/14/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11245 E WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
104199	Fee-for-Service	1154392561	1154392561	1	1	GRANT, RICHARD W MD	3/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55110	41	Internal Medicine	0	In state provider	None	3801 HOWE STREET	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
104201	Fee-for-Service	1841391042	1841391042	1	1	GANDHI, PRAFULL MD	2/14/2025	207R00000X	NA	Other	026	PHYSICIANS	187070	08	Family Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
104224	Fee-for-Service	1942519574	1942519574	1	1	GILBERT, CAROL L	2/16/2011	No Taxonomy Provided	NA	None	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
104231	Fee-for-Service	1427190487	1427190487	1	1	GAREWAL, JAGDEEP S	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64095	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
104261	Fee-for-Service	1992984991	1992984991	1	1	GOLDENBERG, VIKTORIYA OD	9/21/2007	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY CORPORATION	6433 FALLBROOK AVENUE	None	WEST HILLS	CA	91307	3543	19	06037	34.187778	-118.62621	Los Angeles County
104262	Fee-for-Service	1972967008	1972967008	1	1	GARDNER, IVY MD	7/23/2024	208C00000X	NA	General Surgery	026	PHYSICIANS	185167	02	General Surgery	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
104278	Fee-for-Service	1215967906	1215967906	1	1	GAIDRY, JOHN E MD	10/31/1991	207R00000X	NA	Other	026	PHYSICIANS	44411	08	Family Practice	0	In state provider	None	4501 MISSION BAY DR	STE C	SAN DIEGO	CA	92109	4923	37	06073	32.80307971	-117.2166446	San Diego County
104282	Fee-for-Service	1841633690	1841633690	1	1	GREENFIELD, BRYAN W MD	6/1/2021	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
104302	Fee-for-Service	1407985534	1407985534	2	1	GARDNER FAMILY HEALTH	2/21/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	NETWORK, INC	195 E VIRGINIA ST	None	SAN JOSE	CA	95112	5844	43	06085	37.32593057	-121.8777002	Santa Clara County
104316	Fee-for-Service	1225180367	1225180367	1	1	GENTRY, DAVID W MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95055	42	Nuclear Medicine	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
104344	Fee-for-Service	1851375398	1851375398	1	1	GOHIL, SHRUTI K MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89242	41	Internal Medicine	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
104356	Fee-for-Service	1316906225	1316906225	1	1	GELERIS, ANDREW M MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44192	13	Neurology (M.D. only)	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
104382	Fee-for-Service	1144894882	1144894882	1	1	GONDARA, NISCHINT MD	7/2/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190211	08	Family Practice	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
104387	Fee-for-Service	1407827405	1407827405	1	1	GELLIN, GERALD A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	20774	41	Internal Medicine	0	In state provider	None	3838 CALIFORNIA ST	RM 805	SAN FRANCISCO	CA	94118	1510	38	06075	37.78591809	-122.4575439	San Francisco County
104397	Fee-for-Service	1992472203	1992472203	1	1	GENOA HEALTHCARE LLC	3/1/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2008 N GAREY AVENUE	SUITES 1A AND 1B	POMONA	CA	91767	2722	19	06037	34.08295003	-117.7528173	Los Angeles County
104402	Fee-for-Service	1548567498	1548567498	1	15	GENESIS HEALTHCARE PARTNERS	11/1/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	PC	23600 TELO AVE	220	TORRANCE	CA	90505	4035	19	06037	33.81215054	-118.3384029	Los Angeles County
104426	Fee-for-Service	1902281009	1902281009	1	1	GALEN INPATIENT PHYSICIANS P	10/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
104453	Fee-for-Service	1235626458	1235626458	1	1	GIMUTAO, ANN BERNADETTE D NP	12/22/2021	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
104479	Fee-for-Service	1821193160	1821193160	1	1	GUNNARSEN, NELS C MD	12/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87827	30	Radiology	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
104490	Fee-for-Service	1245487941	1245487941	1	1	GEORGE, PAUL M MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112106	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
104500	Fee-for-Service	1477030260	1477030260	1	1	GRILLO, CASSIE L CCC-SLP	3/23/2021	235Z00000X	NA	Other	037	SPEECH 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
104508	Fee-for-Service	1386792224	1386792224	1	1	GREEN, KATHLEEN A CRNA	4/4/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	RMC MOB2	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
104529	Fee-for-Service	1740595438	1740595438	1	1	GOMEZ, ROSA I LMFT	11/8/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	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
104543	Fee-for-Service	1073282737	1073282737	1	1	GOLDBERG, SHIRA D LMFT	5/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ING CENTERS	433 CALLAN AVE	309	SAN LEANDRO	CA	94577	4643	01	06001	37.72706807	-122.1519034	Alameda County
104588	Fee-for-Service	1013040518	1013040518	1	1	GREENFIELD UNION SD	8/1/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	5400 MONITOR DR	None	BAKERSFIELD	CA	93307	6399	15	06029	35.306109	-119.0118605	Kern County
104589	Fee-for-Service	1407985534	1407985534	2	1	GARDNER FAMILY HEALTH	2/21/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	NETWORK, INC	195 E VIRGINIA ST	None	SAN JOSE	CA	95112	5844	43	06085	37.32593057	-121.8777002	Santa Clara County
104618	Fee-for-Service	1891880159	1891880159	1	1	GOLLAPUDI, RAMAKRISHNA P	12/10/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48964	41	Internal Medicine	0	In state provider	None	3700 SUNSET LN	STE 2	ANTIOCH	CA	94509	6123	07	06013	37.98481899	-121.8042927	Contra Costa County
104628	Fee-for-Service	1790899300	1790899300	1	1	GOLLIN, YVONNE G MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	85078	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
104631	Fee-for-Service	1851375398	1851375398	1	1	GOHIL, SHRUTI K MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89242	77	Infectious Disease	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
104654	Fee-for-Service	1588004535	1588004535	1	1	GU, EVERETT H MD	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156100	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
104671	Fee-for-Service	1598740995	1598740995	1	1	GRACE, RANDALL 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	10930 N TATUM BLVD	STE 103	PHOENIX	AZ	85028	6069	00	None	33.586029	-111.9782925	Maricopa County
104700	Fee-for-Service	1235140468	1235140468	1	1	GOULD, RICHARD E MD A PRO	6/29/2006	207RH0003X	NA	Oncology	026	PHYSICIANS	73353	78	Neoplastic Diseases/Oncology	0	In state provider	FESSIONAL MEDICAL CORPOR	8700 BEVERLY BLVD	STE C2000	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
104709	Fee-for-Service	1346390762	1346390762	1	1	GIBRALTAR HEALTHCARE	3/19/2012	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLIES INC	1791 ERRINGER RD	STE 102	SIMI VALLEY	CA	93065	3559	56	06111	34.269723	-118.761427	Ventura County
104720	Fee-for-Service	1922366186	1922366186	1	1	GARDNER FAMILY HEALTH	11/8/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	3351 EL CAMINO REAL	SUITE 100	ATHERTON	CA	94027	3802	41	06081	37.4659667	-122.2071835	San Mateo County
104722	Fee-for-Service	1164570644	1164570644	1	1	GENNIS, 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	945 N 12TH ST	STE 3506	MILWAUKEE	WI	53233	1305	00	None	43.042428	-87.92718546	Milwaukee County
104762	Fee-for-Service	1497374045	1497374045	1	1	GODIN, JENNIFER OT	8/27/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
104788	Fee-for-Service	1427352632	1427352632	1	1	GRAVES, SUSANNAH J K MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120500	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
104792	Fee-for-Service	1790943355	1790943355	1	1	GHAFOURI, ROYA MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115937	18	Ophthalmology	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
104802	Fee-for-Service	1649628512	1649628512	1	1	GOODWIN, KELSEY Q DO	8/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
104816	Fee-for-Service	1003836016	1003836016	1	1	GUSTAFSON, JOHN C MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	36782	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
104842	Fee-for-Service	1134161326	1134161326	1	1	GARFIELD BEACH CVS, LLC	5/1/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	22968 VICTORY BLVD	None	WOODLAND HILLS	CA	91367	1634	19	06037	34.18641647	-118.6272945	Los Angeles County
104854	Fee-for-Service	1316982879	1316982879	1	3	GENERAL VASCULAR SURGERY	10/19/1983	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	MED GRP INC	13851 E 14TH ST	STE 202	SAN LEANDRO	CA	94578	2627	01	06001	37.71458918	-122.1418781	Alameda County
104860	Fee-for-Service	1720471113	1720471113	1	1	GIRGIS, JACOB A MD	6/8/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144645	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104881	Fee-for-Service	1407985534	1407985534	2	1	GARDNER FAMILY HEALTH	2/21/2011	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	NETWORK, INC	195 E VIRGINIA ST	None	SAN JOSE	CA	95112	5844	43	06085	37.32593057	-121.8777002	Santa Clara County
104885	Fee-for-Service	1649744129	1649744129	1	1	GILLETTE, IAN M RCP	6/30/2021	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
104906	Fee-for-Service	1891880159	1891880159	1	1	GOLLAPUDI, RAMAKRISHNA P	12/10/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48964	10	Gastroenterology (M.D. only)	0	In state provider	None	3700 SUNSET LN	STE 2	ANTIOCH	CA	94509	6123	07	06013	37.98481899	-121.8042927	Contra Costa County
104915	Fee-for-Service	1649215542	1649215542	1	1	GARFIELD BEACH CVS, LLC	10/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	861 N HACIENDA BLVD	None	LA PUENTE	CA	91744	2809	19	06037	34.03549853	-117.950171	Los Angeles County
104972	Fee-for-Service	1275851941	1275851941	1	1	GALLEGOS, ATHENA L LMFT	5/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
104989	Fee-for-Service	1235140468	1235140468	1	1	GOULD, RICHARD E MD A PRO	6/29/2006	207RH0003X	NA	Oncology	026	PHYSICIANS	73353	68	Hematology	0	In state provider	FESSIONAL MEDICAL CORPOR	8700 BEVERLY BLVD	STE C2000	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
105011	Fee-for-Service	1922366186	1922366186	1	1	GARDNER FAMILY HEALTH	11/20/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	3351 EL CAMINO REAL	SUITE 100	ATHERTON	CA	94027	3802	41	06081	37.4659667	-122.2071835	San Mateo County
105023	Fee-for-Service	1235411844	1235411844	1	1	GOHARBIN, ALI MD	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117121	01	General Practice	0	In state provider	None	19950 RINALDI ST	None	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
105051	Fee-for-Service	1114737822	1114737822	1	1	GUTIERREZ, CYNTHIA CNP	2/19/2025	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
105135	Fee-for-Service	1376610428	1376610428	1	1	GECKELER, WILLIAM R MD	7/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	47868	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
105176	Fee-for-Service	1386393494	1386393494	1	1	GETMAN, TATIANA DO	11/22/2024	207R00000X	NA	Other	026	PHYSICIANS	21671	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
105188	Fee-for-Service	1275591349	1275591349	1	1	GRADITOR, MARSHALL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38911	18	Ophthalmology	0	In state provider	None	7345 MEDICAL CENTER DR	STE 320	CANOGA PARK	CA	91307	1962	19	06037	34.20369349	-118.629837	Los Angeles County
105216	Fee-for-Service	1114942794	1114942794	1	1	GRUMBACH, KEVIN MD	3/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	59564	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
105235	Fee-for-Service	1366098709	1366098709	1	1	GHATTAS, GEORGE G PT	10/30/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1870 CENTRAL ST	None	VISALIA	CA	93277	4418	54	06107	36.314541	-119.310201	Tulare County
105253	Fee-for-Service	1437523198	1437523198	1	1	GOODBAN, JONATHAN LMFT	10/6/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
105276	Fee-for-Service	1235140468	1235140468	1	1	GOULD, RICHARD E MD A PRO	6/29/2006	207RH0003X	NA	Oncology	026	PHYSICIANS	73353	41	Internal Medicine	0	In state provider	FESSIONAL MEDICAL CORPOR	8700 BEVERLY BLVD	STE C2000	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
105278	Fee-for-Service	1811909880	1811909880	1	1	GUZMAN, ELOISE E MD	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
105283	Fee-for-Service	1679682504	1679682504	1	1	GORMICAN, STEPHEN MD	7/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32038	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
105286	Fee-for-Service	1316172240	1316172240	1	1	GREEN, MICHAEL M MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142977	68	Hematology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
105297	Fee-for-Service	1922366186	1922366186	1	1	GARDNER FAMILY HEALTH	11/20/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	3351 EL CAMINO REAL	SUITE 100	ATHERTON	CA	94027	3802	41	06081	37.4659667	-122.2071835	San Mateo County
105310	Fee-for-Service	1487798773	1487798773	1	1	GALLEMORE RON P MD INC	3/3/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	RETINA MACULA INSTITUTE	4201 TORRANCE BLVD	STE 220	TORRANCE	CA	90503	4537	19	06037	33.8375955	-118.358748	Los Angeles County
105371	Fee-for-Service	1508914391	1508914391	1	1	GANDHI, SWATI S MD	4/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84900	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
105374	Fee-for-Service	1396010740	1396010740	1	1	GREER, KARL A MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127109	01	General Practice	0	In state provider	None	3883 AIRWAY DRIVE	SUITE 202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
105389	Fee-for-Service	1669546453	1669546453	2	1	GHALILI, STEVEN S MD	10/25/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66615	08	Family Practice	0	In state provider	None	648 E 21ST ST	None	LOS ANGELES	CA	90011	1146	19	06037	34.02604371	-118.2589922	Los Angeles County
105441	Fee-for-Service	1871688754	1871688754	1	1	GAINOR, ROBERT E MD	7/10/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79476	05	Anesthesiology	0	In state provider	None	FRESNO & R STREET	None	FRESNO	CA	93721	1365	10	06019	36.741663	-119.7841005	Fresno County
105454	Fee-for-Service	1184045619	1184045619	2	1	GUARDANT HEALTH, INC	6/14/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	505 PENOBSCOT DR	None	REDWOOD CITY	CA	94063	4737	41	06081	37.500705	-122.217517	San Mateo County
105492	Fee-for-Service	1518325026	1518325026	1	1	GRIFFITHS, LIANN T OD	6/14/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8120 TIMBERLAKE WAY	STE 211	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
105505	Fee-for-Service	1902814783	1902814783	1	1	GAUVIN, JEFFREY M MD	5/7/2012	208600000X	NA	General Surgery	026	PHYSICIANS	99759	02	General Surgery	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
105507	Fee-for-Service	1487698759	1487698759	2	1	GARFIELD BEACH CVS, LLC	10/20/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9256 SLAUSON AVE	None	PICO RIVERA	CA	90660	4526	19	06037	33.96910997	-118.0992195	Los Angeles County
105508	Fee-for-Service	1770901043	1770901043	1	1	GOLDMAN, ALEXANDER M MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138662	01	General Practice	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
105540	Fee-for-Service	1922444009	1922444009	1	1	GIBBONS, JOANNA F DO	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14133	01	General Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
105564	Fee-for-Service	1972609998	1972609998	1	2	GARDEN PARK	2/1/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	17001 SAGA DR	None	YORBA LINDA	CA	92886	3627	30	06059	33.89052724	-117.8377705	Orange County
105573	Fee-for-Service	1316172240	1316172240	1	1	GREEN, MICHAEL M MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142977	78	Neoplastic Diseases/Oncology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
105599	Fee-for-Service	1205221066	1205221066	1	1	GHEZELAYAGH, TALAYEH S MD	11/13/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	191723	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
105633	Fee-for-Service	1972864692	1972864692	1	1	GONZALEZ, AURELIO M MD	4/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120878	08	Family Practice	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	7759	27	06053	36.65911769	-121.6448024	Monterey County
105644	Fee-for-Service	1285913087	1285913087	2	1	GARFIELD BEACH CVS LLC	5/26/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2800 DUBLIN BLVD	None	DUBLIN	CA	94568	4589	01	06001	37.70271	-121.8531555	Alameda County
105649	Fee-for-Service	1225371313	1225371313	1	1	GENTILUOMO, JESSE M MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147714	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
105652	Fee-for-Service	1649437930	1649437930	1	1	GRAVES, AMY L LMFT	7/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7365 CARNELIAN ST	STE 202	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
105724	Fee-for-Service	1437770930	1437770930	1	1	GUTIERREZ, GABRIELA E LMFT	10/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
105733	Fee-for-Service	1548556020	1548556020	1	1	GARDUNO, LAKISHA MD	5/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	124746	08	Family Practice	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
105789	Fee-for-Service	1053924282	1053924282	1	1	GENOA HEALTHCARE, LLC	8/4/2021	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1393 BAILEY DRIVE	SUITE 149	HANFORD	CA	93230	5922	16	06031	36.32726257	-119.6663418	Kings County
105807	Fee-for-Service	1427592229	1427592229	1	1	GOLDSTEIN, JOY A MD	7/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153451	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
105809	Fee-for-Service	1164467064	1164467064	1	1	GARFIELD BEACH CVS, LLC	12/14/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	74955 US HIGHWAY 111	None	INDIAN WELLS	CA	92210	7136	33	06065	33.72135216	-116.3577986	Riverside County
105821	Fee-for-Service	1053484162	1053484162	1	1	GOOZE, LISA L MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53946	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
105864	Fee-for-Service	1316172240	1316172240	1	1	GREEN, MICHAEL M MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142977	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
105881	Fee-for-Service	1841359353	1841359353	1	1	GUPTA, ARVIN A MD	6/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6970 WEST PATRICK LN	STE 140	LAS VEGAS	NV	89113	0270	00	None	36.07786716	-115.2442656	Clark County
105882	Fee-for-Service	1578634507	1578634507	1	1	GIAP, ANDREW Q MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60064	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
105891	Fee-for-Service	1205256229	1205256229	1	1	GITTINGS, DANIEL MD	8/6/2021	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	167442	None	None	0	In state provider	None	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
105896	Fee-for-Service	1174736342	1174736342	1	1	GENE CARE, INC	6/9/2004	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	POMONA ADULT DAY HEALTH	324 PALOMA DR	None	POMONA	CA	91767	5620	19	06037	34.0611426	-117.739402	Los Angeles County
105912	Fee-for-Service	1902817810	1902817810	1	1	GUNBERG, STEVEN R DO	9/29/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	13266	30	Radiology	0	In state provider	None	1133 N PALM CANYON DR	STE B	PALM SPRINGS	CA	92262	4431	33	06065	33.838164	-116.546796	Riverside County
105969	Fee-for-Service	1275863599	1275863599	1	1	GOLDEN STATE ANESTHESIA	6/23/2010	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	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
105971	Fee-for-Service	1366537045	1366537045	1	1	GHEBRIAL, MINA S MD	4/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60916	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
106012	Fee-for-Service	1154975738	1154975738	1	1	GOLDMAN, EVAN D OD	9/10/2019	152W00000X	NA	Other	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
106017	Fee-for-Service	1376566158	1376566158	1	1	GILL, ZORA S MD	9/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	38733	02	General Surgery	0	In state provider	None	2501 H ST	None	BAKERSFIELD	CA	93301	2817	15	06029	35.38218122	-119.0211754	Kern County
106106	Fee-for-Service	1053484162	1053484162	1	1	GOOZE, LISA L MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53946	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
106124	Fee-for-Service	1871890525	1871890525	1	1	GREER, BENJAMIN MD	2/9/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	45340	None	None	0	In state provider	None	710 S BROADWAY	STE 212	WALNUT CREEK	CA	94596	5219	07	06013	37.89702115	-122.0569066	Contra Costa County
106149	Fee-for-Service	1003209586	1003209586	1	1	GEE, CYNTHIA DO	8/26/2019	207P00000X	NA	Other	026	PHYSICIANS	17247	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
106167	Fee-for-Service	1578634507	1578634507	1	1	GIAP, ANDREW Q MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60064	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
106168	Fee-for-Service	1841359353	1841359353	1	1	GUPTA, ARVIN A MD	6/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	6970 WEST PATRICK LN	STE 140	LAS VEGAS	NV	89113	0270	00	None	36.07786716	-115.2442656	Clark County
106187	Fee-for-Service	1174892087	1174892087	1	1	GOWRINATHAN, SHANTHI MD	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119204	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
106255	Fee-for-Service	1275863599	1275863599	1	1	GOLDEN STATE ANESTHESIA	9/11/2017	207L00000X	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
106306	Fee-for-Service	1376566158	1376566158	1	1	GILL, ZORA S MD	9/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	38733	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2501 H ST	None	BAKERSFIELD	CA	93301	2817	15	06029	35.38218122	-119.0211754	Kern County
106320	Fee-for-Service	1073018438	1073018438	1	1	GENTRY HEALTH SERVICES INC	2/4/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	33381 WALKER RD	STE A	AVON LAKE	OH	44012	1463	00	None	41.49331649	-82.044351	Lorain County
106331	Fee-for-Service	1821345620	1821345620	1	1	GARFIELD BEACH CVS LLC	1/8/2013	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	701 PORTOLA DR	None	SAN FRANCISCO	CA	94127	1209	38	06075	37.74428483	-122.4534134	San Francisco County
106340	Fee-for-Service	1699292425	1699292425	1	1	GARFIELD BEACH CVS LLC	11/16/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2620 E CHAPMAN AVE	None	ORANGE	CA	92869	3207	30	06059	33.78779652	-117.8252415	Orange County
106376	Fee-for-Service	1225105729	1225105729	1	1	GOLDEN WEST RAD MED GRP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPLIT RADIOLOGY	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
106395	Fee-for-Service	1053484162	1053484162	1	1	GOOZE, LISA L MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53946	01	General 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
106398	Fee-for-Service	1871948265	1871948265	1	1	GHUMAN, APAR S DO	6/30/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	18023	25	Physical Medicine and Rehabilitation	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
106408	Fee-for-Service	1538742598	1538742598	1	1	GENOA HEALTHCARE LLC	11/24/2021	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	560 COHASSET RD	SUITE 110	CHICO	CA	95929	2490	04	06007	39.7519137	-121.8477606	Butte County
106418	Fee-for-Service	1710151238	1710151238	1	1	GATES, SHANNON D MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103930	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
106434	Fee-for-Service	1720173206	1720173206	1	1	GUGGA, JARNAIL S MD INC	4/11/1978	207RP1001X	NA	Pulmonology	026	PHYSICIANS	31418	41	Internal Medicine	0	In state provider	None	741 S ORANGE AVE	FL 1	WEST COVINA	CA	91790	2662	19	06037	34.07079634	-117.9445034	Los Angeles County
106457	Fee-for-Service	1578634507	1578634507	1	1	GIAP, ANDREW Q MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60064	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
106461	Fee-for-Service	1740353002	1740353002	1	1	GLEASON, BRIANA C MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106649	22	Pathology (M.D. only)	0	In state provider	None	3301 C STREET	STE 200-E	SACRAMENTO	CA	95816	3302	34	06067	38.579877	-121.456143	Sacramento County
106471	Fee-for-Service	1578737029	1578737029	1	1	GRAW, BRADLEY P MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104283	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
106484	Fee-for-Service	1467746024	1467746024	1	1	GANCARCZYK, STEPHANIE M MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149309	20	Orthopedic Surgery	0	In state provider	None	260 INTERNATION CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
106495	Fee-for-Service	1821588559	1821588559	1	1	GUPTA, SRISHTI	8/23/2024	207ZP0105X	NA	Other	026	PHYSICIANS	186109	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
106577	Fee-for-Service	1740443928	1740443928	1	1	GUBER, KEVIN M MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104185	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
106600	Fee-for-Service	1235202680	1235202680	1	1	GREANEY, MARTIN T MD	7/1/1979	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34312	08	Family Practice	0	In state provider	None	5225 TELEGRAPH RD	None	VENTURA	CA	93003	4113	56	06111	34.27661221	-119.2246197	Ventura County
106624	Fee-for-Service	1164528741	1164528741	1	2	GELLENS, ANDREW J MD	7/29/2019	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71477	15	Obstetrics (D.O. only)	0	In state provider	None	8851 CENTER DR	210	LA MESA	CA	91942	3017	37	06073	32.78189749	-117.0075062	San Diego County
106625	Fee-for-Service	1215322870	1215322870	1	1	GRATEROL, JOSEPH MD	4/7/2019	207P00000X	NA	Other	026	PHYSICIANS	145887	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
106647	Fee-for-Service	1326365818	1326365818	1	1	GHISLETTA, STEFANIE	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
106657	Fee-for-Service	1922034511	1922034511	1	1	GLASGOW, BENJAMIN J MD	5/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50625	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA RM I-340	None	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
106660	Fee-for-Service	1588979058	1588979058	1	1	GASKELL, SANDRA L	2/8/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3117 B MCHENRY AVE	None	MODESTO	CA	95350	3117	50	06099	37.6839	-120.9942465	Stanislaus County
106678	Fee-for-Service	1114691896	1114691896	1	1	GRISWOLD, BRYN V	10/4/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	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
106687	Fee-for-Service	1811315674	1811315674	1	1	GHASHGHAEI, ROXANA MD	6/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138044	41	Internal Medicine	0	In state provider	None	1006 W LA PALMA	None	ANAHEIM	CA	92801	3650	30	06059	33.84713552	-117.9305145	Orange County
106707	Fee-for-Service	1245388073	1245388073	1	1	GONCALVES, JOSE L	8/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72422	01	General Practice	0	In state provider	None	393 E WALNUT ST	None	PASADENA	CA	91188	0001	19	06037	34.14955087	-118.1422348	Los Angeles County
106709	Fee-for-Service	1194766014	1194766014	1	1	GARFIELD BEACH CVS, LLC	2/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	42155 WASHINGTON ST.	None	PALM DESERT	CA	92211	8006	33	06065	33.742359	-116.3039485	Riverside County
106719	Fee-for-Service	1013329671	1013329671	1	1	GALLAGHER, MELISSA A LMFT	1/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	680 PLACERVILLE DR.	SUITE A2	PLACERVILLE	CA	95667	4292	09	06017	38.73150701	-120.8208168	El Dorado County
106726	Fee-for-Service	1043643323	1043643323	1	1	GERLACH, REBECCA M MD	2/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126860	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
106730	Fee-for-Service	1922049857	1922049857	1	1	GOLAN, YASEMIN MD	2/6/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153633	40	Pediatrics	0	In state provider	None	222 GREEN VALLEY RD	None	FREEDOM	CA	95019	3136	44	06087	36.93777813	-121.7711905	Santa Cruz County
106732	Fee-for-Service	1821096942	1821096942	1	1	GOSKOWICZ, MAKI C MD	12/31/1993	207N00000X	NA	Dermatology	026	PHYSICIANS	73340	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 525	LA MESA	CA	91942	3096	37	06073	32.77978322	-117.0094766	San Diego County
106755	Fee-for-Service	1548217011	1548217011	2	1	GERINET PHYSICIAN SERVICES	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	4010 WATSON PLAZA DR	STE 140	LAKEWOOD	CA	90712	4047	19	06037	33.83123565	-118.1550195	Los Angeles County
106756	Fee-for-Service	1710515218	1710515218	1	1	GREATNESS HOME HEALTH INC	10/30/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	STE 210	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
106759	Fee-for-Service	1497730295	1497730295	1	1	GROSS, DOUGLAS S MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	71930	None	None	0	In state provider	None	635 ANDERSON RD	STE 17	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
106764	Fee-for-Service	1528312758	1528312758	1	1	GALEN INPATIENT PHYSICIANS	1/1/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
106765	Fee-for-Service	1013967108	1013967108	1	1	GULATI, RAJESH MD	4/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53517	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3296	30	06059	33.78674051	-117.8888713	Orange County
106766	Fee-for-Service	1275194185	1275194185	1	1	GUZMAN, ANDREW PSYD	1/9/2020	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
106796	Fee-for-Service	1871601591	1871601591	1	1	GONZALEZ, LESLIE M MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	76307	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
106812	Fee-for-Service	1366464059	1366464059	2	1	GARFIELD BEACH CVS LLC	11/29/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10576 FOOTHILL BLVD	None	RANCHO CUCAMONGA	CA	91730	3890	36	06071	34.108776	-117.5742945	San Bernardino County
106847	Fee-for-Service	1679149801	1679149801	1	1	GEIGER & ASSOCIATES MARRIAGE	6/11/2021	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	AND FAMILY THERAPY INC	5790 MAGNOLIA AVE	STE 202	RIVERSIDE	CA	92506	1874	33	06065	33.96267292	-117.3905848	Riverside County
106850	Fee-for-Service	1659524288	1659524288	1	2	GALT JOINT UNION HIGH	7/1/2015	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	150 CALEMIA WAY	None	GALT	CA	95632	0000	34	06067	0	0	None
106853	Fee-for-Service	1053376590	1053376590	1	1	GOSNELL, JESSICA MD	2/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62146	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
106866	Fee-for-Service	1619516648	1619516648	1	1	GOW, AMY B NP	5/28/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 N PEPPER AVE	FL 6	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
106939	Fee-for-Service	1073347977	1073347977	1	1	GARCIA, REBEKAH NP	2/5/2025	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
106962	Fee-for-Service	1275576522	1275576522	1	1	GN MEDICAL ASSOCIATES INC	5/1/2001	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	3090 BRISTOL STREET	200	COSTA MESA	CA	92626	3061	30	06059	33.6851583	-117.8854726	Orange County
106994	Fee-for-Service	1972614956	1972614956	1	1	GILPIN, BRIAN G MD	4/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86410	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
107041	Fee-for-Service	1548217011	1548217011	2	1	GERINET PHYSICIAN SERVICES	10/2/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	4010 WATSON PLAZA DR	STE 140	LAKEWOOD	CA	90712	4047	19	06037	33.83123565	-118.1550195	Los Angeles County
107042	Fee-for-Service	1245298884	1245298884	1	1	GUTIERREZ, ARLAINE B MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63754	40	Pediatrics	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
107046	Fee-for-Service	1427117274	1427117274	1	1	GOTTHEIL, ELISA A PHD	4/19/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22753	-	NOT APPLICABLE	0	In state provider	None	115 E FESLER ST	None	SANTA MARIA	CA	93454	4404	42	06083	34.95648451	-120.435021	Santa Barbara County
107051	Fee-for-Service	1245860592	1245860592	1	1	G AND G HOSPICE CARE INC	5/6/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10523 BURBANK BLVD	SUITE 119	NORTH HOLLYWOOD	CA	91601	2233	19	06037	34.17216449	-118.36017	Los Angeles County
107052	Fee-for-Service	1528312758	1528312758	1	1	GALEN INPATIENT PHYSICIANS	1/1/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
107056	Fee-for-Service	1023403342	1023403342	1	1	GRANADOS, JESUS MD	2/4/2020	207P00000X	NA	Other	026	PHYSICIANS	161740	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
107072	Fee-for-Service	1689720112	1689720112	1	1	GOMEZ, SERGIO R MD INC	12/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74276	08	Family Practice	0	In state provider	None	1410 N GAREY AVE	None	POMONA	CA	91767	3810	19	06037	34.07202454	-117.7522105	Los Angeles County
107098	Fee-for-Service	1780093823	1780093823	1	1	GRIFFIN, AMY	2/10/2023	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
107117	Fee-for-Service	1841369519	1841369519	2	1	GANGARAM, BALRAM MD	10/7/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	155846	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
107159	Fee-for-Service	1760638183	1760638183	1	1	GARDNER, CARRIE M MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110634	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
107161	Fee-for-Service	1811221542	1811221542	1	1	GORADIETSKY, SETH PSYD	10/26/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ING & PSYCHOLOGICAL SERV	572 GREEN ST	302	PASADENA	CA	91101	2045	19	06037	34.1445435	-118.1386313	Los Angeles County
107169	Fee-for-Service	1548537335	1548537335	1	1	GOLLAPUDI, KIRAN MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112402	34	Urology and Urological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
107186	Fee-for-Service	1083962336	1083962336	1	1	GHASEMI, RAHA PSYD	5/8/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
107244	Fee-for-Service	1881967172	1881967172	1	1	GIDNEY, BRETT ANDREW MEDICAL	8/21/2014	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	81336	06	Cardiovascular Disease (M.D. only)	0	In state provider	CORPORATION	504 W PUEBLO ST	STE 101	SANTA BARBARA	CA	93105	6211	42	06083	34.42829882	-119.7243868	Santa Barbara County
107299	Fee-for-Service	1881843431	1881843431	2	1	GERSON, SAMUEL J MD	8/9/2022	207P00000X	NA	Other	026	PHYSICIANS	116916	None	None	0	In state provider	None	3830 VALLEY CENTRE DR	SUITE 702	SAN DIEGO	CA	92130	3320	37	06073	32.93777252	-117.2318423	San Diego County
107319	Fee-for-Service	1346685153	1346685153	1	1	GUERRERO, WHITNEY MD	11/13/2024	208600000X	NA	General Surgery	026	PHYSICIANS	186198	02	General Surgery	0	In state provider	None	2021 22ND ST	None	BAKERSFIELD	CA	93301	3802	15	06029	35.37907949	-119.025603	Kern County
107327	Fee-for-Service	1861664765	1861664765	1	1	GONZALEZ, CARLOS PT	9/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	100 BARRANCA ST.	SUITE 920	WEST COVINA	CA	91791	1637	19	06037	34.073073	-117.8812535	Los Angeles County
107328	Fee-for-Service	1245275148	1245275148	1	1	GARFIELD BEACH CVS LLC	5/23/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	611 S BROOKHURST ST	None	ANAHEIM	CA	92804	3500	30	06059	33.824538	-117.958967	Orange County
107338	Fee-for-Service	1245860592	1245860592	1	1	G AND G HOSPICE CARE INC	5/6/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10523 BURBANK BLVD	SUITE 119	NORTH HOLLYWOOD	CA	91601	2233	19	06037	34.17216449	-118.36017	Los Angeles County
107374	Fee-for-Service	1538556592	1538556592	1	1	GREWAL, DENNIS B S MD	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15476	41	Internal Medicine	0	In state provider	None	1880 N ORANGE GROVE AVE	None	POMONA	CA	91767	3006	19	06037	34.07803211	-117.74833	Los Angeles County
107402	Fee-for-Service	1073889465	1073889465	1	1	GUTTIKONDA, RAKHESH DO	3/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13307	24	Plastic Surgery	0	In state provider	None	3520 FOURTH AVENUE	None	SAN DIEGO	CA	92103	4913	37	06073	32.741955	-117.1615965	San Diego County
107413	Fee-for-Service	1861109423	1861109423	1	1	GARFIELD BEACH CVS LLC	6/29/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3049 E COAST HWY	None	CORONA DEL MAR	CA	92625	2234	30	06059	33.59804355	-117.8717797	Orange County
107424	Fee-for-Service	1699763508	1699763508	1	1	GOLDBERG, ERIC L	6/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97687	30	Radiology	0	In state provider	None	1800 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
107427	Fee-for-Service	1558561365	1558561365	1	1	GOOSBY, ERIC P MD	3/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	40869	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
107436	Fee-for-Service	1952075269	1952075269	1	1	GONZALES, NATHAN JON M PT	9/24/2021	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
107448	Fee-for-Service	1578563789	1578563789	1	1	GARCIA-CHUAPOCO, ROWENA	11/20/1995	174400000X	NA	Other	026	PHYSICIANS	51290	10	Gastroenterology (M.D. only)	0	In state provider	None	2100 WEBSTER ST	STE 423	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
107449	Fee-for-Service	1215923180	1215923180	1	1	GUZZI, LOUISE 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	291 SOUTHHALL LANE	None	MAITLAND	FL	32751	7274	00	None	28.6292341	-81.39348083	Orange County
107450	Fee-for-Service	1164421814	1164421814	1	1	GREEN-AMOS, VALERIE R MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91907	08	Family Practice	0	In state provider	None	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	34	06067	38.475585	-121.4285265	Sacramento County
107459	Fee-for-Service	1518916311	1518916311	1	1	GROSSMAN MEDICAL GROUP	5/19/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	4108	19	06037	34.20369349	-118.629837	Los Angeles County
107472	Fee-for-Service	1083842298	1083842298	1	1	GREEN, ERIC M MD	4/1/2020	207R00000X	NA	Other	026	PHYSICIANS	133451	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
107476	Fee-for-Service	1588637193	1588637193	1	1	GRENIER, RICHARD DPM	12/1/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
107533	Fee-for-Service	1881967172	1881967172	1	1	GIDNEY, BRETT ANDREW MEDICAL	8/21/2014	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	81336	41	Internal Medicine	0	In state provider	CORPORATION	504 W PUEBLO ST	STE 101	SANTA BARBARA	CA	93105	6211	42	06083	34.42829882	-119.7243868	Santa Barbara County
107544	Fee-for-Service	1447446125	1447446125	1	1	GOUFMAN, DIMITRY B MD INC	7/31/2018	193400000X	NA	Other	026	PHYSICIANS	52758	04	Otology, Laryngology, Rhinology	0	In state provider	None	302 W LA VETA AVE	SUITE 201	ORANGE	CA	92866	2607	30	06059	33.78057554	-117.8554725	Orange County
107545	Fee-for-Service	1487896908	1487896908	1	1	GIRMA, MICHAEL MD	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111951	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
107563	Fee-for-Service	1427150325	1427150325	1	1	GALLEGO, KELLY M MD	3/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84081	24	Plastic Surgery	0	In state provider	None	460 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
107603	Fee-for-Service	1215391982	1215391982	1	1	GUPTA, ALEXANDER R MD	7/26/2020	208600000X	NA	General Surgery	026	PHYSICIANS	153601	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
107613	Fee-for-Service	1083023923	1083023923	1	1	GUNN, TYLER M MD	7/12/2021	208G00000X	NA	General Surgery	026	PHYSICIANS	172280	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
107623	Fee-for-Service	1649315433	1649315433	1	1	GILL, MEHAR S MD	9/11/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	41443	36	Psychiatry	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
107638	Fee-for-Service	1225535255	1225535255	1	1	GARDNER, RAMSEY L MD	8/25/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	179687	None	None	0	In state provider	None	3900 GARFIELD AVE	None	CARMICHAEL	CA	95608	6647	34	06067	38.635974	-121.3360515	Sacramento County
107649	Fee-for-Service	1124093208	1124093208	1	1	GIRARD, KRISTINE A MD	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88798	36	Psychiatry	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
107653	Fee-for-Service	1467524652	1467524652	1	1	GREATER LONG BEACH	4/8/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORTHOPAEDIC SURG/MED GRP	1040 ELM AVE	STE 100	LONG BEACH	CA	90813	3265	19	06037	33.779799	-118.1879535	Los Angeles County
107664	Fee-for-Service	1942270426	1942270426	1	1	GREGG KOVACS D.O.	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2615 FAIRWAY ST	None	DICKINSON	ND	58601	2590	00	None	46.88685143	-102.8241973	Stark County
107686	Fee-for-Service	1467749739	1467749739	1	1	GARCIA, DEANNE C	8/1/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
107712	Fee-for-Service	1376040097	1376040097	1	1	GUENDEL, ALEXANDER M MD	8/1/2023	207P00000X	NA	Other	026	PHYSICIANS	185561	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
107723	Fee-for-Service	1619986965	1619986965	1	1	GROOMER, JASON DO	10/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8134	08	Family Practice	0	In state provider	None	12626 RIVERSIDE DR	#301	VALLEY VILLAGE	CA	91607	3473	19	06037	34.15758449	-118.408131	Los Angeles County
107736	Fee-for-Service	1316332497	1316332497	1	1	GHOSH, MOYUKH MD	2/15/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	144868	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
107764	Fee-for-Service	1942439021	1942439021	1	1	GAVINI, ARUNA MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127382	68	Hematology	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
107765	Fee-for-Service	1558389668	1558389668	1	1	GENER, RAUL G MD	12/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84493	41	Internal Medicine	0	In state provider	None	1711 W TEMPLE ST	STE 5606	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
107768	Fee-for-Service	1508330978	1508330978	1	1	GUTIERREZ, LINDSAY D CNP	2/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
107855	Fee-for-Service	1891018180	1891018180	1	2	GOMEZ, GABRIELA T LMFT	9/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
107891	Fee-for-Service	1467554220	1467554220	1	1	GREEN, EDWARD MD	12/1/2000	174400000X	NA	Other	026	PHYSICIANS	71869	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
107911	Fee-for-Service	1649807454	1649807454	1	1	GROVER MED LLC	2/28/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	100 NEWBRIDGE RD	STE 6	HICKSVILLE	NY	11801	3948	00	None	40.764312	-73.527642	Nassau County
107931	Fee-for-Service	1568841815	1568841815	1	1	GONZALEZ, VERONICA MD	7/21/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	163218	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
107937	Fee-for-Service	1124093208	1124093208	1	1	GIRARD, KRISTINE A MD	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88798	26	Psychiatry (child)	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
107959	Fee-for-Service	1922708056	1922708056	1	1	GENOA HEALTHCARE LLC	9/26/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	39031 OCEAN DRIVE	SUITE 1	GUALALA	CA	95445	8434	23	06045	38.76987785	-123.5300928	Mendocino County
107991	Fee-for-Service	1255967410	1255967410	1	1	GRAVESANDE, CADISHA A LMFT	5/15/2020	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
108005	Fee-for-Service	1871987131	1871987131	1	1	GUINNESS, RYAN R MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144158	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
108009	Fee-for-Service	1619986965	1619986965	1	1	GROOMER, JASON DO	10/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8134	12	Manipulative Therapy (D.O. only)	0	In state provider	None	12626 RIVERSIDE DR	#301	VALLEY VILLAGE	CA	91607	3473	19	06037	34.15758449	-118.408131	Los Angeles County
108039	Fee-for-Service	1164447678	1164447678	1	1	GARCIA, EDDIE M MD	11/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	53767	18	Ophthalmology	0	In state provider	None	10942 RAMONOA BLVD	STE A	EL MONTE	CA	91731	2644	19	06037	34.07199583	-118.0369162	Los Angeles County
108040	Fee-for-Service	1104867142	1104867142	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3155 SILVER CREEK RD	None	SAN JOSE	CA	95121	1730	43	06085	37.30806395	-121.8117776	Santa Clara County
108043	Fee-for-Service	1407309594	1407309594	1	1	GOZALI, ALEXA DO	8/31/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17348	08	Family Practice	0	In state provider	None	30131 TOWN CENTER DR	STE 135	LAGUNA NIGUEL	CA	92677	2010	30	06059	33.52530096	-117.7148334	Orange County
108060	Fee-for-Service	1942439021	1942439021	1	1	GAVINI, ARUNA MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127382	78	Neoplastic Diseases/Oncology	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
108070	Fee-for-Service	1114365897	1114365897	1	1	GUITARTE, CAMILLA U MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147330	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
108084	Fee-for-Service	1215445770	1215445770	1	1	GARAGULAKIAN, SYLVA PA-C	12/15/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	56226	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
108092	Fee-for-Service	1053329193	1053329193	1	1	GAMAGAMI, ALLAN MD	9/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	76720	02	General Surgery	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
108139	Fee-for-Service	1821032194	1821032194	1	1	GARFIELD BEACH CVS, LLC	9/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5505 CARSON ST	None	LAKEWOOD	CA	90713	3004	19	06037	33.83238715	-118.1248096	Los Angeles County
108155	Fee-for-Service	1952495392	1952495392	1	1	GORINSTEIN, ISRAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35991	13	Neurology (M.D. only)	0	In state provider	A PROFESSIONAL CORP	5901 W OLYMPIC BLVD	STE 420	LOS ANGELES	CA	90036	4669	19	06037	34.05764121	-118.3603115	Los Angeles County
108162	Fee-for-Service	1841677390	1841677390	1	1	GEE, KELLY DO	12/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16310	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
108185	Fee-for-Service	1255641080	1255641080	1	1	GARCIA, MICHAEL A MD INC	10/26/2010	193400000X	NA	Other	026	PHYSICIANS	76266	67	Endocrinology	0	In state provider	None	25078 PEACHLAND AVE	STE A	NEWHALL	CA	91321	2533	19	06037	34.37865037	-118.5468731	Los Angeles County
108198	Fee-for-Service	1881271260	1881271260	1	1	GREENE, CLAIRE C MD	9/3/2024	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
108230	Fee-for-Service	1902019441	1902019441	1	1	GARCIA, OSCAR A MD	9/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104524	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
108246	Fee-for-Service	1609839232	1609839232	1	1	GORSKI, LAURA A DO	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	2011 PINTO LANE	STE 200	LAS VEGAS	NV	89106	4018	00	None	36.16430955	-115.168563	Clark County
108264	Fee-for-Service	1255017737	1255017737	1	1	GET AGING	4/18/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	38	Geriatrics	0	In state provider	None	1753 CARROLL AVE	None	SAN FRANCISCO	CA	94124	2647	38	06075	37.72602127	-122.3954592	San Francisco County
108275	Fee-for-Service	1487045969	1487045969	1	1	GRAYHEK, KRISTIE L NP	3/18/2015	No Taxonomy Provided	NA	None	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
108287	Fee-for-Service	1275971293	1275971293	1	1	GARFIELD BEACH CVS LLC	12/6/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	135 PIERCE ST	None	DALY CITY	CA	94015	1934	41	06081	37.68597551	-122.472603	San Mateo County
108299	Fee-for-Service	1922063700	1922063700	1	1	GHILARDUCCI, MARK MD	7/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59002	01	General Practice	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
108314	Fee-for-Service	1386674869	1386674869	1	1	GARNER, EVAN H MD	3/18/2011	2084P0800X	NA	Psychiatry	026	PHYSICIANS	69510	36	Psychiatry	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
108328	Fee-for-Service	1629335427	1629335427	1	1	GLICK, AMY R MD	8/13/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	153517	36	Psychiatry	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
108337	Fee-for-Service	1477598662	1477598662	1	1	GOLLIN, GERALD MD	12/1/1998	208600000X	NA	General Surgery	026	PHYSICIANS	84953	85	Surgery-Pediatric	0	In state provider	None	11370 ANDERSON ST	# 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
108381	Fee-for-Service	1417271016	1417271016	1	1	GOULD, ROBERT R MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118406	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
108393	Fee-for-Service	1346220753	1346220753	1	1	GOLDSTEIN, DAVID J L MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137444	01	General Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
108434	Fee-for-Service	1689990038	1689990038	1	1	GOLDMAN, JOSHUA T MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120763	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
108451	Fee-for-Service	1518902410	1518902410	1	1	GARFIELD BEACH CVS LLC	9/27/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 REDLANDS MALL	None	REDLANDS	CA	92373	4705	36	06071	34.05648141	-117.1833351	San Bernardino County
108457	Fee-for-Service	1679791578	1679791578	1	1	GARCIA, DIANA G MD	6/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88128	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
108460	Fee-for-Service	1801003603	1801003603	1	1	GARRIDO, ELAINA M LMFT	11/4/2024	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
108462	Fee-for-Service	1205570181	1205570181	1	1	GOLDEN STATE CARE PC	5/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	3150 G ST	STE E	MERCED	CA	95340	1346	24	06047	37.32054811	-120.4691942	Merced County
108463	Fee-for-Service	1861926123	1861926123	1	1	GUPTA, PREETI MD	9/4/2024	207RC0200X	NA	Other	026	PHYSICIANS	None	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
108497	Fee-for-Service	1992727697	1992727697	2	1	GARFIELD BEACH CVS LLC	9/28/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1240 BROADWAY	None	CHULA VISTA	CA	91911	2911	37	06073	32.60506463	-117.0794418	San Diego County
108504	Fee-for-Service	1215345194	1215345194	1	1	GEISE, EVAN T DO	11/11/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14765	None	None	0	In state provider	None	1196 N PARK AVE	None	POMONA	CA	91768	3027	19	06037	34.06976919	-117.7549069	Los Angeles County
108542	Fee-for-Service	1942783741	1942783741	1	1	GUTIERREZ, LILIANA LMFT	11/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	37251 37TH STREET EAST	None	PALMDALE	CA	93550	7609	19	06037	34.559505	-118.0626565	Los Angeles County
108564	Fee-for-Service	1982669222	1982669222	1	1	GOLDBERG, ANDREW N MD	4/7/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85676	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
108585	Fee-for-Service	1972746253	1972746253	1	1	GHASSEMI, JEFFREY G MD	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114223	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
108726	Fee-for-Service	1831200591	1831200591	1	1	GROSZ, DANIEL E MD	6/20/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	49772	-	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
108731	Fee-for-Service	1669642187	1669642187	1	1	GE, NENGJIE MD PC	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70942	18	Ophthalmology	0	In state provider	None	16300 SAND CANYON AVE	#608	IRVINE	CA	92618	3706	30	06059	33.66115075	-117.7742405	Orange County
108750	Fee-for-Service	1356585350	1356585350	1	1	GOROSH, LOREN R MD	7/15/2012	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
108751	Fee-for-Service	1861926123	1861926123	1	1	GUPTA, PREETI MD	9/4/2024	207RC0200X	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
108804	Fee-for-Service	1457417248	1457417248	1	1	GABBAI, RAMIN MD	7/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	71442	45	Nephrology (Renal-Kidney)	0	In state provider	None	8737 BEVERLY BLVD	STE 403	WEST HOLLYWOOD	CA	90048	1828	19	06037	34.07687959	-118.381876	Los Angeles County
108815	Fee-for-Service	1699954966	1699954966	1	1	GAVIN, SARA R LMFT	11/25/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	48348	-	NOT APPLICABLE	0	In state provider	None	215 W BEAMER STREET	None	WOODLAND	CA	95695	2510	57	06113	38.68483629	-121.7937301	Yolo County
108854	Fee-for-Service	1982669222	1982669222	1	1	GOLDBERG, ANDREW N MD	4/7/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85676	84	Surgery-Head and Neck	0	In state provider	None	1001 POTRERO AVE	RM 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
108866	Fee-for-Service	1093909319	1093909319	1	1	GRACIANO, LUIS E LMFT	8/24/2018	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
108908	Fee-for-Service	1073571139	1073571139	1	1	GILLIAM, AMY E MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70772	07	Dermatology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
108963	Fee-for-Service	1306945431	1306945431	1	1	GREWEL, JASMIN K MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96926	08	Family Practice	0	In state provider	None	3811 VALLEY CENTRE DR	None	SAN DIEGO	CA	92130	3318	37	06073	32.93760492	-117.2320932	San Diego County
109040	Fee-for-Service	1932334802	1932334802	1	1	GAVIN, KELLY L LMFT	12/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
109055	Fee-for-Service	1265591515	1265591515	1	1	GILLON, JEAN W MD	11/8/2022	2086S0129X	NA	General Surgery	026	PHYSICIANS	56808	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
109056	Fee-for-Service	1184482069	1184482069	1	1	GOMEDPRO LLC	5/22/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7458 CLEAR LAKE ALLEY	None	SACRAMENTO	CA	95829	8741	34	06067	38.487888	-121.353813	Sacramento County
109081	Fee-for-Service	1336269752	1336269752	1	1	GRAHAM-SEGO CORPORATION	4/29/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	T	108 SAUSALITO BLVD.	None	CASSELBERRY	FL	32707	5764	00	None	28.643517	-81.321705	Seminole County
109101	Fee-for-Service	1275741134	1275741134	2	1	GOLDEN AGE ADHC LLC	4/25/2024	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	135 N MICKINLEY ST	None	CORONA	CA	92879	6566	33	06065	33.88349923	-117.5155107	Riverside County
109111	Fee-for-Service	1619053121	1619053121	1	1	GRANOVETTER, DAVID A MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67173	83	Rheumatology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
109121	Fee-for-Service	1760566756	1760566756	1	1	GREEN, DONALD F MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78265	47	Miscellaneous	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
109134	Fee-for-Service	1134582687	1134582687	1	1	GOERLICH, ERIN E	7/30/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	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
109142	Fee-for-Service	1982669222	1982669222	1	1	GOLDBERG, ANDREW N MD	4/7/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85676	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVE	RM 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
109152	Fee-for-Service	1720187610	1720187610	1	1	GONZALEZ-GOMEZ, IGINACIO	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67049	22	Pathology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
109169	Fee-for-Service	1457370736	1457370736	1	1	GROSSMAN, MARK S MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79624	41	Internal Medicine	0	In state provider	None	11600 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90025	1782	19	06037	34.05055194	-118.4594619	Los Angeles County
109189	Fee-for-Service	1306386800	1306386800	1	1	GAMBINA, KARISSA LMFT	1/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23121 VERDUGO DRIVE	SUITE 105	LAGUNA HILLS	CA	92653	1003	30	06059	33.62655523	-117.7292097	Orange County
109197	Fee-for-Service	1073571139	1073571139	1	1	GILLIAM, AMY E MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70772	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
109203	Fee-for-Service	1124545835	1124545835	1	1	GLOVER, JESSICA NP	3/9/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
109262	Fee-for-Service	1992335889	1992335889	1	1	GEISMAR, STEPHANIE LMFT	9/12/2024	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
109310	Fee-for-Service	1558370551	1558370551	1	1	GENICOFF, ALAN L MD	7/1/2001	207P00000X	NA	Other	026	PHYSICIANS	86130	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
109311	Fee-for-Service	1508952151	1508952151	1	1	GOTBAUM, MARC H LMFT	9/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
109392	Fee-for-Service	1588068787	1588068787	1	2	GROWING MINDS PSYCHOLOGICAL	3/1/2019	103TB0200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	3655 ALAMO ST	SUITE 300	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
109415	Fee-for-Service	1689364721	1689364721	1	4	GEM MEDICAL GROUP CORPORATIO	2/6/2024	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
109437	Fee-for-Service	1811024037	1811024037	1	1	GORN, SYBILLE K PHD	1/1/1999	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	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
109444	Fee-for-Service	1922086594	1922086594	1	1	GENTILI, AMILCARE MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44208	30	Radiology	0	In state provider	UCLA RADIOLOGY MED GRP	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
109450	Fee-for-Service	1376875500	1376875500	1	1	GABLE, MICHAEL E	5/27/2010	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	150 EAST WILLOW ST	None	BISHOP	CA	93514	2719	14	06027	37.36281292	-118.3942729	Inyo County
109458	Fee-for-Service	1457370736	1457370736	1	1	GROSSMAN, MARK S MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79624	40	Pediatrics	0	In state provider	None	11600 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90025	1782	19	06037	34.05055194	-118.4594619	Los Angeles County
109474	Fee-for-Service	1720599475	1720599475	1	1	GILL, SUPRIA K PHD	3/5/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
109572	Fee-for-Service	1790022416	1790022416	1	1	GREWAL, HARKIRAN K MD	6/18/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	135633	77	Infectious Disease	0	In state provider	None	1447 CEDARWOOD LANE	STE A	PLEASANTON	CA	94566	6175	01	06001	37.67102566	-121.8742221	Alameda County
109590	Fee-for-Service	1386960961	1386960961	1	1	GEBAUER, LAUREN E MD	9/10/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	134923	07	Dermatology	0	In state provider	None	2290 SACRAMENTO ST	None	VALLEJO	CA	94590	2929	48	06095	38.12370851	-122.2637378	Solano County
109614	Fee-for-Service	1811425036	1811425036	1	1	GARCIA, JOSHUA MD	7/17/2023	207P00000X	NA	Other	026	PHYSICIANS	183355	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
109615	Fee-for-Service	1538498324	1538498324	1	1	GARAFALO-CULMER, MELISSA A	1/22/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5100 ADOLFO ROAD	None	CAMARILLO	CA	93012	6792	56	06111	34.21612519	-119.0000909	Ventura County
109627	Fee-for-Service	1619118973	1619118973	1	1	GUI, DORINA MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114127	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
109628	Fee-for-Service	1851046874	1851046874	1	1	GUTIERREZ, SARAH L CNM	9/6/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	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
109644	Fee-for-Service	1629156450	1629156450	1	1	GOTANDA, STEVEN T MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23933	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
109679	Fee-for-Service	1588068787	1588068787	1	2	GROWING MINDS PSYCHOLOGICAL	7/17/2020	103TB0200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	3655 ALAMO ST	SUITE 300	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
109685	Fee-for-Service	1962680421	1962680421	1	9	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E103	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
109731	Fee-for-Service	1467070052	1467070052	1	1	GAMBLE, SARA L PT	1/13/2021	2251N0400X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1914 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2203	07	06013	37.87851556	-122.0745896	Contra Costa County
109775	Fee-for-Service	1639749138	1639749138	1	1	GAVIN, KATHARINE DO	9/18/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22994	08	Family Practice	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
109808	Fee-for-Service	1083643456	1083643456	1	1	GUTIERREZ, JESUS A MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51240	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
109818	Fee-for-Service	1174546071	1174546071	1	1	GHADISHAH, ELHAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55006	01	General Practice	0	In state provider	None	9808 VENICE BLVD	STE 710	CULVER CITY	CA	90232	6829	19	06037	34.0236396	-118.3980847	Los Angeles County
109834	Fee-for-Service	1760480610	1760480610	1	1	GARFIELD HEALTH CENTER	4/19/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	210 N GARFIELD	STE 203	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
109883	Fee-for-Service	1063760981	1063760981	1	1	GU, PAN LCSW	11/19/2014	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
109921	Fee-for-Service	1306423082	1306423082	1	1	GUZMAN, IRENE DO	8/21/2024	208M00000X	NA	Other	026	PHYSICIANS	20981	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
109930	Fee-for-Service	1073711156	1073711156	1	1	GHAYURI, MOHAMMADREZA MD	2/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54929	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	36	06071	34.13604853	-117.29952	San Bernardino County
109936	Fee-for-Service	1114409059	1114409059	1	1	GLECKMAN, LANA S NP	5/12/2022	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
109954	Fee-for-Service	1326076241	1326076241	1	1	GERMANY, STEVEN E DO	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	5997	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
109963	Fee-for-Service	1376540039	1376540039	2	1	GEPHART, ROSANNE B	11/12/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	583 SUMMERFIELD ROAD	None	SANTA ROSA	CA	95409	5239	49	06097	38.45268	-122.672088	Sonoma County
109967	Fee-for-Service	1588068787	1588068787	1	2	GROWING MINDS PSYCHOLOGICAL	8/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CORPORATION	3655 ALAMO ST	SUITE 300	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
109974	Fee-for-Service	1962680421	1962680421	1	9	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E103	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
109986	Fee-for-Service	1124351051	1124351051	1	1	GUNAWARDANE, NILANTHI D MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130772	None	None	0	In state provider	None	39400 PASEO PADRO PKY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
109988	Fee-for-Service	1740710185	1740710185	1	1	GOENS, DONALD MD	8/17/2023	207R00000X	NA	Other	026	PHYSICIANS	169456	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
110002	Fee-for-Service	1437205689	1437205689	1	1	GARVEY, CHRISTINE M NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
110018	Fee-for-Service	1427661750	1427661750	1	1	GRACEFUL AGING HOSPICE CARE	11/24/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	5236 COLODNY DR	STE 206B	AGOURA HILLS	CA	91301	4913	19	06037	34.14403336	-118.742661	Los Angeles County
110031	Fee-for-Service	1578010567	1578010567	1	1	GEARHART, DIANE	1/27/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1705 28TH ST	None	BAKERSFIELD	CA	93301	1902	15	06029	35.38477999	-119.0215335	Kern County
110096	Fee-for-Service	1184387615	1184387615	1	1	GRAND POLITE INC.	2/15/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6624 FOOTHILL BLVD	None	TUJUNGA	CA	91042	1005	19	06037	34.24663425	-118.2766564	Los Angeles County
110106	Fee-for-Service	1174546071	1174546071	1	1	GHADISHAH, ELHAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55006	08	Family Practice	0	In state provider	None	9808 VENICE BLVD	STE 710	CULVER CITY	CA	90232	6829	19	06037	34.0236396	-118.3980847	Los Angeles County
110119	Fee-for-Service	1205228012	1205228012	1	1	GLASGOW, CATHERINE L CNP	9/10/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
110121	Fee-for-Service	1164874541	1164874541	1	1	GONZALEZ, NICOLAS I OD	6/25/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
110122	Fee-for-Service	1760480610	1760480610	1	1	GARFIELD HEALTH CENTER	4/19/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	210 N GARFIELD	STE 203	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
110129	Fee-for-Service	1013317767	1013317767	1	1	GIOVANNETTI, ERIN R NP	7/14/2017	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
110172	Fee-for-Service	1538579362	1538579362	1	1	GILL, KAMALVIR K MD	12/10/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
110193	Fee-for-Service	1790816718	1790816718	1	1	GANGULY, KARUNESH MD	10/27/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	94651	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
110238	Fee-for-Service	1326076241	1326076241	1	1	GERMANY, STEVEN E DO	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	5997	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
110250	Fee-for-Service	1154329324	1154329324	1	1	GEORGE S.FORTNER 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	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
110260	Fee-for-Service	1093720682	1093720682	1	1	GODIL, ASLAM MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51796	10	Gastroenterology (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
110293	Fee-for-Service	1770229924	1770229924	1	1	GRACE HOME CARE INC	9/8/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	35224 TAVEL ST	None	WINCHESTER	CA	92596	4515	33	06065	33.60964683	-117.0809702	Riverside County
110301	Fee-for-Service	1093401259	1093401259	1	1	GENOA HEALTHCARE LLC	12/22/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8352 COMMONWEALTH AVE	ROOM P	BUENA PARK	CA	90621	2526	30	06059	33.8698947	-117.9872467	Orange County
110306	Fee-for-Service	1427661750	1427661750	1	1	GRACEFUL AGING HOSPICE CARE	11/24/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	5236 COLODNY DR	STE 206B	AGOURA HILLS	CA	91301	4913	19	06037	34.14403336	-118.742661	Los Angeles County
110314	Fee-for-Service	1083052021	1083052021	1	1	GALARRETA AIMA, CAROLINA I M	6/25/2019	207SG0201X	NA	Other	026	PHYSICIANS	143594	None	None	0	In state provider	D	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
110345	Fee-for-Service	1518996875	1518996875	1	1	GEORGIEV, MARY-JO PHD	6/14/2005	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
110353	Fee-for-Service	1043494982	1043494982	1	1	GHOBADI, ALI MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98862	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
110356	Fee-for-Service	1841536463	1841536463	2	1	GARFIELD BEACH CVS LLC	12/19/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 KENILWORTH DR	None	PETALUMA	CA	94952	3400	49	06097	38.24393236	-122.6278369	Sonoma County
110366	Fee-for-Service	1417904244	1417904244	1	1	GUCEV, GILGOR V MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79121	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	# 14-901	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
110380	Fee-for-Service	1316590391	1316590391	1	1	GARABET, CARMEN N PSYD	9/23/2019	103T00000X	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
110384	Fee-for-Service	1528019270	1528019270	1	1	GOODMAN, MICHAEL R MD	12/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	70755	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
110406	Fee-for-Service	1396701884	1396701884	1	1	GUDWANI, SANGEETA MD	11/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122970	41	Internal Medicine	0	In state provider	None	1180 E SHAW	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
110409	Fee-for-Service	1760480610	1760480610	1	1	GARFIELD HEALTH CENTER	4/19/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	210 N GARFIELD	STE 203	MONTEREY PARK	CA	91754	1746	19	06037	34.064181	-118.122834	Los Angeles County
110411	Fee-for-Service	1851653968	1851653968	1	1	GHOLAMREZANEZHAD, ALI MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133625	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
110424	Fee-for-Service	1144284373	1144284373	2	2	GARRETSON, CHARLES A	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2850 SIERRA SUNRISE TER	None	CHICO	CA	95928	8401	04	06007	39.74566647	-121.7841904	Butte County
110444	Fee-for-Service	1376053702	1376053702	1	1	GALLOWAY, MEGAN CNM	1/14/2025	367A00000X	NA	Certified Nurse Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
110460	Fee-for-Service	1538579362	1538579362	1	1	GILL, KAMALVIR K MD	12/10/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	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
110470	Fee-for-Service	1639122377	1639122377	1	1	GOKLANEY, ANIL K MD	4/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101873	66	Emergency Medicine (Urgent Care)	0	In state provider	None	41870 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	36	06071	34.24602097	-116.8885243	San Bernardino County
110480	Fee-for-Service	1659824399	1659824399	1	1	GRADY, ERIC S PHD	9/21/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
110486	Fee-for-Service	1386866176	1386866176	1	1	GARDNER, CAROL Q MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	72702	01	General Practice	0	In state provider	None	1215 E CHAPMAN AVENUE	SUITE 10	ORANGE	CA	92866	2237	30	06059	33.78786853	-117.840456	Orange County
110513	Fee-for-Service	1003070541	1003070541	1	1	GOREY, CHRISTINE D DO	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12135	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
110549	Fee-for-Service	1093720682	1093720682	1	1	GODIL, ASLAM MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51796	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
110655	Fee-for-Service	1306806880	1306806880	1	1	GLINES, MELINDA E MD	5/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83936	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
110658	Fee-for-Service	1073233714	1073233714	1	1	GIBSON, JEANETTE M LCSW	4/2/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
110709	Fee-for-Service	1033502281	1033502281	1	1	GONZALEZ-MORKOS, BETTY PSYD	9/12/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
110711	Fee-for-Service	1144284373	1144284373	2	2	GARRETSON, CHARLES A	4/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86610	41	Internal Medicine	0	In state provider	None	2850 SIERRA SUNRISE TER	None	CHICO	CA	95928	8401	04	06007	39.74566647	-121.7841904	Butte County
110731	Fee-for-Service	1710419387	1710419387	1	1	GOSHINSKA, AARON MD	11/30/2023	207PE0004X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	None	36.03815706	-114.9842287	Clark County
110732	Fee-for-Service	1407172687	1407172687	1	1	GENSHEIMER, MICHAEL F MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134180	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
110748	Fee-for-Service	1689745440	1689745440	1	1	GLEESON, JOSEPH G MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85292	40	Pediatrics	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
110790	Fee-for-Service	1558354563	1558354563	1	1	GOOD LIFE MED SYSTEM INC	11/7/2003	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1001 W 17TH ST	STE R	COSTA MESA	CA	92627	4512	30	06059	33.63601354	-117.941058	Orange County
110830	Fee-for-Service	1720097124	1720097124	1	1	GORONZY, JORG J MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54550	83	Rheumatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
110862	Fee-for-Service	1043449291	1043449291	1	1	GERINET PHYSICIAN SERVICES	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	700 N CENTRAL AVE	SUITE 550	GLENDALE	CA	91203	3299	19	06037	34.15708991	-118.2579615	Los Angeles County
110870	Fee-for-Service	1265599690	1265599690	1	1	GANDEK, KRISTEN P	2/22/2013	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
110885	Fee-for-Service	1306806617	1306806617	1	2	GIVENS, LARRY MD	4/21/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	42596	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
110918	Fee-for-Service	1447326319	1447326319	1	1	GARDINER, ROBERT E MD	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66818	36	Psychiatry	0	In state provider	None	5500 UNIVERSITY PARKWAY	None	SAN BERNARDINO	CA	92407	2397	36	06071	34.17917599	-117.3266088	San Bernardino County
110949	Fee-for-Service	1568992436	1568992436	1	1	GOSHTASBI, MAZIAR MD	11/5/2021	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	173449	None	None	0	In state provider	None	147 BRENT	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
110964	Fee-for-Service	1033175211	1033175211	1	1	GLOR, RITA DO	2/27/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6708	08	Family Practice	0	In state provider	MEDICAL ASSOCIATION	11903 DOWNEY AVE	None	DOWNEY	CA	90242	2529	19	06037	33.93182184	-118.1389215	Los Angeles County
111000	Fee-for-Service	1578052411	1578052411	1	1	GONZALES, MARI A LMFT	4/4/2022	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
111019	Fee-for-Service	1407172687	1407172687	1	1	GENSHEIMER, MICHAEL F MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134180	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
111023	Fee-for-Service	1215944285	1215944285	1	1	GUICE, MICHAEL J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33573	01	General Practice	0	In state provider	None	1127 WILSHIRE BLVD	STE 1509	LOS ANGELES	CA	90017	4006	19	06037	34.05270508	-118.2641005	Los Angeles County
111066	Fee-for-Service	1740315613	1740315613	1	1	GEREDA, MARIA ANA CHAVEZ LM	4/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	500 ESTUDILLO AVE	ROOM 6	SAN LEANDRO	CA	94577	4612	01	06001	37.72657939	-122.150155	Alameda County
111095	Fee-for-Service	1710272661	1710272661	1	1	GARVIN, DANIEL S DO	6/2/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	21143	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
111111	Fee-for-Service	1184278798	1184278798	1	1	GAGAN DEEP SINGH PC	12/8/2022	207QA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	650 W OLIVE AVE	B	MERCED	CA	95348	2423	24	06047	37.31918551	-120.479715	Merced County
111119	Fee-for-Service	1720097124	1720097124	1	1	GORONZY, JORG J MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54550	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
111133	Fee-for-Service	1326152422	1326152422	1	1	GILL, HARCHARAN MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50632	34	Urology and Urological Surgery	0	In state provider	THE STANFORD UNIVERSITY	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
111153	Fee-for-Service	1043449291	1043449291	1	1	GERINET PHYSICIAN SERVICES	8/22/2008	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	700 N CENTRAL AVE	SUITE 550	GLENDALE	CA	91203	3299	19	06037	34.15708991	-118.2579615	Los Angeles County
111163	Fee-for-Service	1336338433	1336338433	1	1	GUPTA, NIDHI MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129032	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
111194	Fee-for-Service	1396106605	1396106605	1	1	GAMBINO, MEGAN R CCC-SLP	1/27/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
111206	Fee-for-Service	1629588033	1629588033	1	1	GOOD CHOICE HOSPICE CARE	9/5/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17050 CHATSWORTH ST	STE 223	GRANADA HILLS	CA	91344	7818	19	06037	34.26477251	-118.5039945	Los Angeles County
111211	Fee-for-Service	1154305712	1154305712	1	1	GERAGHTY, ESTELLA M MD	7/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87689	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
111221	Fee-for-Service	1134150014	1134150014	1	1	GELLAND, YURI MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79830	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
111226	Fee-for-Service	1174176820	1174176820	1	1	GOLDEN IRVINE OPTOMETRY INC.	8/27/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15435 JEFFREY RD	STE. 138	IRVINE	CA	92618	4112	30	06059	33.680449	-117.777994	Orange County
111229	Fee-for-Service	1366521825	1366521825	1	1	GULERIA, PUSHPINDER S MD	12/1/2001	207RE0101X	NA	Endocrinology	026	PHYSICIANS	76268	67	Endocrinology	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
111264	Fee-for-Service	1871650689	1871650689	2	1	GRASS VALLEY EYE OPTOMETRIC	5/27/2011	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	670 SUTTON WY	None	GRASS VALLEY	CA	95945	5392	29	06057	39.23319097	-121.0359874	Nevada County
111276	Fee-for-Service	1538670930	1538670930	1	1	GUSTAVO A MONDRAGON MD A MED	6/19/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	ICAL CORPORATION	480 FOURTH AVE STE 500	None	CHULA VISTA	CA	91910	4414	37	06073	32.63411298	-117.0816772	San Diego County
111286	Fee-for-Service	1295843738	1295843738	1	1	GUPTA, MUKUL MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	73216	68	Hematology	0	In state provider	None	317 WEST PUEBLO STREET	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
111302	Fee-for-Service	1477713048	1477713048	1	5	GOBER, BRIANNE C MD	8/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145392	None	None	0	In state provider	None	622 ANZA	None	EL CAJON	CA	92020	6602	37	06073	32.789403	-116.9482165	San Diego County
111333	Fee-for-Service	1578883252	1578883252	1	1	GREER, ROCKY S MD	12/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122249	None	None	0	In state provider	None	1400 CHURCH STREET	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
111349	Fee-for-Service	1316129166	1316129166	1	1	GROLEAU, KIMBERLY A PT	12/2/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	568 N SUNRISE AVE	STE 100	ROSEVILLE	CA	95661	3035	31	06061	38.7576732	-121.2534645	Placer County
111351	Fee-for-Service	1508130204	1508130204	1	1	GUENZI, CHRISTINE D MD	10/31/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140549	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
111359	Fee-for-Service	1437641115	1437641115	1	1	GOLDEN STATE PHARMACY	8/9/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1617 N CALIFORNIA ST	STE 1F	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
111373	Fee-for-Service	1649759135	1649759135	1	1	GONZALEZ, ANDREW LMFT	10/9/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41880 KALMIA ST	115	MURRIETA	CA	92562	8831	33	06065	33.55740114	-117.2157733	Riverside County
111395	Fee-for-Service	1780661405	1780661405	1	1	GAYNOR, SANFORD H MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	6215	41	Internal Medicine	0	In state provider	#115	1045 W REDONDO BEACH BLV	None	GARDENA	CA	90247	4128	19	06037	33.89247044	-118.2931941	Los Angeles County
111397	Fee-for-Service	1457422354	1457422354	1	1	GILBERT, MARTIN N MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47345	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
111400	Fee-for-Service	1942325113	1942325113	1	1	GHAFOURI, NAZLI MD	3/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94326	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
111433	Fee-for-Service	1457340986	1457340986	1	1	GROLMAN, RODNEY E MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53617	02	General Surgery	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
111444	Fee-for-Service	1730267451	1730267451	1	1	GIBBONS, SUZANNE I MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63306	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
111450	Fee-for-Service	1659835296	1659835296	1	1	GASTELUM-HERNANDEZ, REBECCA	9/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C LCSW	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
111492	Fee-for-Service	1629588033	1629588033	1	1	GOOD CHOICE HOSPICE CARE	9/5/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17050 CHATSWORTH ST	STE 223	GRANADA HILLS	CA	91344	7818	19	06037	34.26477251	-118.5039945	Los Angeles County
111511	Fee-for-Service	1588789085	1588789085	1	1	GOLDSTEIN, BURTON G MD	12/5/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	87726	18	Ophthalmology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
111514	Fee-for-Service	1568856169	1568856169	1	2	GRAEF, M P LMFT	6/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	360 TESCONI CIR	STE C	SANTA ROSA	CA	95401	4677	49	06097	38.447415	-122.7339675	Sonoma County
111517	Fee-for-Service	1366521825	1366521825	1	1	GULERIA, PUSHPINDER S MD	12/1/2001	207RE0101X	NA	Endocrinology	026	PHYSICIANS	76268	41	Internal Medicine	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
111539	Fee-for-Service	1982855698	1982855698	1	1	GASQUE, DOE D CNP	7/8/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19333 BEAR VALLEY RD	SUITE 101	APPLE VALLEY	CA	92308	5149	36	06071	34.47104148	-117.2413863	San Bernardino County
111557	Fee-for-Service	1134269145	1134269145	1	1	GOOD, JULIE J MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63103	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
111565	Fee-for-Service	1538670930	1538670930	1	1	GUSTAVO A MONDRAGON MD A MED	6/19/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	ICAL CORPORATION	480 FOURTH AVE STE 500	None	CHULA VISTA	CA	91910	4414	37	06073	32.63411298	-117.0816772	San Diego County
111569	Fee-for-Service	1295843738	1295843738	1	1	GUPTA, MUKUL MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	73216	78	Neoplastic Diseases/Oncology	0	In state provider	None	317 WEST PUEBLO STREET	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
111590	Fee-for-Service	1790307007	1790307007	1	1	GEORGE, ANDREW DPM	7/7/2023	390200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	728 N. EUCLID AVE	None	ONTARIO	CA	91762	2712	36	06071	34.071399	-117.65061	San Bernardino County
111623	Fee-for-Service	1114090206	1114090206	1	1	GOOD SHEPHERD HEALTH CARE	1/1/1992	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1131 ARIZONA AVE	None	SANTA MONICA	CA	90401	2009	19	06037	34.02370279	-118.4894957	Los Angeles County
111681	Fee-for-Service	1780661405	1780661405	1	1	GAYNOR, SANFORD H MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	6215	45	Nephrology (Renal-Kidney)	0	In state provider	#115	1045 W REDONDO BEACH BLV	None	GARDENA	CA	90247	4128	19	06037	33.89247044	-118.2931941	Los Angeles County
111682	Fee-for-Service	1487716643	1487716643	1	1	GALLA-PRAUS, VANESSA	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
111695	Fee-for-Service	1932145091	1932145091	1	1	GARFIELD BEACH CVS LLC	1/26/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1485 E VALLEY BLVD	None	ALHAMBRA	CA	91801	5239	19	06037	34.07931022	-118.1097008	Los Angeles County
111726	Fee-for-Service	1851520225	1851520225	1	1	GHODASARA, SWETA L MD	7/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130250	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	3RD FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
111751	Fee-for-Service	1043235161	1043235161	1	1	GERALD SALOMON	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
111762	Fee-for-Service	1669538997	1669538997	1	2	GHALY, AZIZ S MD	1/15/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	100549	33	Thoracic Surgery	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
111769	Fee-for-Service	1336470509	1336470509	1	1	GUENTHER, KIMBERLY A DO	12/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11116	08	Family Practice	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
111809	Fee-for-Service	1215959846	1215959846	2	1	GARFIELD BEACH CVS LLC	9/27/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19201 BEAR VALLEY RD	None	APPLE VALLEY	CA	92308	2702	36	06071	34.468614	-117.243513	San Bernardino County
111823	Fee-for-Service	1275560500	1275560500	1	1	GOLDEN EYE OPTOMETRY INC	8/6/2013	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17497 MAIN ST	None	HESPERIA	CA	92345	6268	36	06071	34.41854387	-117.2814553	San Bernardino County
111845	Fee-for-Service	1699791517	1699791517	1	1	GRAY, ZACHARY A	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77555	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
111865	Fee-for-Service	1548387525	1548387525	1	1	GERNON, THOMAS J J MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139412	04	Otology, Laryngology, Rhinology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
111868	Fee-for-Service	1811053796	1811053796	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
111897	Fee-for-Service	1720070683	1720070683	1	1	GARY M GREENBERG, 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
111939	Fee-for-Service	1467866772	1467866772	1	1	GRACEFUL CARE HOSPICE INC	7/23/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2082 NEWBURY RD	SUITE 12	NEWBURY PARK	CA	91320	3356	56	06111	34.18325613	-118.9246441	Ventura County
111959	Fee-for-Service	1639259443	1639259443	1	1	GO, CYNTHIA MD	7/8/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	84938	None	None	0	In state provider	None	2121 COLORADO AVE	SUITE C	TURLOCK	CA	95382	2012	50	06099	37.5117454	-120.8353096	Stanislaus County
111991	Fee-for-Service	1669402384	1669402384	1	1	GALLO, CONSTANTINO MD	12/29/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36983	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	173 N MORRISON AVE	STE D	SAN JOSE	CA	95126	2712	43	06085	37.33258801	-121.9084887	Santa Clara County
111997	Fee-for-Service	1184936866	1184936866	1	1	GROOM, SANDRA L LCSW	5/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1415 VICTOR AVE	A	REDDING	CA	96003	4035	45	06089	40.58717312	-122.3389834	Shasta County
112000	Fee-for-Service	1104034420	1104034420	1	1	GUZMAN, MINERVA LMFT	3/18/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
112033	Fee-for-Service	1104985845	1104985845	1	1	GREENBLATT, KELLIE D MD	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96199	02	General Surgery	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
112047	Fee-for-Service	1790217164	1790217164	1	1	GUPTA, SAARIK MD	8/17/2023	207R00000X	NA	Other	026	PHYSICIANS	186248	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
112049	Fee-for-Service	1386688653	1386688653	1	1	GARFIELD BEACH CVS, LLC	3/21/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10575 SCRIPPS POWAY PRKY	None	SAN DIEGO	CA	92131	3917	37	06073	32.93719547	-117.099881	San Diego County
112067	Fee-for-Service	1780762351	1780762351	1	1	GO, VANESSA U MD	5/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93980	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
112119	Fee-for-Service	1669977740	1669977740	1	1	GABRIEL, ANDREW DO	3/2/2022	207R00000X	NA	Other	026	PHYSICIANS	17886	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
112120	Fee-for-Service	1689699621	1689699621	1	1	GEORGE BENTZEL	1/21/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2900 12TH AVE N	STE 355W	BILLINGS	MT	59101	7589	00	None	45.792225	-108.518706	Yellowstone County
112128	Fee-for-Service	1063770410	1063770410	1	1	GAWRYS, BREANNA L DO	6/10/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14639	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
112140	Fee-for-Service	1124008974	1124008974	1	1	GROEGER, EUGENE C MD	1/1/1975	208600000X	NA	General Surgery	026	PHYSICIANS	31287	02	General Surgery	0	In state provider	None	2645 OCEAN AVE	STE 307	SAN FRANCISCO	CA	94132	1647	38	06075	37.73199657	-122.4739936	San Francisco County
112200	Fee-for-Service	1669491700	1669491700	1	2	GARDENA HOSPITAL LP	8/10/2023	3336I0012X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
112217	Fee-for-Service	1164858866	1164858866	1	1	GOULD, CHRISTINE E PHD	5/27/2021	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
112228	Fee-for-Service	1467866772	1467866772	1	1	GRACEFUL CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2082 NEWBURY RD	SUITE 12	NEWBURY PARK	CA	91320	3356	56	06111	34.18325613	-118.9246441	Ventura County
112230	Fee-for-Service	1699533851	1699533851	1	1	GOLD MOUNTAIN TRANSPORT LLC	3/27/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3875 TAYLOR RD	STE K	LOOMIS	CA	95650	9272	31	06061	38.81489544	-121.2011302	Placer County
112236	Fee-for-Service	1245500065	1245500065	1	1	GEGG-MITCHELL, JEVON P 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
112245	Fee-for-Service	1568403475	1568403475	2	1	GARFIELD BEACH CVS, LLC	4/7/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2001 PACIFIC COAST HWY	None	LOMITA	CA	90717	2604	19	06037	33.7895335	-118.314819	Los Angeles County
112248	Fee-for-Service	1538219936	1538219936	1	1	GHOSH, PRADIPTA MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96208	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
112286	Fee-for-Service	1750670410	1750670410	1	1	GONZALEZ DIAZ, ISABEL MD	5/15/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	115314	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
112313	Fee-for-Service	1700040011	1700040011	2	1	GEATRAKAS, CHRISTINA S MD	7/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	119278	30	Radiology	0	In state provider	AS MD	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
112314	Fee-for-Service	1851130819	1851130819	1	1	GALEN INPATIENT PHYSICIANS P	7/9/2024	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
112316	Fee-for-Service	1477916880	1477916880	1	1	GLENCER, ALEXA C MD	9/12/2024	208600000X	NA	General Surgery	026	PHYSICIANS	152517	02	General Surgery	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
112320	Fee-for-Service	1306909791	1306909791	1	1	GOLD, KATHRYN A MD	2/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139391	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
112330	Fee-for-Service	1013102797	1013102797	1	1	GARCIA, JUAN M LCSW	8/4/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
112362	Fee-for-Service	1780631002	1780631002	1	1	GREEN, MICHAEL S MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	80363	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 CITRUS GROVE LN	None	OXNARD	CA	93036	9030	56	06111	34.22109563	-119.1795427	Ventura County
112377	Fee-for-Service	1912254129	1912254129	1	1	GAMMON, MARY A OT	9/11/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
112382	Fee-for-Service	1922041060	1922041060	1	1	GOLDSTEIN, MITCHELL R MD	6/4/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68702	40	Pediatrics	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
112421	Fee-for-Service	1417020579	1417020579	1	1	GARCIA LEE & CONCEPCION	5/31/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	RIVER BEND MED ASSOC	7248 S LAND PARK DR	STE 205	SACRAMENTO	CA	95831	3661	34	06067	38.494602	-121.513743	Sacramento County
112429	Fee-for-Service	1568425288	1568425288	1	1	GINOZA, GLENN W MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50932	40	Pediatrics	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
112442	Fee-for-Service	1548351513	1548351513	1	1	GOCKE, STEPHEN E MD	9/30/1983	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	48685	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
112458	Fee-for-Service	1851190656	1851190656	1	1	GOMEZ, NAOMI LCSW	4/18/2025	No Taxonomy Provided	NA	None	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
112520	Fee-for-Service	1598151714	1598151714	1	1	GEORGIE, DANIEL MD	6/25/2018	207R00000X	NA	Other	026	PHYSICIANS	146440	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
112551	Fee-for-Service	1700099249	1700099249	1	1	GENTILE, JASON K MD	6/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95677	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
112559	Fee-for-Service	1427140052	1427140052	1	1	GRATTON, SARAH B MD	9/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91970	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
112604	Fee-for-Service	1851130819	1851130819	1	1	GALEN INPATIENT PHYSICIANS P	7/9/2024	208M00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
112623	Fee-for-Service	1669713699	1669713699	1	1	GUO, JUAN MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114744	90	Pathology-Forensic	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
112626	Fee-for-Service	1003359613	1003359613	1	1	GNS MEDICAL SUPPLIES, INC.	1/24/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	14304 N FENTON RD	None	FENTON	MI	48430	1544	00	None	42.82022526	-83.70756776	Genesee County
112627	Fee-for-Service	1700850559	1700850559	1	1	GOPI, RAMESH K MD	7/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74998	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
112634	Fee-for-Service	1316042450	1316042450	1	1	GRAHAM, RICHARD A MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	53354	13	Neurology (M.D. only)	0	In state provider	None	11832 ROSECRANS AVE	None	NORWALK	CA	90650	4107	19	06037	33.90211977	-118.0813129	Los Angeles County
112647	Fee-for-Service	1114426004	1114426004	1	1	GARCIA, DAVID LMFT	5/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1461 FORD ST	202	REDLANDS	CA	92373	3909	36	06071	34.03913285	-117.1563139	San Bernardino County
112681	Fee-for-Service	1922041060	1922041060	1	1	GOLDSTEIN, MITCHELL R MD	6/4/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68702	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
112698	Fee-for-Service	1912111840	1912111840	1	1	GAPASIN MANOR INC	10/2/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3813 STEEDMAN WAY	None	STOCKTON	CA	95209	5020	39	06077	38.03834098	-121.3642187	San Joaquin County
112712	Fee-for-Service	1639240245	1639240245	1	1	GAROFALO, FRANK A DC	11/26/2018	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	14181 YORBA ST	STE 100	TUSTIN	CA	92780	2061	30	06059	33.756534	-117.8302885	Orange County
112714	Fee-for-Service	1417020579	1417020579	1	1	GARCIA LEE & CONCEPCION	5/31/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	RIVER BEND MED ASSOC	7248 S LAND PARK DR	STE 205	SACRAMENTO	CA	95831	3661	34	06067	38.494602	-121.513743	Sacramento County
112728	Fee-for-Service	1730122052	1730122052	1	1	GUSS, DAVID MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	36122	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 DICKINSON ST	# H207	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
112740	Fee-for-Service	1265434021	1265434021	1	1	GERLIC, RICHARD H MD	2/8/2015	207N00000X	NA	Dermatology	026	PHYSICIANS	45115	07	Dermatology	0	In state provider	None	1388 COURT ST	STE B	REDDING	CA	96001	1650	45	06089	40.58444066	-122.3963013	Shasta County
112790	Fee-for-Service	1043553662	1043553662	1	1	GUZIK, KATE E MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134497	01	General Practice	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
112820	Fee-for-Service	1467464156	1467464156	1	1	GHIASSI, ALIDAD MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60348	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
112849	Fee-for-Service	1194935205	1194935205	1	1	GARCIA, RICHARD STAGGERS	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75626	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
112851	Fee-for-Service	1497711451	1497711451	1	1	GROSS, CARL A MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	35542	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1306 MARICOPA HWY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
112860	Fee-for-Service	1194939025	1194939025	1	1	GAPASIN MANOR INC	3/7/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2325 STANFIELD DR	None	STOCKTON	CA	95209	4017	39	06077	38.03665245	-121.3432453	San Joaquin County
112865	Fee-for-Service	1750056255	1750056255	1	1	GRIFFIN, VALERIE NP	2/26/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 MISSION BLVD	None	JACKSON	CA	95642	2564	03	06005	38.35007723	-120.7659932	Amador County
112872	Fee-for-Service	1699808188	1699808188	1	1	GUINANE, JANEL M LCSW	4/16/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	70118	-	NOT APPLICABLE	0	In state provider	None	480 MANOR PLAZA	None	PACIFICA	CA	94044	1839	41	06081	37.64988472	-122.4917972	San Mateo County
112881	Fee-for-Service	1518908482	1518908482	1	1	GARFIELD BEACH CVS, LLC	5/11/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	32900 PACIFIC COAST HWY	None	DANA POINT	CA	92629	3464	30	06059	33.48510795	-117.7250529	Orange County
112889	Fee-for-Service	1891074688	1891074688	2	1	GARFIELD BEACH CVS LLC	11/29/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	499 W ORANGE SHOW RD	None	SAN BERNARDINO	CA	92408	2029	36	06071	34.07959554	-117.2922305	San Bernardino County
112933	Fee-for-Service	1376939314	1376939314	1	1	GRANDE RONDE HOSPITAL	11/20/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 4TH ST	None	LA GRANDE	OR	97850	1906	00	None	45.31665181	-118.0966184	Union County
112941	Fee-for-Service	1770979890	1770979890	1	1	GUITTARD, JESSE MD	7/2/2019	390200000X	NA	Other	026	PHYSICIANS	144475	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
112946	Fee-for-Service	1578883252	1578883252	1	2	GREER, ROCKY S MD	8/19/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	122249	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
112949	Fee-for-Service	1356408017	1356408017	1	1	GONZALES, ROBERT P OD	1/31/1987	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1415 N BRISTOL ST	None	SANTA ANA	CA	92706	3303	30	06059	33.757164	-117.885014	Orange County
112968	Fee-for-Service	1194233494	1194233494	1	1	GHAMARI, NEDA LMFT	9/26/2023	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
112986	Fee-for-Service	1912123597	1912123597	1	1	GOYAL, DEEPIKA CNP	3/4/2019	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
112990	Fee-for-Service	1356517130	1356517130	1	1	GRANCHI, PHILIP J MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102395	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
113003	Fee-for-Service	1922316173	1922316173	1	1	GEARHART, JENNIFER E	2/28/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
113016	Fee-for-Service	1780814442	1780814442	1	1	GRIMES, BRANDON MD	6/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115192	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1805	19	06037	34.07671715	-118.3799413	Los Angeles County
113083	Fee-for-Service	1518588227	1518588227	1	1	GOLDEN STAR HOSPICE AND	3/25/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE	800 BROOKHURST ST	SUITE 3D	ANAHEIM	CA	92804	4301	30	06059	33.821514	-117.9589105	Orange County
113084	Fee-for-Service	1801938824	1801938824	1	1	GUAJARDO, KIMBERLY PSYD	1/12/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1891 EFFIE ST	None	LOS ANGELES	CA	90026	1711	19	06037	34.08461594	-118.2570874	Los Angeles County
113096	Fee-for-Service	1073055612	1073055612	1	5	GOLDEN STATE URGENT CARE PRO	4/30/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2888 COCHRAN STREET	None	SIMI VALLEY	CA	93065	2782	56	06111	34.27898255	-118.7378325	Ventura County
113108	Fee-for-Service	1467464156	1467464156	1	1	GHIASSI, ALIDAD MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60348	46	Hand Surgery	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
113134	Fee-for-Service	1194935205	1194935205	1	1	GARCIA, RICHARD STAGGERS	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75626	40	Pediatrics	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
113140	Fee-for-Service	1497711451	1497711451	1	1	GROSS, CARL A MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	35542	08	Family Practice	0	In state provider	None	1306 MARICOPA HWY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
113159	Fee-for-Service	1083634315	1083634315	1	1	GAUPP,ROBIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SANTA FE RADIOLOGY PC	455 ST MICHEALS DR	None	SANTA FE	NM	87505	0000	00	None	35.659854	-105.945444	Santa Fe County
113225	Fee-for-Service	1013966225	1013966225	1	1	GOCKE, JAMES M NP	8/14/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
113253	Fee-for-Service	1922037563	1922037563	1	1	GRIMES, SARAH M MD	6/30/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66157	01	General Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
113266	Fee-for-Service	1184345266	1184345266	1	1	GARCIA, NATALIE A	9/18/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14021 AMARGOSA RD	SUITE 100	VICTORVILLE	CA	92392	6404	36	06071	34.50419053	-117.3300794	San Bernardino County
113270	Fee-for-Service	1790950079	1790950079	1	1	GAMBLE, SUSAN R MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	123317	41	Internal Medicine	0	In state provider	None	15630 18TH AVENUE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
113298	Fee-for-Service	1043685654	1043685654	1	1	GEORGE, HEATHER M CNP	8/16/2022	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
113301	Fee-for-Service	1225175888	1225175888	1	1	GUELLER, SERGIO F LCSW	4/27/2016	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1447 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4154	19	06037	34.01888332	-118.1142075	Los Angeles County
113357	Fee-for-Service	1215399449	1215399449	1	1	GUZMAN, ESTEFANY LMSW	12/7/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9431 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5879	36	06071	34.082244	-117.5756135	San Bernardino County
113370	Fee-for-Service	1518588227	1518588227	1	1	GOLDEN STAR HOSPICE AND	3/25/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE	800 BROOKHURST ST	SUITE 3D	ANAHEIM	CA	92804	4301	30	06059	33.821514	-117.9589105	Orange County
113380	Fee-for-Service	1487010997	1487010997	1	1	GHEBREYESUS, ERMIAS E CRNA	4/26/2016	No Taxonomy Provided	NA	None	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
113403	Fee-for-Service	1982706974	1982706974	1	1	GUJRATHI, SUNIL MD	10/10/2023	2085R0204X	NA	Other	026	PHYSICIANS	191344	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
113427	Fee-for-Service	1497711451	1497711451	1	1	GROSS, CARL A MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	35542	01	General Practice	0	In state provider	None	1306 MARICOPA HWY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
113449	Fee-for-Service	1477893261	1477893261	1	1	GROVEY, BRITTANY D MD	6/7/2018	207L00000X	NA	Other	026	PHYSICIANS	129072	70	Clinic (mixed specialty)	0	In state provider	None	5850 OBERLIN DRIVE	SUITE 100	SAN DIEGO	CA	92121	4710	37	06073	32.894677	-117.1928626	San Diego County
113494	Fee-for-Service	1255678686	1255678686	1	1	GONZALEZ, DIANNA LMFT	4/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
113496	Fee-for-Service	1114476769	1114476769	1	1	GALLAGHER, BRANDY L CNP	5/18/2017	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
113507	Fee-for-Service	1922042274	1922042274	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	638 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2848	30	06059	33.45932277	-117.6517315	Orange County
113526	Fee-for-Service	1720665508	1720665508	1	1	GARNER, DANIELLE	2/27/2025	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
113527	Fee-for-Service	1487657243	1487657243	1	1	GILBERT, CHRISTOPHER MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35403	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
113559	Fee-for-Service	1750445201	1750445201	1	1	GRUNDLER, WILLIAM G MD	6/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87153	41	Internal Medicine	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
113560	Fee-for-Service	1962983734	1962983734	1	1	GARCIA, YVETTE M NP	3/22/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8635 FIRESTONE BLVD	STE 100	DOWNEY	CA	90241	5242	19	06037	33.93691837	-118.1265474	Los Angeles County
113605	Fee-for-Service	1639232788	1639232788	1	1	GARG, SHIPRA MD	1/3/2024	207ZP0102X	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
113656	Fee-for-Service	1134168370	1134168370	1	1	GELPI, JUAN R. MD	12/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 FIRST COLONIAL RD	STE 203	VIRGINIA BCH	VA	23454	2418	00	None	36.8666554	-76.02945618	Virginia Beach city
113673	Fee-for-Service	1346472859	1346472859	1	1	GENESIS LABORATORY MANAGEMEN	7/26/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	T, LLC	1912 HIGHWAY 35 SOUTH	SUITE 202 & 203	OAKHURST	NJ	07755	2768	00	None	40.26292234	-74.04179899	Monmouth County
113729	Fee-for-Service	1073534335	1073534335	1	1	GREENWICH EMERGENCY MEDICAL	3/22/2017	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1111 E PUTNAM AVE	None	RIVERSIDE	CT	06878	1335	00	None	41.04084165	-73.58413123	Western Connecticut Planning Region
113736	Fee-for-Service	1477893261	1477893261	1	1	GROVEY, BRITTANY D MD	6/7/2018	207L00000X	NA	Other	026	PHYSICIANS	129072	05	Anesthesiology	0	In state provider	None	5850 OBERLIN DRIVE	SUITE 100	SAN DIEGO	CA	92121	4710	37	06073	32.894677	-117.1928626	San Diego County
113738	Fee-for-Service	1245213727	1245213727	1	1	GATES, JOAN M MD	12/27/2019	207P00000X	NA	Other	026	PHYSICIANS	37742	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
113785	Fee-for-Service	1487823936	1487823936	1	1	GAUTHIER, MARY B MD	7/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	113249	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
113813	Fee-for-Service	1972987717	1972987717	1	1	GIRGIS, CHRISTINE F OD	8/29/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	236 N MARKET ST	None	INGLEWOOD	CA	90301	1217	19	06037	33.96582518	-118.351974	Los Angeles County
113815	Fee-for-Service	1720665508	1720665508	1	1	GARNER, DANIELLE	2/27/2025	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
113833	Fee-for-Service	1003914102	1003914102	1	1	GOLDBERG, BRYAN D MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88821	None	None	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
113878	Fee-for-Service	1952378762	1952378762	1	1	GEE, BETHESDA Y MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87951	01	General Practice	0	In state provider	None	7301 TOPANGA CANYON BLVD	SUITE 330	CANOGA PARK	CA	91303	1357	19	06037	34.203222	-118.605988	Los Angeles County
113896	Fee-for-Service	1215240338	1215240338	1	1	GRENTZER, JACLYN M MD	6/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145051	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
113917	Fee-for-Service	1932549623	1932549623	1	1	GRIGSBY, JONATHAN S DO	3/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12866	08	Family Practice	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
113933	Fee-for-Service	1669411542	1669411542	1	1	GORLICK, LAURENCE K MD	1/22/1996	207R00000X	NA	Other	026	PHYSICIANS	36580	41	Internal Medicine	0	In state provider	ASSOCIATES INTERNAL MED	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
113935	Fee-for-Service	1457575706	1457575706	1	1	GONZALEZ, JORGE MD	6/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	57888	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
113970	Fee-for-Service	1316982879	1316982879	1	1	GENERAL VASCULAR SURGERY	10/19/1983	174400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	MED GRP INC	3012 SUMMIT ST	# G621	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
113976	Fee-for-Service	1760265136	1760265136	1	1	GUYO HOME CARE	1/16/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	7036 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1824	37	06073	32.76875048	-117.046242	San Diego County
113992	Fee-for-Service	1518970409	1518970409	1	1	GREENSWEIG, GARY A DO	3/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	4368	08	Family Practice	0	In state provider	None	651 CHERRY ST	None	SANTA ROSA	CA	95404	4202	49	06097	38.444841	-122.7154995	Sonoma County
114085	Fee-for-Service	1114964764	1114964764	1	1	GOLLOGLY, SOHRAB MD	1/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83746	20	Orthopedic Surgery	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
114130	Fee-for-Service	1386394872	1386394872	1	1	GRUSKY, ALAN Z MD	4/2/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189125	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
114135	Fee-for-Service	1225283260	1225283260	1	1	GUMUSANELI, ERGI O MD	4/19/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	133155	None	None	0	In state provider	None	222 WEST HENDERSON AVE	None	PORTERVILLE	CA	93257	1731	54	06107	36.0804034	-119.0217006	Tulare County
114150	Fee-for-Service	1154469393	1154469393	1	1	GIAMMONA, ANDREW J MD	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54447	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
114189	Fee-for-Service	1528281417	1528281417	1	1	GUIDRY, BERNADETTE M LMFT	4/20/2020	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
114223	Fee-for-Service	1881813228	1881813228	1	1	GARCIA, MARISTELA B MD	12/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52252	38	Geriatrics	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
114228	Fee-for-Service	1821434358	1821434358	1	1	GARCIA, MIGUEL A MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143179	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
114273	Fee-for-Service	1760444160	1760444160	1	1	GARY WARREN HILLMAN, 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	1 E CLARK BASS BLVD	None	MCALESTER	OK	74501	4209	00	None	34.93578655	-95.75025857	Pittsburg County
114275	Fee-for-Service	1720286446	1720286446	1	1	GUERIN, ELAINA S DO	12/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9683	41	Internal Medicine	0	In state provider	None	1411 E 31 ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
114299	Fee-for-Service	1982030409	1982030409	1	1	GREENER, MICHAEL S LCSW	9/18/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 EAST FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
114304	Fee-for-Service	1811056427	1811056427	1	1	GEBRESELASSIE, W MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43179	45	Nephrology (Renal-Kidney)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
114315	Fee-for-Service	1013950450	1013950450	1	1	GREGORIUS, THEODORE K	12/12/2005	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	84930	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
114317	Fee-for-Service	1346611530	1346611530	1	1	GREEN, ALISSA LMFT	2/9/2022	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
114354	Fee-for-Service	1477004307	1477004307	1	1	GALICIA, EMMANUEL V NP	6/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26357 MCBEAN PKWY	STE 205	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
114375	Fee-for-Service	1114964764	1114964764	1	1	GOLLOGLY, SOHRAB MD	1/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83746	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
114378	Fee-for-Service	1609515808	1609515808	1	1	GIGENA, JENNIFER LMFT	11/12/2024	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
114405	Fee-for-Service	1871667196	1871667196	1	1	GAUR, ALOK MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87870	20	Orthopedic Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
114413	Fee-for-Service	1942223664	1942223664	1	1	GROSS, MATTHEW MD	3/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80214	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
114500	Fee-for-Service	1225735871	1225735871	1	1	GONZALEZ TORRES, MARIANA LM	2/26/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 N. DEMAREE ST	013	VISALIA	CA	93291	4101	54	06107	36.337878	-119.3323815	Tulare County
114526	Fee-for-Service	1497728182	1497728182	1	1	GRIFFIN, SARAH M MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74899	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
114591	Fee-for-Service	1811056427	1811056427	1	1	GEBRESELASSIE, W MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43179	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
114598	Fee-for-Service	1912101056	1912101056	1	1	GILL, PARVEEN K LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
114601	Fee-for-Service	1467828871	1467828871	1	1	GOODE, JULIE A LMFT	9/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5182 KATELLA AVENUE	206	LOS ALAMITOS	CA	90720	2824	30	06059	33.80290985	-118.0427805	Orange County
114605	Fee-for-Service	1114223518	1114223518	1	1	GOLSHANI, POUYAN MD	9/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135402	30	Radiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
114640	Fee-for-Service	1699041566	1699041566	1	1	GARDNER FAMILY HEALTH	5/18/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	725 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1900	43	06085	37.34328626	-121.8756374	Santa Clara County
114650	Fee-for-Service	1922043819	1922043819	1	1	GARFIELD BEACH CVS, LLC	6/17/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3327 ROSECRANS ST	None	SAN DIEGO	CA	92110	4223	37	06073	32.74779742	-117.2076448	San Diego County
114655	Fee-for-Service	1689610248	1689610248	1	1	GAMBAROTA, C MARCI	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 RED ROCK DRIVE	None	GALLUP	NM	87301	0000	00	None	35.50662903	-108.7272069	McKinley County
114674	Fee-for-Service	1265881551	1265881551	1	1	GARFIELD BEACH CVS LLC	10/7/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8956 FOOTHILL BLVD	None	RANCHO CUCAMONGA	CA	91730	3447	36	06071	34.10675745	-117.6098175	San Bernardino County
114714	Fee-for-Service	1831686245	1831686245	1	1	GUTIERREZ, ANGELINA M LPCC	3/5/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
114737	Fee-for-Service	1801470992	1801470992	1	1	GARG, SUNAKSHI DPM	10/4/2024	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
114749	Fee-for-Service	1851489355	1851489355	1	1	GORDON, MICHAEL MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	35946	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	8910 UNIVERSITY CENTER L	STE 800	SAN DIEGO	CA	92122	1031	37	06073	32.87053963	-117.226785	San Diego County
114782	Fee-for-Service	1548463854	1548463854	1	1	GHOSTINE, MICHELLE S MD	12/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101687	04	Otology, Laryngology, Rhinology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
114785	Fee-for-Service	1245517689	1245517689	1	1	GRAHAM, LYNNEAE	3/4/2024	171M00000X	NA	Other	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
114834	Fee-for-Service	1215048541	1215048541	1	1	GRACE, MARY E MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	75174	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
114864	Fee-for-Service	1487108007	1487108007	1	1	GREENWALD, ARIEL S	10/14/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
114888	Fee-for-Service	1962453134	1962453134	1	1	GOOD SAMARITAN HOSPITAL	10/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3600 NW SAMARITAN DR	None	CORVALLIS	OR	97330	3700	00	None	44.60340934	-123.2532543	Benton County
114899	Fee-for-Service	1730768011	1730768011	1	1	GOOD DAY PHYSICAL THERAPY PC	7/3/2024	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9324 GARVEY AVE	UNIT J	SOUTH EL MONTE	CA	91733	1090	19	06037	34.06269254	-118.065933	Los Angeles County
114911	Fee-for-Service	1316911548	1316911548	1	1	GATTO-WOITEK, LINDA S LCSW	9/8/2014	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5021 1/2 MANSFIELD ST	None	SAN DIEGO	CA	92116	1939	37	06073	32.76963975	-117.1182389	San Diego County
114926	Fee-for-Service	1407095003	1407095003	1	1	GUTIERREZ-YACH, MARIA F MD	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106410	None	None	0	In state provider	None	44439 17TH ST WEST	SUITE 104	LANCASTER	CA	93534	2854	19	06037	34.69070437	-118.161312	Los Angeles County
114928	Fee-for-Service	1699041566	1699041566	1	1	GARDNER FAMILY HEALTH	4/15/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	725 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1900	43	06085	37.34328626	-121.8756374	Santa Clara County
115007	Fee-for-Service	1598109761	1598109761	1	1	GOWAN, AMY J MD	6/5/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	149549	08	Family Practice	0	In state provider	None	200 SOUTH WELLS ROAD	STE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
115017	Fee-for-Service	1821010422	1821010422	2	1	GARFIELD BEACH CVS LLC	1/24/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3150 W SHAW AVE	None	FRESNO	CA	93711	3215	10	06019	36.80841792	-119.8478855	Fresno County
115019	Fee-for-Service	1972705580	1972705580	1	1	GREGUREK, STEVEN F MD	5/23/2018	207ZP0105X	NA	Other	026	PHYSICIANS	133983	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
115023	Fee-for-Service	1306031810	1306031810	1	1	GOBA, DANIEL K MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112723	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1910 OUTLET CENTER DR	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
115024	Fee-for-Service	1184971194	1184971194	1	1	GABARAIN, GABRIEL MD	8/21/2018	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	155356	84	Surgery-Head and Neck	0	In state provider	None	4646 BROCKTON AVE	SUITE 201	RIVERSIDE	CA	92506	0104	33	06065	33.9760171	-117.3860626	Riverside County
115046	Fee-for-Service	1477626927	1477626927	1	1	GRIS, ELIA PT	8/30/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25129 THE OLD RD STE 100	None	STEVENSON RANCH	CA	91381	2281	19	06037	34.3752041	-118.5639379	Los Angeles County
115051	Fee-for-Service	1619371085	1619371085	1	1	GUSTAVUS, MELANIE CCC-SLP	8/30/2020	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
115089	Fee-for-Service	1801971882	1801971882	1	1	GUROY, MARY ELLEN A MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	37441	77	Infectious Disease	0	In state provider	None	165 ROWLAND WAY	STE 200	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
115154	Fee-for-Service	1831323369	1831323369	1	1	GOPAL, SRILA	8/28/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	151332	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
115164	Fee-for-Service	1477319010	1477319010	1	1	GASTON, JAKE ROBERT PT	4/16/2024	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
115178	Fee-for-Service	1962453134	1962453134	1	1	GOOD SAMARITAN HOSPITAL	1/15/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3600 NW SAMARITAN DR	None	CORVALLIS	OR	97330	3700	00	None	44.60340934	-123.2532543	Benton County
115180	Fee-for-Service	1164809281	1164809281	1	1	GONG, MARVIN D MD DO	7/10/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	16588	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 1000A	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
115183	Fee-for-Service	1902435001	1902435001	1	1	GRIESE, ALIA LMFT	7/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	120 PEARL ALLEY	None	SANTA CRUZ	CA	95060	3915	44	06087	36.97318801	-122.0265447	Santa Cruz County
115190	Fee-for-Service	1710219738	1710219738	1	1	GONZALEZ, RUBEN MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110468	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
115202	Fee-for-Service	1144580879	1144580879	1	1	GINSBACH, KIMBERLY A	6/25/2018	390200000X	NA	Other	026	PHYSICIANS	137602	40	Pediatrics	0	In state provider	None	7237 E SOUTHGATE DR	STE A	SACRAMENTO	CA	95823	2631	34	06067	38.494629	-121.435686	Sacramento County
115215	Fee-for-Service	1699041566	1699041566	1	1	GARDNER FAMILY HEALTH	5/18/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	725 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1900	43	06085	37.34328626	-121.8756374	Santa Clara County
115259	Fee-for-Service	1598103780	1598103780	1	1	GELLER, MONICA G PSYD	8/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3655 ALAMO ST	202	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
115274	Fee-for-Service	1013951383	1013951383	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	731 S WEIR CANYON RD	None	ANAHEIM	CA	92808	1960	30	06059	33.86248951	-117.7388014	Orange County
115279	Fee-for-Service	1396912424	1396912424	1	1	GIAN M MUSARRA MD	3/9/2015	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
115308	Fee-for-Service	1306031810	1306031810	1	1	GOBA, DANIEL K MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112723	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
115328	Fee-for-Service	1518160258	1518160258	1	1	GILLEY-AVRAMIS, JOSLIN M MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100713	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
115333	Fee-for-Service	1750364451	1750364451	1	1	GRETCHEN E BLAIR, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 E 19TH ST	None	THE DALLES	OR	97058	3317	00	None	45.58806554	-121.164498	Wasco County
115342	Fee-for-Service	1346981750	1346981750	1	1	GRAY, PORSHA K NP	1/8/2023	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
115350	Fee-for-Service	1285334268	1285334268	1	1	GOLDEN HOLISTIC CARE INC	9/27/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18000 STUDEBAKER RD	STE 700	CERRITOS	CA	90703	2684	19	06037	33.86863289	-118.0988933	Los Angeles County
115376	Fee-for-Service	1801275987	1801275987	1	1	GOLINGHO, MARY PAZ T MD	9/25/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154137	08	Family Practice	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
115377	Fee-for-Service	1801971882	1801971882	1	1	GUROY, MARY ELLEN A MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	37441	41	Internal Medicine	0	In state provider	None	165 ROWLAND WAY	STE 200	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
115387	Fee-for-Service	1457326852	1457326852	1	1	GRINBERG, GARY G MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100593	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
115392	Fee-for-Service	1831226380	1831226380	2	1	GERACHT, JENNIFER C MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84972	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
115399	Fee-for-Service	1104860477	1104860477	1	1	GARFIELD BEACH CVS, LLC	3/20/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17625 HARVARD AVE	None	IRVINE	CA	92614	8547	30	06059	33.6768845	-117.8316155	Orange County
115418	Fee-for-Service	1275078461	1275078461	1	1	GARCIA, BLANCA	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
115419	Fee-for-Service	1215049499	1215049499	1	1	GNANASHANMUGAM, DEVASENA	3/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83615	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
115461	Fee-for-Service	1669574968	1669574968	1	3	GARCIA, DON L MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52231	08	Family Practice	0	In state provider	None	532 W CHAPMAN AVE	None	PLACENTIA	CA	92870	5701	30	06059	33.87315894	-117.8756844	Orange County
115463	Fee-for-Service	1356356034	1356356034	1	1	GABBAL, FRANCES MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45614	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
115492	Fee-for-Service	1689752321	1689752321	1	1	GUTMANN, SIDNEY M MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54102	18	Ophthalmology	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
115508	Fee-for-Service	1073055612	1073055612	1	4	GOLDEN STATE URGENT CARE PRO	4/30/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1487 LANDESS AVE	None	MILPITAS	CA	95035	6953	43	06085	37.41542091	-121.8774666	Santa Clara County
115533	Fee-for-Service	1780781369	1780781369	1	1	GENSLER, LIANNE S MD	3/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83162	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
115550	Fee-for-Service	1376027912	1376027912	1	1	GARCIA, CELESTE LCSW	10/23/2024	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
115576	Fee-for-Service	1376040717	1376040717	1	1	GHOBRYAL, OLIVIA MD	7/2/2024	207R00000X	NA	Other	026	PHYSICIANS	184941	41	Internal Medicine	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
115582	Fee-for-Service	1235216177	1235216177	1	1	GARMEL, GUS M MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	71012	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
115617	Fee-for-Service	1780840397	1780840397	1	1	GOODWINE, DIANA S MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125805	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 BON AIR ROAD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
115637	Fee-for-Service	1952426017	1952426017	1	1	GOLDSZTEIN, HERNAN MD	11/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117595	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
115642	Fee-for-Service	1619901394	1619901394	1	1	GONG, QINZHI	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79469	None	None	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
115645	Fee-for-Service	1679078281	1679078281	1	1	GILCHRIST, MEGAN M MD	8/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	187308	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
115651	Fee-for-Service	1881625572	1881625572	1	1	GELLER, JAMES I MD	11/27/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	None	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
115656	Fee-for-Service	1689771362	1689771362	1	1	GILBERT CAILLOUET	6/20/2018	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
115667	Fee-for-Service	1801971882	1801971882	1	1	GUROY, MARY ELLEN A MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	37441	01	General Practice	0	In state provider	None	165 ROWLAND WAY	STE 200	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
115695	Fee-for-Service	1891976627	1891976627	1	1	GEE, SHARON B LCSW	1/14/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115708	Fee-for-Service	1982201646	1982201646	1	1	GOLUB, SETH D LMFT	12/2/2024	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
115747	Fee-for-Service	1649347584	1649347584	1	1	GRILL, BRUCE B MD	3/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	48011	40	Pediatrics	0	In state provider	None	1505 W 17TH ST	STE 3	SAN BERNARDINO	CA	92411	1202	36	06071	34.13045153	-117.31869	San Bernardino County
115771	Fee-for-Service	1437775418	1437775418	1	1	GARDUCE, KARSTEN MICHELLO V	4/16/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	CNP	1900 19TH AVE	None	SAN FRANCISCO	CA	94116	1250	38	06075	37.75211157	-122.4762664	San Francisco County
115848	Fee-for-Service	1134411424	1134411424	1	1	GARCIA-MONTOYA, NATALIE MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130720	01	General Practice	0	In state provider	None	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
115849	Fee-for-Service	1598054991	1598054991	1	1	GUO, DAVID P MD	1/28/2019	208800000X	NA	Other	026	PHYSICIANS	122619	34	Urology and Urological Surgery	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
115870	Fee-for-Service	1841784287	1841784287	1	1	GHC OF UPLAND RCFE, LLC	12/10/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	275 GARNET WAY	None	UPLAND	CA	91786	5932	36	06071	34.097193	-117.6549365	San Bernardino County
115884	Fee-for-Service	1427373141	1427373141	1	1	GAZALLO, JULIANA M MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118473	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
115893	Fee-for-Service	1730567579	1730567579	1	2	GCH MEDICAL GROUP INC	1/29/2021	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1720 TERMINO AVENUE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
115894	Fee-for-Service	1588832679	1588832679	1	1	GIANZERO, MARC V MD APC	2/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54882	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
115937	Fee-for-Service	1881625572	1881625572	1	1	GELLER, JAMES I MD	11/27/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	None	68	Hematology	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
115947	Fee-for-Service	1598770091	1598770091	1	1	GOLCONDA, MURALIKRISHNA	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52858	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
115977	Fee-for-Service	1437171121	1437171121	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	133 SERRAMONTE CTR	None	DALY CITY	CA	94015	2349	41	06081	37.66930344	-122.4711524	San Mateo County
116024	Fee-for-Service	1811072648	1811072648	2	1	GILLIAM, LISA K MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55435	67	Endocrinology	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
116076	Fee-for-Service	1255423976	1255423976	1	1	GASTRO-DIGESTIVE MEDICAL	4/29/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	GROUP	3621 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3512	19	06037	33.93082719	-118.2024698	Los Angeles County
116115	Fee-for-Service	1104238013	1104238013	1	1	GANAPATHY, ANURADHA MD	9/10/2020	207P00000X	NA	Other	026	PHYSICIANS	153702	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
116146	Fee-for-Service	1659951754	1659951754	1	1	GARCIA, JAIRO MD	4/22/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	184268	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
116157	Fee-for-Service	1063896462	1063896462	1	1	GREEN HEIGHTS HEALTH CARE	9/11/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	620 LINDEN DR	None	OXNARD	CA	93033	9164	56	06111	34.176118	-119.1836763	Ventura County
116178	Fee-for-Service	1649592981	1649592981	1	1	GUPTA, ANUJ MD CORPORATION	10/14/2011	261QP3300X	NA	Other	026	PHYSICIANS	85939	05	Anesthesiology	0	In state provider	None	162 S RANCHO SANTA FE RD	STE A50	ENCINITAS	CA	92024	4348	37	06073	33.03625145	-117.2377809	San Diego County
116197	Fee-for-Service	1316365828	1316365828	1	1	GUERRA, MARSHA T MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143288	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
116212	Fee-for-Service	1922525807	1922525807	1	1	GUARDIAN FLIGHT LLC	4/27/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	3474 OLD INTL AIRPORT RD	None	ANCHORAGE	AK	99502	1003	00	None	61.173306	-149.94864	Municipality of Anchorage
116234	Fee-for-Service	1598770091	1598770091	1	1	GOLCONDA, MURALIKRISHNA	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52858	45	Nephrology (Renal-Kidney)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
116282	Fee-for-Service	1326201146	1326201146	1	1	GILL, ROOP MD	7/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110466	24	Plastic Surgery	0	In state provider	None	300 MEDICAL PLAZA	SUITE 200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
116332	Fee-for-Service	1538490446	1538490446	1	1	GOO, JEANNA S MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110636	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
116349	Fee-for-Service	1053791509	1053791509	1	1	GRANDY PODIATRY GROUP	5/21/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	730 46TH AVE	None	SACRAMENTO	CA	95819	3419	34	06067	38.570787	-121.44474	Sacramento County
116360	Fee-for-Service	1285746040	1285746040	1	1	GANZ, RICHARD R MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30698	66	Emergency Medicine (Urgent Care)	0	In state provider	None	455 MARCH AVE	STE C	HEALDSBURG	CA	95448	3385	49	06097	38.6259371	-122.8642559	Sonoma County
116367	Fee-for-Service	1255423976	1255423976	1	1	GASTRO-DIGESTIVE MEDICAL	4/29/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	3621 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3512	19	06037	33.93082719	-118.2024698	Los Angeles County
116388	Fee-for-Service	1174812606	1174812606	1	1	GHOBRIAL, ANDREW A MD	3/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	123720	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
116408	Fee-for-Service	1285336875	1285336875	1	1	GAN, FRANCIS	4/8/2025	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
116433	Fee-for-Service	1407994973	1407994973	1	1	GABR, CHRISTINE A MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54932	05	Anesthesiology	0	In state provider	None	501 S BUENA VISTA STREET	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
116484	Fee-for-Service	1306954714	1306954714	1	1	GARCIA, EDDIE M MD APC	11/1/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	53767	18	Ophthalmology	0	In state provider	None	10942 RAMONA BLVD	STE A	EL MONTE	CA	91731	2644	19	06037	34.07199583	-118.0369162	Los Angeles County
116498	Fee-for-Service	1962516898	1962516898	1	1	GANDHY, ANITA P MD	3/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81491	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
116505	Fee-for-Service	1447229570	1447229570	1	1	GANJIANPOUR, MEHRDAD MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71208	20	Orthopedic Surgery	0	In state provider	A PROF CORP	8670 WILSHIRE BLVD	STE 202	BEVERLY HILLS	CA	90211	2930	19	06037	34.06629779	-118.3807407	Los Angeles County
116535	Fee-for-Service	1215167242	1215167242	1	1	GARFIELD BEACH CVS LLC	2/17/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1175 W LATHROP RD	None	MANTECA	CA	95336	8326	39	06077	37.8264555	-121.2350985	San Joaquin County
116538	Fee-for-Service	1255457859	1255457859	1	1	GILBERT, DAN W OD	11/8/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2955 VAN BUREN BLVD	H-2	RIVERSIDE	CA	92503	5674	33	06065	33.90865123	-117.4368482	Riverside County
116620	Fee-for-Service	1205877115	1205877115	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7911 HAVEN AVE	None	RANCHO CUCAMONGA	CA	91730	3066	36	06071	34.109991	-117.5757545	San Bernardino County
116626	Fee-for-Service	1104073949	1104073949	1	1	GICHUHI, PENNINAH	9/26/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3809 S BRADLEY ST	None	VISALIA	CA	93292	3436	54	06107	36.296307	-119.2819905	Tulare County
116629	Fee-for-Service	1538224803	1538224803	1	1	GIFFORD, THOMAS O MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150420	04	Otology, Laryngology, Rhinology	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
116648	Fee-for-Service	1285746040	1285746040	1	1	GANZ, RICHARD R MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30698	41	Internal Medicine	0	In state provider	None	455 MARCH AVE	STE C	HEALDSBURG	CA	95448	3385	49	06097	38.6259371	-122.8642559	Sonoma County
116698	Fee-for-Service	1437304110	1437304110	1	1	GILL, TEJINDER K MD	3/9/2020	207R00000X	NA	Other	026	PHYSICIANS	111802	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
116700	Fee-for-Service	1881118255	1881118255	1	1	GARCIA, JANET M LMFT	9/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4344 LATHAM ST	STE 110	RIVERSIDE	CA	92501	0400	33	06065	34.00198519	-117.3739252	Riverside County
116760	Fee-for-Service	1790753606	1790753606	1	1	GINWALLA, CHERIE F MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	66012	40	Pediatrics	0	In state provider	None	969 PLUMAS ST	None	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
116786	Fee-for-Service	1366785149	1366785149	1	1	GLINSKII, VLADIMIR MD	11/9/2021	2278C0205X	NA	Other	026	PHYSICIANS	155950	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
116807	Fee-for-Service	1265472849	1265472849	1	1	GROVER, MALEAH MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	37514	42	Nuclear Medicine	0	In state provider	None	301 NEWPORT BEACH BLVD	None	NEWPORT BEACH	CA	92663	0000	30	06059	33.6242782	-117.9284249	Orange County
116815	Fee-for-Service	1346278124	1346278124	1	1	GINDI, NABILA E MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	30005	01	General Practice	0	In state provider	None	1096 N WESTERN AVE	BLDG I	LOS ANGELES	CA	90029	2310	19	06037	34.090524	-118.309141	Los Angeles County
116880	Fee-for-Service	1720287436	1720287436	1	1	GUPTA, SAMEER MD	3/13/2008	207K00000X	NA	Other	026	PHYSICIANS	87331	03	Allergy	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
116907	Fee-for-Service	1326365933	1326365933	1	1	GERA, ATUL MD	6/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119199	30	Radiology	0	In state provider	None	1900 SULLIVAN DR	None	DALY CITY	CA	94015	9641	41	06081	37.67984327	-122.4730264	San Mateo County
116916	Fee-for-Service	1104073949	1104073949	1	1	GICHUHI, PENNINAH	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	3809 S BRADLEY ST	None	VISALIA	CA	93292	3436	54	06107	36.296307	-119.2819905	Tulare County
116920	Fee-for-Service	1700826070	1700826070	1	1	GORMAN, SUSAN R MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78572	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
116936	Fee-for-Service	1760551543	1760551543	1	1	GU, DAVID G DO APC	4/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	6851	41	Internal Medicine	0	In state provider	None	723 S GARFIELD AVE	STE 201	ALHAMBRA	CA	91801	4429	19	06037	34.08841931	-118.1231009	Los Angeles County
116969	Fee-for-Service	1710336300	1710336300	1	1	GLASS BEACH MEDICAL SERVICES	8/1/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	AMC	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
116979	Fee-for-Service	1609989037	1609989037	1	1	GARCIA, LAWRENCE S MD	12/31/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	46093	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	234 BAKER ST	None	BAKERSFIELD	CA	93305	5856	15	06029	35.37029516	-118.9952539	Kern County
117017	Fee-for-Service	1639140403	1639140403	1	1	GOLDMAN, JAROSLAW I. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4646 N MARINE DR	STE 125	CHICAGO	IL	60640	5759	00	None	41.96679637	-87.64901299	Cook County
117041	Fee-for-Service	1710014089	1710014089	1	1	GRONDAHL, LISE M MD	6/1/1999	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51187	36	Psychiatry	0	In state provider	None	1220 UNIVERSITY DR	STE 101	MENLO PARK	CA	94025	4259	41	06081	37.45094703	-122.1880886	San Mateo County
117056	Fee-for-Service	1417275967	1417275967	1	1	GLECO LLC	5/24/2010	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ADMINISTRATOR	16123 VINE STREET	None	HESPERIA	CA	92345	3113	36	06071	34.43183187	-117.311333	San Bernardino County
117080	Fee-for-Service	1639311665	1639311665	1	1	GOLDSMITH, CRYSTAL M MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124748	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
117094	Fee-for-Service	1265472849	1265472849	1	1	GROVER, MALEAH MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	37514	30	Radiology	0	In state provider	None	301 NEWPORT BEACH BLVD	None	NEWPORT BEACH	CA	92663	0000	30	06059	33.6242782	-117.9284249	Orange County
117097	Fee-for-Service	1497824189	1497824189	1	1	GARDENA EMERGENCY MED	3/3/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ASSOCIATES INC	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
117102	Fee-for-Service	1063583045	1063583045	1	1	GRAU, PEGGY L MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53036	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
117170	Fee-for-Service	1902950843	1902950843	1	1	GULLETT, JOHN H MD	4/26/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	26506	77	Infectious Disease	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
117176	Fee-for-Service	1811214455	1811214455	1	1	GARZA, ARMANDO S MD	3/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115116	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
117199	Fee-for-Service	1740835743	1740835743	1	1	GRACELIGHT COMMUNITY HEALTH	5/4/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	303 LOMA DR	SUITE 202	LOS ANGELES	CA	90017	1103	19	06037	34.0595565	-118.2659336	Los Angeles County
117240	Fee-for-Service	1003633348	1003633348	1	1	GRACE, HALEY R	10/22/2024	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
117242	Fee-for-Service	1710171855	1710171855	2	1	GARFIELD BEACH CVS LLC	10/19/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2161 MONTEREY HWY	None	SAN JOSE	CA	95125	1057	43	06085	37.304649	-121.865778	Santa Clara County
117257	Fee-for-Service	1962978429	1962978429	2	1	GEISS MED HOSPICE LLC	4/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2592 N SANTIAGO BLVD	None	ORANGE	CA	92867	1862	30	06059	33.83189005	-117.8339285	Orange County
117285	Fee-for-Service	1235155318	1235155318	1	1	GUERRERO, ETHELWOLDO MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61539	01	General Practice	0	In state provider	None	240 SPRUCE ST	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
117320	Fee-for-Service	1417441494	1417441494	1	1	GEVORGYAN, VICTORIA MD	10/3/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	163753	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
117398	Fee-for-Service	1437425956	1437425956	1	1	GHAI, ANCHAL MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135862	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
117430	Fee-for-Service	1811962970	1811962970	1	1	GERSHMAN, GEORGE MD	3/7/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	62846	40	Pediatrics	0	In state provider	None	436 N ROXBURY DR	STE 203	BEVERLY HILLS	CA	90210	5017	19	06037	34.06771782	-118.4065755	Los Angeles County
117486	Fee-for-Service	1740835743	1740835743	1	1	GRACELIGHT COMMUNITY HEALTH	5/4/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	303 LOMA DR	SUITE 202	LOS ANGELES	CA	90017	1103	19	06037	34.0595565	-118.2659336	Los Angeles County
117541	Fee-for-Service	1962978429	1962978429	2	1	GEISS MED HOSPICE LLC	4/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2592 N SANTIAGO BLVD	None	ORANGE	CA	92867	1862	30	06059	33.83189005	-117.8339285	Orange County
117554	Fee-for-Service	1942236401	1942236401	1	1	GWYNN, ROBERT E MD	10/3/1972	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	16492	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3300 WEBSTER ST	STE 710	OAKLAND	CA	94609	3122	01	06001	37.82132826	-122.2621843	Alameda County
117589	Fee-for-Service	1629145438	1629145438	1	1	GILBERTSON, VANITA C MD	6/30/1984	2085B0100X	NA	MRI Provider	026	PHYSICIANS	43191	30	Radiology	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
117687	Fee-for-Service	1417489626	1417489626	1	1	GRAY, ERIC J MD	7/2/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158255	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
117699	Fee-for-Service	1487670501	1487670501	1	2	GIFTED ARMS INC.	5/9/2019	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	SERVICES	1400 EASTON DR	UNIT 141	BAKERSFIELD	CA	93309	9404	15	06029	35.36987284	-119.0452201	Kern County
117701	Fee-for-Service	1073166351	1073166351	2	1	GARG, NADISH MD	5/22/2023	207R00000X	NA	Other	026	PHYSICIANS	181297	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
117706	Fee-for-Service	1760113401	1760113401	1	1	GUIDED TRANSITIONS MEDIATION	6/27/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AND FAMILY COUNSELING I	16041 KAMANA RD	STE A	APPLE VALLEY	CA	92307	1331	36	06071	34.54277199	-117.2713892	San Bernardino County
117716	Fee-for-Service	1811962970	1811962970	1	1	GERSHMAN, GEORGE MD	3/7/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	62846	10	Gastroenterology (M.D. only)	0	In state provider	None	436 N ROXBURY DR	STE 203	BEVERLY HILLS	CA	90210	5017	19	06037	34.06771782	-118.4065755	Los Angeles County
117740	Fee-for-Service	1134460587	1134460587	1	1	GUERRERO, SUSAN J PHD	1/5/2015	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
117760	Fee-for-Service	1326472093	1326472093	1	1	GONZALEZ, DARLENE LMFT	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
117773	Fee-for-Service	1740835743	1740835743	1	1	GRACELIGHT COMMUNITY HEALTH	9/6/2022	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	303 LOMA DR	SUITE 202	LOS ANGELES	CA	90017	1103	19	06037	34.0595565	-118.2659336	Los Angeles County
117775	Fee-for-Service	1295027076	1295027076	1	1	GADIENT, PAUL M MD	11/1/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	150996	13	Neurology (M.D. only)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
117787	Fee-for-Service	1114933827	1114933827	2	1	GRIFFIN, JOHN R MD	8/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82100	24	Plastic Surgery	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
117798	Fee-for-Service	1992978423	1992978423	1	1	GUTH, JAMES C MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110008	13	Neurology (M.D. only)	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
117800	Fee-for-Service	1033275425	1033275425	1	1	GONG, KEVIN D LMFT	8/15/2020	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
117819	Fee-for-Service	1770654600	1770654600	1	1	GRUBER, JAN M MD	11/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95742	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
117844	Fee-for-Service	1942236401	1942236401	1	1	GWYNN, ROBERT E MD	10/3/1972	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	16492	41	Internal Medicine	0	In state provider	None	3300 WEBSTER ST	STE 710	OAKLAND	CA	94609	3122	01	06001	37.82132826	-122.2621843	Alameda County
117861	Fee-for-Service	1114968567	1114968567	1	1	GLASS, 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	1400 EAST BOULDER	None	COLORADO SPRINGS	CO	80907	0000	00	None	38.8388119	-104.7995065	El Paso County
117953	Fee-for-Service	1245252931	1245252931	2	1	GARFIELD BEACH CVS LLC	3/30/2018	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29676 RANCHO CA ROAD	None	TEMECULA	CA	92591	5283	33	06065	33.50553789	-117.1447582	Riverside County
117957	Fee-for-Service	1508412057	1508412057	1	1	GALEN RX PHARMACY INC	11/4/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4111 OCEAN VIEW BLVD	None	MONTROSE	CA	91020	1518	19	06037	34.20996446	-118.2279794	Los Angeles County
117971	Fee-for-Service	1770871386	1770871386	1	1	GUZICK, SARAH L LMFT	5/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
117973	Fee-for-Service	1770703571	1770703571	1	1	GOLDEN VALLEY HEALTH CTR	3/1/1997	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	DOS PALOS	1405 CALIFORNIA AVE	None	DOS PALOS	CA	93620	2300	24	06047	36.98665246	-120.6290163	Merced County
118009	Fee-for-Service	1124039698	1124039698	1	1	GARFINKLE, MARK A MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55953	41	Internal Medicine	0	In state provider	None	26732 CROWN VALLEY PKWY	SUITE 151	MISSION VIEJO	CA	92691	6337	30	06059	33.56347704	-117.66546	Orange County
118016	Fee-for-Service	1992912950	1992912950	1	1	GENDY-SHAKER, ELIZABETH S MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	97366	40	Pediatrics	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
118019	Fee-for-Service	1265460166	1265460166	1	1	GEISER, MICHAEL T MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	35489	36	Psychiatry	0	In state provider	None	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
118075	Fee-for-Service	1093153017	1093153017	1	1	GARFIELD BEACH CVS LLC	5/4/2015	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26973 NEWPORT RD	None	MENIFEE	CA	92584	9221	33	06065	33.68499548	-117.187929	Riverside County
118078	Fee-for-Service	1609642578	1609642578	1	1	GOLDEN SUNSET VILLA LLC	8/22/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1995 SUNSET DRIVE	None	ESCONDIDO	CA	92025	6606	37	06073	33.10004613	-117.0681971	San Diego County
118082	Fee-for-Service	1053739144	1053739144	1	1	GREWAL, JASLEEN K MD	7/28/2017	390200000X	NA	Other	026	PHYSICIANS	140480	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
118094	Fee-for-Service	1437514452	1437514452	1	1	GEBHARDT, FELICE A PT	1/10/2024	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
118104	Fee-for-Service	1538350293	1538350293	1	1	GOMEZ GONZALEZ, ALEXIS NP	9/6/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	622240	-	NOT APPLICABLE	0	In state provider	None	2115 N WILMINGTON AVE	None	COMPTON	CA	90222	2030	19	06037	33.91197848	-118.2391821	Los Angeles County
118118	Fee-for-Service	1225064538	1225064538	1	1	GENYK, YURI S MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66208	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
118147	Fee-for-Service	1407154545	1407154545	1	1	GARBER, DARIUSH MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134585	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
118176	Fee-for-Service	1619261138	1619261138	1	1	GLYNN, NICOLE C MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116076	40	Pediatrics	0	In state provider	None	2200 OFARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
118182	Fee-for-Service	1770571515	1770571515	1	1	GOYAL, HARI O MD	2/9/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65439	01	General Practice	0	In state provider	None	395 DEL NORTE AVE	None	YUBA CITY	CA	95991	4121	51	06101	39.14453094	-121.6172174	Sutter County
118235	Fee-for-Service	1144240235	1144240235	1	2	GOLDEN, JAMES W MD	9/19/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	27107	-	NOT APPLICABLE	0	In state provider	None	303 SOUTH C ST	None	LOMPOC	CA	93436	7092	42	06083	34.63525845	-120.451628	Santa Barbara County
118275	Fee-for-Service	1861574832	1861574832	1	1	GILBERTSON-DAHDAL, DOROTHY	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
118288	Fee-for-Service	1508187824	1508187824	1	1	GORAYA, ARASHDEEP S MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144892	01	General Practice	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
118294	Fee-for-Service	1902338239	1902338239	1	1	GURM, HASHROOP MD	9/1/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	185707	None	None	0	In state provider	None	7095 N CHESTNUT AVE	STE 101	FRESNO	CA	93720	0360	10	06019	36.83995818	-119.7370077	Fresno County
118345	Fee-for-Service	1669574968	1669574968	1	2	GARCIA, DON L MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52231	01	General Practice	0	In state provider	None	896 S HARBOR BLVD	None	ANAHEIM	CA	92805	5158	30	06059	33.82203054	-117.9155263	Orange County
118352	Fee-for-Service	1114294477	1114294477	2	1	GOMEZ-OSPINA, NATALIA MD	2/20/2019	207SG0201X	NA	Other	026	PHYSICIANS	124481	01	General Practice	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
118393	Fee-for-Service	1689692865	1689692865	1	1	GARRISON, JARED D MD	9/22/2008	261QR1300X	NA	Rural Health Center	026	PHYSICIANS	8298	08	Family Practice	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
118514	Fee-for-Service	1689364721	1689364721	1	1	GEM MEDICAL GROUP CORPORATIO	5/20/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
118517	Fee-for-Service	1982966735	1982966735	1	2	GALSTER, KELLEN T MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135358	None	None	0	In state provider	None	400 NORTH MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
118519	Fee-for-Service	1962058297	1962058297	1	1	GOOD SAMARITAN SHELTER	9/11/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	608 W OCEAN AVE	None	LOMPOC	CA	93436	6630	42	06083	34.63900429	-120.4647085	Santa Barbara County
118543	Fee-for-Service	1609096403	1609096403	1	1	GOLDEN VALLEY HLTH CTR	10/15/1992	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	LOS BANOS	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	24	06047	37.06376226	-120.860675	Merced County
118597	Fee-for-Service	1366296071	1366296071	1	1	GOSWELL, ALEXANDER MD	7/8/2024	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
118601	Fee-for-Service	1487289369	1487289369	1	1	GILMORE, MEGHAN E CNP	1/28/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
118604	Fee-for-Service	1295787935	1295787935	1	1	GILLES, DAVID 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	1512 12TH AVE RD	None	NAMPA	ID	83686	6008	00	None	43.55346193	-116.5727785	Canyon County
118612	Fee-for-Service	1760559116	1760559116	1	1	GOLDBERG, GLENN I DO	5/24/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	5649	None	None	0	In state provider	None	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
118628	Fee-for-Service	1932183472	1932183472	1	1	GU, YIYI MD	4/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88414	83	Rheumatology	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
118716	Fee-for-Service	1730123969	1730123969	1	1	GOUD, CHETAN MD	10/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53813	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
118737	Fee-for-Service	1386776144	1386776144	1	1	GUEVARRA, MARY GRACE PT	10/21/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
118751	Fee-for-Service	1376021931	1376021931	1	1	GARCIA, VALERIE D	12/18/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	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
118763	Fee-for-Service	1134325822	1134325822	1	1	GOMEZ, SERGIO R MD INC	8/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74276	08	Family Practice	0	In state provider	None	2005 N GAREY AVE	None	POMONA	CA	91767	2721	19	06037	34.08317921	-117.7529341	Los Angeles County
118773	Fee-for-Service	1427117274	1427117274	1	2	GOTTHEIL, ELISA A PHD	4/5/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	351 PASEO NUEVO	# 2F	SANTA BARBARA	CA	93101	3382	42	06083	34.4188645	-119.6987045	Santa Barbara County
118796	Fee-for-Service	1598020844	1598020844	1	1	GUPTA, SHUBHRA MD	9/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156150	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
118812	Fee-for-Service	1962680421	1962680421	1	15	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1199 DELBON AVENUE	SUITE 5	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
118817	Fee-for-Service	1447300264	1447300264	1	1	GARCIA, CARLOS MD	12/6/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55337	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
118833	Fee-for-Service	1609096403	1609096403	1	1	GOLDEN VALLEY HLTH CTR	10/15/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	LOS BANOS	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	24	06047	37.06376226	-120.860675	Merced County
118836	Fee-for-Service	1972762987	1972762987	1	1	GARCIA, MELANIE S NP	3/16/2021	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
118840	Fee-for-Service	1831137025	1831137025	1	1	GOLDSCHMID, DAVID MD	7/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	34004	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
118872	Fee-for-Service	1679601041	1679601041	1	1	GUTKIN, MIKHAIL PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY STREET	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
118889	Fee-for-Service	1801914239	1801914239	1	1	GRACE, LISA LMFT	12/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	825 COLLEGE AVE	2	SANTA ROSA	CA	95404	4108	49	06097	38.445705	-122.712534	Sonoma County
118894	Fee-for-Service	1164467965	1164467965	1	1	GARFIELD BEACH CVS LLC	9/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6588 FOOTHILL RD	None	TUJUNGA	CA	91042	2705	19	06037	34.24620315	-118.2755586	Los Angeles County
118905	Fee-for-Service	1962680421	1962680421	1	6	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 300	MODESTO	CA	95350	4570	50	06099	37.666233	-120.993933	Stanislaus County
118912	Fee-for-Service	1962701227	1962701227	1	1	GEN, DMITRIY DO	7/18/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	11253	08	Family Practice	0	In state provider	None	1560 E CHEVY CHASE DR	STE 245	GLENDALE	CA	91206	4197	19	06037	34.15290734	-118.2302295	Los Angeles County
118929	Fee-for-Service	1942244298	1942244298	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9038 BALBOA BLVD	None	NORTHRIDGE	CA	91325	2610	19	06037	34.234758	-118.502502	Los Angeles County
118930	Fee-for-Service	1700974722	1700974722	1	1	GELIN,JOAN MD,	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5656 S POWER RD	None	GILBERT	AZ	85295	0000	00	None	33.31386	-111.6877185	Maricopa County
118937	Fee-for-Service	1902455447	1902455447	1	1	GHIO AND ASSOCIATES INC	9/19/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	624 W 9TH ST STE 202	None	SAN PEDRO	CA	90731	3158	19	06037	33.73607853	-118.290789	Los Angeles County
118939	Fee-for-Service	1619003811	1619003811	2	1	GRAND WHLCHR & MED SUPP	12/27/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ALL WHLCHR & MOBILITY	41917 ALBRAE ST	None	FREMONT	CA	94538	3121	01	06001	37.51354754	-121.9756878	Alameda County
118960	Fee-for-Service	1194762310	1194762310	1	1	GRANT, SCOTT MD	8/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	32479	18	Ophthalmology	0	In state provider	None	301 W BASTANCHURY RD	STE 285	FULLERTON	CA	92835	3432	30	06059	33.89397383	-117.9316737	Orange County
118973	Fee-for-Service	1295083764	1295083764	2	1	GRACE RX PHARMACY INC	12/22/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1724 E WASHINGTON BLVD	None	PASADENA	CA	91104	2751	19	06037	34.16909687	-118.1150986	Los Angeles County
118996	Fee-for-Service	1386816205	1386816205	1	1	GRANT LINE PHARMACY INC	8/12/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	GRANT LINE PHARMACY INC	2160 W GRANT LINE RD	STE 205	TRACY	CA	95377	7330	39	06077	37.75399922	-121.455877	San Joaquin County
119029	Fee-for-Service	1598737645	1598737645	1	1	GUZMAN, KATARINA MD	5/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53016	66	Emergency Medicine (Urgent Care)	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
119049	Fee-for-Service	1447591854	1447591854	1	1	GHATAN, CHRISTINE E MD	5/13/2020	2085R0204X	NA	Other	026	PHYSICIANS	113752	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119051	Fee-for-Service	1265864185	1265864185	1	1	GREG SHIH-HAN YEN MEDICAL CO	10/17/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	RP	131 E LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1449	19	06037	34.1029798	-118.098273	Los Angeles County
119091	Fee-for-Service	1609045467	1609045467	1	1	GALIFIANAKIS, NICHOLAS B MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91051	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
119098	Fee-for-Service	1962680421	1962680421	1	15	GOLDEN VALLEY HEALTH CENTERS	9/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1199 DELBON AVENUE	SUITE 5	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
119115	Fee-for-Service	1881871614	1881871614	1	1	GOSHTASBI, MANA MD	8/9/2018	207R00000X	NA	Other	026	PHYSICIANS	154955	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
119127	Fee-for-Service	1144240235	1144240235	1	1	GOLDEN, JAMES W MD	2/8/2015	207RX0202X	NA	Oncology	026	PHYSICIANS	27107	41	Internal Medicine	0	In state provider	None	225 E LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1414	19	06037	34.10310649	-118.0972338	Los Angeles County
119185	Fee-for-Service	1013277698	1013277698	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1825 41ST AVE	None	CAPITOLA	CA	95010	2504	44	06087	36.9756663	-121.9650927	Santa Cruz County
119191	Fee-for-Service	1962680421	1962680421	1	6	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1524 MCHENRY AVENUE	SUITE 300	MODESTO	CA	95350	4570	50	06099	37.666233	-120.993933	Stanislaus County
119222	Fee-for-Service	1952590937	1952590937	1	1	GRILL, MARIE F MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112964	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
119228	Fee-for-Service	1104987635	1104987635	1	1	GREGORY A COST, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5050 NE HOYT ST	STE 516	PORTLAND	OR	97213	2983	00	None	45.52717448	-122.611527	Multnomah County
119231	Fee-for-Service	1679797369	1679797369	1	1	GONZALEZ COTA, ALAN MD	6/18/2024	208VP0014X	NA	Other	026	PHYSICIANS	120456	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
119240	Fee-for-Service	1346769593	1346769593	1	1	GLOBAL DIAGNOSTIC LABS, LLC	3/3/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	4960 PEACHTREE INDUSTRIA	SUITE 220	NORCROSS	GA	30071	1580	00	None	33.96672181	-84.19742407	Gwinnett County
119244	Fee-for-Service	1992195309	1992195309	1	1	GOULD, JACQUELINE R NP	2/2/2017	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
119253	Fee-for-Service	1437741683	1437741683	1	1	GARCIA RODRIGUEZ, DIEGO PHD	4/30/2021	103T00000X	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
119287	Fee-for-Service	1568873727	1568873727	1	1	GHADA KASSAB MD MEDICAL CORP	11/19/2014	193400000X	NA	Other	026	PHYSICIANS	114457	07	Dermatology	0	In state provider	None	3023 BUNKER HILL STREET	SUITE 102	SAN DIEGO	CA	92109	5706	37	06073	32.80338605	-117.2152206	San Diego County
119290	Fee-for-Service	1700958196	1700958196	1	1	GENESIS RESPIRATORY SERVICES	1/27/2014	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	INC	4132 GALLIA STREET	None	NEW BOSTON	OH	45662	6511	00	None	38.75439328	-82.9339821	Scioto County
119310	Fee-for-Service	1598822645	1598822645	1	1	GUO, AILI MD	4/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130171	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
119354	Fee-for-Service	1093726895	1093726895	1	1	GUTTAS, JEFFREY J MD	11/30/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	61256	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 S SAN MATEO DR	STE 400	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
119356	Fee-for-Service	1942953872	1942953872	1	1	GARCIA, MARTHA L LCSW	7/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	765 N MAIN ST	STE #127	CORONA	CA	92880	1440	33	06065	33.892072	-117.5636837	Riverside County
119358	Fee-for-Service	1295771350	1295771350	1	1	GARFIELD BEACH CVS, LLC	7/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 W. WHITTIER	None	MONTEBELLO	CA	90640	4736	19	06037	34.01023919	-118.1088317	Los Angeles County
119409	Fee-for-Service	1063521961	1063521961	1	1	GOLDENRING, JOHN M MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	37744	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
119413	Fee-for-Service	1164509311	1164509311	1	1	GONZALEZ-JASKULAK, ELIZABETH	9/7/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	45 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7925859	Santa Cruz County
119432	Fee-for-Service	1740243609	1740243609	1	1	GUPTA, PRAGYA B MD	5/1/2023	208VP0014X	NA	Other	026	PHYSICIANS	152074	None	None	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
119471	Fee-for-Service	1922156249	1922156249	1	1	GRANT JOINT UNION HIGH	3/28/1996	251300000X	NA	Other	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	1333 GRAND AVE	None	SACRAMENTO	CA	95838	3654	34	06067	38.637009	-121.435326	Sacramento County
119484	Fee-for-Service	1043902612	1043902612	1	1	GARGAN, EMILY M	2/27/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1440 WASHINGTON BLVD	A5	CONCORD	CA	94521	4098	07	06013	37.94935969	-121.9564591	Contra Costa County
119521	Fee-for-Service	1508131590	1508131590	1	2	GOGNA, KARUN MD DO	2/19/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	152027	-	NOT APPLICABLE	0	In state provider	None	510 S SECOND AVE	SUITE 6 & 7	COVINA	CA	91723	3017	19	06037	34.0805013	-117.8878213	Los Angeles County
119569	Fee-for-Service	1467288381	1467288381	1	1	GALUS, SARAH OD	9/25/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	622 ABBOTT STREET	None	SALINAS	CA	93901	4315	27	06053	36.66170619	-121.6412319	Monterey County
119575	Fee-for-Service	1912766841	1912766841	1	1	GUIDED GROWTH THERAPY GROUP	2/21/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1603 CALIFORNIA AVE	STE 137	BAKERSFIELD	CA	93304	1346	15	06029	35.36840322	-119.0203755	Kern County
119647	Fee-for-Service	1265651178	1265651178	1	1	GADUE, RICHARD H LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH RD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
119653	Fee-for-Service	1295047892	1295047892	1	1	GHAZI, POURYA M MD	4/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112980	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
119660	Fee-for-Service	1225567779	1225567779	1	1	GUPTA, YASHA P MD	10/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	186740	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
119698	Fee-for-Service	1659691889	1659691889	1	1	GUPTA, MAMTA R MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148757	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
119711	Fee-for-Service	1548282148	1548282148	2	1	GARFIELD BEACH CVS LLC	11/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	141 LAKEWOOD CENTER MALL	None	LAKEWOOD	CA	90712	2419	19	06037	33.852582	-118.1405115	Los Angeles County
119728	Fee-for-Service	1215015946	1215015946	1	1	GLASER, LOUISE F MD FAAP	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84205	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
119732	Fee-for-Service	1790965960	1790965960	1	1	GANONG, ALISON C MD	12/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101686	25	Physical Medicine and Rehabilitation	0	In state provider	None	1139 THIRD STREET	None	SOUTH LAKE TAHOE	CA	96150	3465	09	06017	38.91323462	-119.9965999	El Dorado County
119739	Fee-for-Service	1407081342	1407081342	1	1	GILL, FIRDOSE DO	4/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10782	41	Internal Medicine	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
119740	Fee-for-Service	1639110562	1639110562	1	1	GONDEL, TESFAYE G MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94161	40	Pediatrics	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
119764	Fee-for-Service	1336322296	1336322296	1	1	GILLUM, HEATHER A CRNA	11/7/2011	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
119776	Fee-for-Service	1881700029	1881700029	1	1	GREENWALD, LELAND M MD	7/31/1991	207RN0300X	NA	Nephrology	026	PHYSICIANS	70256	13	Neurology (M.D. only)	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
119777	Fee-for-Service	1336210574	1336210574	2	1	GANESA HEALTH CARE	3/6/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ALLCARE PHARMACY	331 MAIN ST	None	SALINAS	CA	93901	2705	27	06053	36.67295657	-121.6546689	Monterey County
119798	Fee-for-Service	1215773544	1215773544	1	1	GLORIA CHUNG, D.O., INC	7/31/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1101 E HOLT AVE	STE G	POMONA	CA	91767	5800	19	06037	34.06297561	-117.7280971	Los Angeles County
119818	Fee-for-Service	1619146800	1619146800	1	1	GOYA, DEBBIE M OD &	12/1/1998	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MAYEDA, JANIS L OD INC	2202 W ARTESIA	STE A	TORRANCE	CA	90504	2963	19	06037	33.87277548	-118.3181895	Los Angeles County
119847	Fee-for-Service	1548746027	1548746027	1	1	GREENWOOD, NICOLE LMFT	6/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2617 K ST	STE 125	SACRAMENTO	CA	95816	5133	34	06067	38.573595	-121.4715825	Sacramento County
119863	Fee-for-Service	1396949574	1396949574	1	1	GALT, JANICE M LMFT	12/16/2020	101Y00000X	NA	Other	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
119874	Fee-for-Service	1285681882	1285681882	1	1	GAULTIER, CYRIL R MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69794	None	None	0	In state provider	None	8635 W 3RD STREET	SUITE 1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
119875	Fee-for-Service	1063645315	1063645315	1	1	GOULDING, EVAN H MD	10/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	64149	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
119878	Fee-for-Service	1780957563	1780957563	1	1	GUTIERREZ, MANDY R LMFT	3/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
119885	Fee-for-Service	1578094546	1578094546	1	1	GOBRIAL, MARLENE DO	12/3/2019	390200000X	NA	Other	026	PHYSICIANS	17506	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
119899	Fee-for-Service	1235651266	1235651266	1	1	GOLDMAN, MONET K LMFT	7/3/2023	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
119921	Fee-for-Service	1659810224	1659810224	1	1	GARNETT, CHELSEA A MD	8/10/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146729	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
119999	Fee-for-Service	1982052684	1982052684	1	1	GEDAMU, LIA NP	8/9/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3300 E SOUTH ST	STE 308	LONG BEACH	CA	90805	4598	19	06037	33.86018093	-118.1537163	Los Angeles County
120001	Fee-for-Service	1598490997	1598490997	1	1	GONZALEZ VERDIN, ANTHONY G P	9/15/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	T	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
120003	Fee-for-Service	1063624658	1063624658	1	1	GARY, JOSHUA L MD	7/2/2021	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	171591	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
120018	Fee-for-Service	1407919483	1407919483	1	1	GRAY, DIANE Y	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
120033	Fee-for-Service	1295290138	1295290138	1	1	GRAVITAS HOSPICE CARE INC	9/29/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	427 S VICTORY BLVD	STE C	BURBANK	CA	91502	2353	19	06037	34.16984851	-118.3139105	Los Angeles County
120102	Fee-for-Service	1174801179	1174801179	1	1	GROVER, ERIC R DO	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13265	01	General Practice	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
120107	Fee-for-Service	1548630692	1548630692	1	1	GLOWALLA, GEOFFREY LMFT	3/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
120192	Fee-for-Service	1104074863	1104074863	1	1	GALAVIZ-ARREOLA, ERIKA LCSW	10/22/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
120221	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	6/24/2024	No Taxonomy Provided	NA	None	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
120237	Fee-for-Service	1841261468	1841261468	1	1	GUTTMAN, 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	2800 E AJO WAY	None	TUCSON	AZ	85713	0000	00	None	32.175801	-110.9306925	Pima County
120254	Fee-for-Service	1952957888	1952957888	1	1	GOMEZ, DOM ERNEST L PT	10/15/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	582 S SUNNYVALE AVE	None	SUNNYVALE	CA	94086	6215	43	06085	37.36886669	-122.0316101	Santa Clara County
120303	Fee-for-Service	1437879624	1437879624	1	1	GAUTAM, DIPENDRA	11/8/2024	2251G0304X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7942 N MAPLE AVE	SUITE 102	FRESNO	CA	93720	0293	10	06019	36.851454	-119.747724	Fresno County
120315	Fee-for-Service	1871847913	1871847913	1	1	GEROLAMO, MATTHEW LCSW	2/10/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
120319	Fee-for-Service	1659788578	1659788578	1	1	GILL, SIMRIN	8/19/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2600 MITCHELL RD	STE G	CERES	CA	95307	9468	50	06099	37.59373003	-120.9386747	Stanislaus County
120320	Fee-for-Service	1295290138	1295290138	1	1	GRAVITAS HOSPICE CARE INC	9/29/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	427 S VICTORY BLVD	STE C	BURBANK	CA	91502	2353	19	06037	34.16984851	-118.3139105	Los Angeles County
120332	Fee-for-Service	1386850006	1386850006	1	1	GONZALEZ-CRUZ, JORGE MD	12/10/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	128674	13	Neurology (M.D. only)	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
120340	Fee-for-Service	1720695596	1720695596	1	1	GARCIA ARROYO, KARINA SELENE	10/9/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9220 NAN ST.	None	PICO RIVERA	CA	90660	3830	19	06037	33.97920605	-118.0944768	Los Angeles County
120343	Fee-for-Service	1083839328	1083839328	1	1	GREEN, LORELLEN M MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97548	41	Internal Medicine	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
120425	Fee-for-Service	1417083999	1417083999	1	1	GOTHARD DAVID M	12/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16597	01	General Practice	0	In state provider	None	12522 LAMBERT RD	STE D	WHITTIER	CA	90606	2758	19	06037	33.96495228	-118.0466484	Los Angeles County
120427	Fee-for-Service	1700041506	1700041506	1	1	GILL, ANUREET K MD	5/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153088	08	Family 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
120455	Fee-for-Service	1114924727	1114924727	1	1	GOGIA, HARINDER S MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50283	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
120461	Fee-for-Service	1982242210	1982242210	1	1	GAIGNARD, ANGELA S PT	4/27/2020	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
120466	Fee-for-Service	1659390599	1659390599	1	1	GRISCHY, JEAN C CRNA	2/6/2018	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
120493	Fee-for-Service	1376728287	1376728287	1	1	GREGORY J WIENER MD APC	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	41749	10	Gastroenterology (M.D. only)	0	In state provider	None	353 CHURCH LN	ST A	CHULA VISTA	CA	91910	3906	37	06073	32.63971988	-117.0781089	San Diego County
120509	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	6/21/2021	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
120550	Fee-for-Service	1437186285	1437186285	1	1	GRIFFITH, PATRICK K	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51011	None	None	0	In state provider	None	401 I ST	# A	MARYSVILLE	CA	95901	5669	58	06115	39.13882888	-121.5963884	Yuba County
120567	Fee-for-Service	1982206413	1982206413	1	1	GRETCHEN MANOR INC	3/26/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	20849 GRETCHEN STREET	None	WINNETKA	CA	91306	4106	19	06037	34.19269175	-118.5878881	Los Angeles County
120579	Fee-for-Service	1154499655	1154499655	1	1	GUPTA, RACHNA K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79833	08	Family Practice	0	In state provider	None	5901 GREEN VALLEY CIR	STE 455	CULVER CITY	CA	90230	6938	19	06037	33.98409358	-118.3923715	Los Angeles County
120587	Fee-for-Service	1821631425	1821631425	1	1	GUTIERREZ, LILIANA	2/5/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3040 CARUSO LN	None	LANCASTER	CA	93536	1034	19	06037	34.68793051	-118.1853045	Los Angeles County
120594	Fee-for-Service	1801866785	1801866785	1	1	GLYER, JOHN R MD	5/16/1977	261QR1300X	NA	Rural Health Center	026	PHYSICIANS	27358	08	Family Practice	0	In state provider	None	1245 S MAIN ST	None	WILLITS	CA	95490	4305	23	06045	39.39914622	-123.3495915	Mendocino County
120625	Fee-for-Service	1720695596	1720695596	1	1	GARCIA ARROYO, KARINA SELENE	10/9/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9220 NAN ST.	None	PICO RIVERA	CA	90660	3830	19	06037	33.97920605	-118.0944768	Los Angeles County
120633	Fee-for-Service	1144242934	1144242934	2	1	GARFIELD BEACH CVS LLC	10/5/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	223 E BETTERAVIA RD	None	SANTA MARIA	CA	93454	7803	42	06083	34.92181336	-120.4329239	Santa Barbara County
120637	Fee-for-Service	1710057179	1710057179	1	1	GARCIA, EMMA	11/21/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8283 GROVE AVE	STE 104	RANCHO CUCAMONGA	CA	91730	3138	36	06071	34.10380433	-117.6285116	San Bernardino County
120725	Fee-for-Service	1336186543	1336186543	1	1	GALHOTRA, RAVI 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	10450 W MCDOWELL RD	STE 101	AVONDALE	AZ	85392	4802	00	None	33.465087	-112.2863085	Maricopa County
120728	Fee-for-Service	1881698421	1881698421	1	1	GUPTA, BARNALI MD	4/27/2020	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	128062	41	Internal Medicine	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
120741	Fee-for-Service	1114924727	1114924727	1	1	GOGIA, HARINDER S MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50283	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
120748	Fee-for-Service	1326525593	1326525593	1	1	GRAJEDA, ANTONIA E OT	2/18/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1640 WEST YOSEMITE AVE	SUITE 1	MANTECA	CA	95337	5192	39	06077	37.79729949	-121.243887	San Joaquin County
120764	Fee-for-Service	1992920649	1992920649	1	1	GILL, RYAN M MD	11/2/2010	207ZP0102X	NA	Other	026	PHYSICIANS	98046	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
120778	Fee-for-Service	1740806975	1740806975	1	1	GONZALEZ, ELVIRA S MD	6/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184558	08	Family Practice	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
120783	Fee-for-Service	1114110640	1114110640	1	1	GOTHAM, DAVID R JR DO INC	11/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	8894	None	None	0	In state provider	None	2204 PLAZA DR	#120	ROCKLIN	CA	95765	4413	31	06061	38.79448621	-121.2699671	Placer County
120791	Fee-for-Service	1942696117	1942696117	1	1	GARVIN, NATHAN MD	8/1/2018	207P00000X	NA	Other	026	PHYSICIANS	144183	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
120796	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	8/18/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
120842	Fee-for-Service	1689108029	1689108029	1	1	GARCIA, BRANDEN MD	8/7/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	186362	None	None	0	In state provider	None	4640 ADMIRALTY WAY	STE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
120850	Fee-for-Service	1447272133	1447272133	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	24500 ALICIA PKWY	None	MISSION VIEJO	CA	92691	4508	30	06059	33.60667951	-117.6896787	Orange County
120877	Fee-for-Service	1821631425	1821631425	1	1	GUTIERREZ, LILIANA	2/5/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3040 CARUSO LN	None	LANCASTER	CA	93536	1034	19	06037	34.68793051	-118.1853045	Los Angeles County
120891	Fee-for-Service	1760634141	1760634141	1	1	GOHIL, AMIT A MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102212	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
120943	Fee-for-Service	1932122041	1932122041	1	1	GILL,AMARJIT	6/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PARKWAY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
120950	Fee-for-Service	1023000270	1023000270	1	1	GREWAL, RAMANDEEP S MD	2/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77029	None	None	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
120957	Fee-for-Service	1386943850	1386943850	1	1	GARCIA, ANNA R MD	7/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122757	01	General Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
120997	Fee-for-Service	1043270119	1043270119	1	1	GERALD FRED PETERSON 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 NORTH SMITH AVE	None	ST PAUL	MN	55102	2344	00	None	44.94251219	-93.1074995	Ramsey County
121031	Fee-for-Service	1013454644	1013454644	1	1	GSM HEALTHCARE SERVICES LLC	2/22/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15122 WALBROOK DR	None	HACIENDA HEIGHTS	CA	91745	1407	19	06037	34.01626516	-117.9764844	Los Angeles County
121044	Fee-for-Service	1730202706	1730202706	1	1	GENSCHMER, SCOTT J LMFT	10/28/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	101 CIRBY HILLS DRIVE	None	ROSEVILLE	CA	95678	4360	31	06061	38.7303989	-121.2872592	Placer County
121060	Fee-for-Service	1457349086	1457349086	1	1	GECHT, ELAINE R	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	40437	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
121061	Fee-for-Service	1194800862	1194800862	1	1	GODFREY, RICHARD S MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45061	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
121064	Fee-for-Service	1740806975	1740806975	1	1	GONZALEZ, ELVIRA S MD	6/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184558	38	Geriatrics	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
121077	Fee-for-Service	1467498527	1467498527	1	1	GARFIELD BEACH CVS LLC	1/5/2010	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 N RIVER ROAD	None	OCEANSIDE	CA	92058	6914	37	06073	33.24529042	-117.323422	San Diego County
121085	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	7/10/2024	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
121102	Fee-for-Service	1134686744	1134686744	1	1	GOLDFINGER, SARAH N NP	8/13/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
121171	Fee-for-Service	1306958095	1306958095	1	1	GREIF, JON DO	12/31/1984	174400000X	NA	Other	026	PHYSICIANS	4984	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
121237	Fee-for-Service	1104332402	1104332402	1	1	GAUNT, JANE E LMFT	5/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
121248	Fee-for-Service	1992201859	1992201859	1	1	GROSSO, ASHTON R DO	1/31/2022	208M00000X	NA	Other	026	PHYSICIANS	19255	None	None	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
121293	Fee-for-Service	1528031879	1528031879	1	1	GOLDNER, ROBIN E LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	245 S HUMBOLDT ST	STE B	WILLITS	CA	95490	3513	23	06045	39.410127	-123.353302	Mendocino County
121361	Fee-for-Service	1679335566	1679335566	1	1	GAFFNEY, KAATI TOLABOR CERT	4/13/2024	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	12	06023	0	0	None
121371	Fee-for-Service	1891131447	1891131447	1	1	GARCIA, MEGHAN F MD	12/7/2022	207K00000X	NA	Other	026	PHYSICIANS	133613	None	None	0	In state provider	None	1451 SECRET RAVINE PKWY	STE 150	ROSEVILLE	CA	95661	6052	31	06061	38.7647101	-121.2431538	Placer County
121373	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	1/5/2023	No Taxonomy Provided	NA	None	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
121384	Fee-for-Service	1134498926	1134498926	1	1	GORDON, CARRIE K NP	1/5/2021	363LF0000X	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
121403	Fee-for-Service	1164907549	1164907549	1	1	GAGE, OCEANNA LCSW	2/18/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
121409	Fee-for-Service	1942377015	1942377015	1	1	GODOROV, DIANE F DO	3/15/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	15320	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
121440	Fee-for-Service	1114658085	1114658085	1	1	GIBBS, ELIZABETH A OT	7/25/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
121451	Fee-for-Service	1386822286	1386822286	1	1	GRIFFIN, ANYA T PHD	5/29/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
121464	Fee-for-Service	1982758389	1982758389	1	2	GRAHAM, BRIAN MD	5/30/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	162611	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
121496	Fee-for-Service	1568559557	1568559557	1	1	GOEL, SANJIV	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44063	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2100 LYNN RD	STE 205	THOUSAND OAKS	CA	91360	8040	56	06111	34.2074907	-118.8854443	Ventura County
121521	Fee-for-Service	1417974460	1417974460	1	1	GINGERY, ROBERT O MD	5/15/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	23370	02	General Surgery	0	In state provider	None	13847 E 14TH ST	STE 115	SAN LEANDRO	CA	94578	2625	01	06001	37.71457844	-122.1418551	Alameda County
121524	Fee-for-Service	1730400961	1730400961	1	1	GROSS, ELLIOTT L MD INC	1/31/1993	193400000X	NA	Other	026	PHYSICIANS	28678	20	Orthopedic Surgery	0	In state provider	None	3831 HUGHES AVE	STE 506	CULVER CITY	CA	90232	6860	19	06037	34.02243278	-118.3981492	Los Angeles County
121528	Fee-for-Service	1063874758	1063874758	1	1	GUENTHER, CHAD M MD	7/17/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	184597	None	None	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
121570	Fee-for-Service	1558754960	1558754960	1	1	GARCIA, RAFAEL OT	3/23/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4000 CIVIC CENTER DRIVE	STE 100	SAN RAFAEL	CA	94903	4173	21	06041	38.0041783	-122.538861	Marin County
121575	Fee-for-Service	1689688442	1689688442	1	1	GUSLAND, CORY B MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	50581	08	Family Practice	0	In state provider	None	300 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1316	42	06083	34.4458497	-119.779596	Santa Barbara County
121621	Fee-for-Service	1871700310	1871700310	1	1	GREGORY, NANCY PHD	8/24/2018	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
121652	Fee-for-Service	1285658690	1285658690	1	1	GUMBS, JOSLYN L MD	2/6/2013	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87245	None	None	0	In state provider	None	5255 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5716	19	06037	34.09815646	-118.304595	Los Angeles County
121657	Fee-for-Service	1497970115	1497970115	1	1	GROVER, RAHUL INC	4/30/2008	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8673 W PICO BLVD	None	LOS ANGELES	CA	90035	2377	19	06037	34.05430223	-118.3810857	Los Angeles County
121661	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	3/3/2025	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
121664	Fee-for-Service	1427369149	1427369149	1	1	GRIFFITH, SALVACION G	8/17/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	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
121676	Fee-for-Service	1538193388	1538193388	1	1	GROSS, COLEMAN	3/31/1994	207R00000X	NA	Other	026	PHYSICIANS	69240	67	Endocrinology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
121731	Fee-for-Service	1225379506	1225379506	1	1	GUGGEMOS, MATTHEW CCC-SLP	10/5/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	955 WALNUT AVE	None	VALLEJO	CA	94592	1021	48	06095	38.0960736	-122.2701348	Solano County
121749	Fee-for-Service	1265180657	1265180657	1	1	GONZALEZ, ERIKA E	8/9/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2344 BUTANO	SUITE C3	SACRAMENTO	CA	95825	0616	34	06067	38.606562	-121.379805	Sacramento County
121753	Fee-for-Service	1982758389	1982758389	1	2	GRAHAM, BRIAN MD	5/30/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	162611	29	Pulmonary Diseases (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
121794	Fee-for-Service	1124048608	1124048608	1	1	GAMARRA, LEWIS MD	7/20/2022	207R00000X	NA	Other	026	PHYSICIANS	70417	None	None	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
121851	Fee-for-Service	1033714530	1033714530	1	1	GARGALA, MICAH R LCSW	2/8/2024	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
121862	Fee-for-Service	1124102108	1124102108	1	1	GREEN, GARY M MD	5/13/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80599	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
121879	Fee-for-Service	1609168681	1609168681	1	1	GUPTA, SHIPRA MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141132	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
121910	Fee-for-Service	1811060668	1811060668	1	1	GAUSLING, RUDOLF MD	12/29/2009	207R00000X	NA	Other	026	PHYSICIANS	81612	41	Internal Medicine	0	In state provider	None	1661 SOQUEL DRIVE	STE D	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
121917	Fee-for-Service	1619240470	1619240470	1	1	GONZALEZ, SUSANA LMFT	4/19/2022	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
121937	Fee-for-Service	1952479594	1952479594	1	2	GREENBERG, JARED M MD	5/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125660	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
121949	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	3/26/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
121961	Fee-for-Service	1538193388	1538193388	1	1	GROSS, COLEMAN	3/31/1994	207R00000X	NA	Other	026	PHYSICIANS	69240	41	Internal Medicine	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
121988	Fee-for-Service	1386683548	1386683548	1	1	GOLDBERG ISAAC 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 GARTH ROAD	STE 400	BAYTOWN	TX	77521	0000	00	None	29.766861	-94.9797495	Harris County
122029	Fee-for-Service	1134161334	1134161334	2	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26550 BOUQUET CANYON RD	None	SAUGUS	CA	91350	2353	19	06037	34.42877282	-118.5358074	Los Angeles County
122060	Fee-for-Service	1265419436	1265419436	1	1	GOVINDASWAMI, BALAJI MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49410	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
122114	Fee-for-Service	1699365189	1699365189	1	1	GOLDEN ROAD HOSPICE INC	11/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	STE 2D	NORTH HOLLYWOOD	CA	91601	2392	19	06037	34.17212154	-118.3819905	Los Angeles County
122121	Fee-for-Service	1063726412	1063726412	1	1	GILL, BALJIT S MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113101	None	None	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
122123	Fee-for-Service	1417035056	1417035056	1	1	GHOTBI, MOHAMMAD SEYED	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50506	41	Internal Medicine	0	In state provider	None	SF INTERNATIONAL AIRPORT	None	SAN FRANCISCO	CA	94128	0000	38	06075	0	0	None
122146	Fee-for-Service	1558072926	1558072926	1	1	GONZALEZ, MODESTO LCSW	1/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
122149	Fee-for-Service	1124102108	1124102108	1	1	GREEN, GARY M MD	5/13/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80599	77	Infectious Disease	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
122172	Fee-for-Service	1699378448	1699378448	1	1	GLADNEY, ERICA J PT	6/14/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
122194	Fee-for-Service	1316961998	1316961998	1	1	GARG, YOGENDER P MD INC	7/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	66071	18	Ophthalmology	0	In state provider	None	1901 OUTLET CENTER DRIVE	#240	OXNARD	CA	93036	0663	56	06111	34.21965581	-119.1491337	Ventura County
122210	Fee-for-Service	1417339326	1417339326	1	1	GALSON, VICTOR W MD	3/1/2022	207P00000X	NA	Other	026	PHYSICIANS	146811	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
122212	Fee-for-Service	1104862267	1104862267	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6215 RIVERSIDE AVE.	None	RIVERSIDE	CA	92506	2179	33	06065	33.95622637	-117.3879655	Riverside County
122237	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	11/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
122262	Fee-for-Service	1912075425	1912075425	1	1	GRAY, LEE-ANNE PSYD	5/30/2023	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
122276	Fee-for-Service	1396060554	1396060554	1	1	GAGE, SUSAN C MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111459	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
122278	Fee-for-Service	1386956068	1386956068	1	1	GREENE, CHEREENA L NP	11/4/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	444 GLENOAKS BLVD	None	GLENDALE	CA	91202	2917	19	06037	34.1598361	-118.2632528	Los Angeles County
122280	Fee-for-Service	1437171048	1437171048	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 HARBISON DR	None	VACAVILLE	CA	95687	3909	48	06095	38.361006	-121.963284	Solano County
122301	Fee-for-Service	1962686808	1962686808	1	1	GABRIEL A. MEDRANO VALLE, 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
122324	Fee-for-Service	1487840419	1487840419	1	1	GRIMM, KATE E MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89238	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
122348	Fee-for-Service	1225770316	1225770316	1	2	GUTHRIE, KAREN D CD	5/23/2024	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	30	06059	0	0	None
122350	Fee-for-Service	1265419436	1265419436	1	1	GOVINDASWAMI, BALAJI MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49410	40	Pediatrics	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
122404	Fee-for-Service	1699365189	1699365189	1	1	GOLDEN ROAD HOSPICE INC	11/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	STE 2D	NORTH HOLLYWOOD	CA	91601	2392	19	06037	34.17212154	-118.3819905	Los Angeles County
122418	Fee-for-Service	1093069411	1093069411	1	1	GADDAM, KISHORE K MD	3/16/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
122421	Fee-for-Service	1023105335	1023105335	1	1	GIST, LAUREN MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	81381	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
122439	Fee-for-Service	1346297991	1346297991	1	1	GREER, LINDA N MD	10/28/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175029	None	None	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
122514	Fee-for-Service	1932557246	1932557246	1	1	GELINAS, JENNIFER MD	9/4/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
122522	Fee-for-Service	1841380524	1841380524	1	1	GELMAN, BORIS MD	11/27/2007	207L00000X	NA	Other	026	PHYSICIANS	95740	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
122524	Fee-for-Service	1063410678	1063410678	1	1	GARCIA, RAMON A MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48129	36	Psychiatry	0	In state provider	None	4300 AUBURN BLVD	STE 202	SACRAMENTO	CA	95841	4103	34	06067	38.643939	-121.3640415	Sacramento County
122526	Fee-for-Service	1033193610	1033193610	1	1	GOLDEN VALLEY HEALTH CTR	8/22/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
122536	Fee-for-Service	1598832172	1598832172	1	2	GERICARE PODIATRY GROUP	7/1/1996	213EP0504X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	8543 BURNS PL	None	STOCKTON	CA	95209	2633	39	06077	38.02775775	-121.3268182	San Joaquin County
122559	Fee-for-Service	1215157433	1215157433	1	1	GARFIELD BEACH CVS, LLC	11/30/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2200 N HARBOR BLVD	None	FULLERTON	CA	92835	2605	30	06059	33.89613923	-117.9289689	Orange County
122566	Fee-for-Service	1891819447	1891819447	1	1	GWARTZ, BRIAN L MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	43746	01	General Practice	0	In state provider	None	210 S GRAND AVE	STE 315	GLENDORA	CA	91741	4284	19	06037	34.133859	-117.872523	Los Angeles County
122582	Fee-for-Service	1245519966	1245519966	1	1	GONZALEZ, LAUREN B OD	5/5/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
122591	Fee-for-Service	1982169561	1982169561	1	2	GENESIS PHARMACY CORP	6/8/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	31946 MISSION TRAIL	SUITE A1	LAKE ELSINORE	CA	92530	4539	33	06065	33.65640803	-117.2979656	Riverside County
122607	Fee-for-Service	1336560457	1336560457	1	1	GENERATIONAL CHANGES, INC	5/23/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	930 TULARE STREET	ROOMS OFFICE 1 TECH RM	FRESNO	CA	93706	3847	10	06019	36.72630695	-119.8007605	Fresno County
122658	Fee-for-Service	1801830872	1801830872	1	1	GEIL, GARY E MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50145	30	Radiology	0	In state provider	None	1100 N TUSTIN AVE	None	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
122662	Fee-for-Service	1760957823	1760957823	1	1	GOLDEN TOUCH HOME HEALTH INC	2/2/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2001 BEVERLY BLVD	SUITE 215	LOS ANGELES	CA	90057	2403	19	06037	34.06612393	-118.2690406	Los Angeles County
122673	Fee-for-Service	1316029515	1316029515	1	1	GUPTA, VANITA MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	66958	01	General Practice	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
122727	Fee-for-Service	1831699396	1831699396	1	1	GUIDEPOST MARRIAGE THERAPY I	5/16/2024	261QM0801X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	LNESS	1650 OREGON ST	STE 114	REDDING	CA	96001	1757	45	06089	40.58198408	-122.3937903	Shasta County
122753	Fee-for-Service	1891749842	1891749842	1	1	GUPTA, PRATIMA MD	5/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82373	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	STE 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
122768	Fee-for-Service	1265426886	1265426886	1	1	GASKE, ABBEY B MD	7/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	72385	34	Urology and Urological Surgery	0	In state provider	None	1127 WILSHIRE BLVD	STE 1001	LOS ANGELES	CA	90017	4001	19	06037	34.05270508	-118.2641005	Los Angeles County
122779	Fee-for-Service	1407080799	1407080799	1	1	GARLAND, ANDREA T MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115655	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8787 HALL RD	None	LAMONT	CA	93241	1953	15	06029	35.25969451	-118.908099	Kern County
122792	Fee-for-Service	1619020484	1619020484	1	1	GREGORY J WITHERS MD INC A M	12/31/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	EDICAL CORP	301 W HUNTINGTON DR	407	ARCADIA	CA	91007	3462	19	06037	34.13481053	-118.0425638	Los Angeles County
122793	Fee-for-Service	1780843102	1780843102	1	1	GILLAM, DAWN E LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
122825	Fee-for-Service	1275968893	1275968893	1	1	GROSS, KIMBERLY W NP	9/11/2014	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	9001	37	06073	32.7537975	-117.1658298	San Diego County
122852	Fee-for-Service	1891819447	1891819447	1	1	GWARTZ, BRIAN L MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	43746	05	Anesthesiology	0	In state provider	None	210 S GRAND AVE	STE 315	GLENDORA	CA	91741	4284	19	06037	34.133859	-117.872523	Los Angeles County
122867	Fee-for-Service	1316120108	1316120108	1	1	GEBHARDT, CASSIDY PSYD	8/20/2018	103T00000X	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
122899	Fee-for-Service	1902207616	1902207616	1	1	GUIRGIS, SONIA Z MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133017	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
122905	Fee-for-Service	1679078885	1679078885	1	1	GREWAL, RAVLEEN K MD	2/4/2025	207RH0003X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2626 N CALIFORNIA ST	STE B	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
122914	Fee-for-Service	1891986147	1891986147	1	1	GINSBURG, AMY L	9/18/2007	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	6865 ALTON PKWY	STE 120	IRVINE	CA	92618	3740	30	06059	33.6576845	-117.7712642	Orange County
122919	Fee-for-Service	1063562874	1063562874	1	1	GAHYAOUMI, AFSHIN MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88411	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
122960	Fee-for-Service	1770649535	1770649535	1	1	GLOBALMED SYSTEM, INC	5/12/2004	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8384 GARDENDALE ST	None	PARAMOUNT	CA	90723	2421	19	06037	33.9137058	-118.1493849	Los Angeles County
122965	Fee-for-Service	1780401349	1780401349	1	1	GONZALEZ, CAROLINA CNP	12/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
122985	Fee-for-Service	1548289820	1548289820	1	1	GROSSMAN, JENNIFER M MD	6/1/1998	207RR0500X	NA	Other	026	PHYSICIANS	81407	83	Rheumatology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
123014	Fee-for-Service	1831699396	1831699396	1	1	GUIDEPOST MARRIAGE THERAPY I	5/16/2024	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	LNESS	1650 OREGON ST	STE 114	REDDING	CA	96001	1757	45	06089	40.58198408	-122.3937903	Shasta County
123017	Fee-for-Service	1104270008	1104270008	1	1	GUTHRIE, LAUREL MD	11/1/2023	2086X0206X	NA	General Surgery	026	PHYSICIANS	151036	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
123065	Fee-for-Service	1114245842	1114245842	1	1	GHIYAM, DANIEL M INC	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75370	08	Family Practice	0	In state provider	None	2840 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	3937	56	06111	34.27167882	-118.7404467	Ventura County
123094	Fee-for-Service	1215248273	1215248273	1	2	GHULAM, MEHBOOB DO	1/1/2017	207R00000X	NA	Other	026	PHYSICIANS	12164	None	None	0	In state provider	None	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
123098	Fee-for-Service	1255913950	1255913950	1	1	GARIEBALLA, AHMED I MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	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
123128	Fee-for-Service	1083830780	1083830780	1	1	GATES, ELIZABETH R PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4125 W NOBLE AVE	STE 315	VISALIA	CA	93277	1662	54	06107	36.325818	-119.3366835	Tulare County
123140	Fee-for-Service	1164438073	1164438073	1	1	GONZALEZ, ANGEL G MD	1/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80580	01	General Practice	0	In state provider	None	2790 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
123147	Fee-for-Service	1376797654	1376797654	1	1	GREY, TUESDAY E	12/9/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
123186	Fee-for-Service	1043245640	1043245640	1	1	GALIER, PETER C MD	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74741	41	Internal Medicine	0	In state provider	None	1131 WILSHIRE BLVD	# 100200	SANTA MONICA	CA	90401	2061	19	06037	34.02509887	-118.4909994	Los Angeles County
123199	Fee-for-Service	1326536293	1326536293	1	1	GE, TIANJIA J MD	4/23/2024	208800000X	NA	Other	026	PHYSICIANS	163797	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
123201	Fee-for-Service	1275898314	1275898314	1	2	GOGINENI, HRISHIKESH C MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154074	20	Orthopedic Surgery	0	In state provider	None	15325 FAIRFIELD RANCH RD	STE. 150	CHINO HILLS	CA	91709	8834	36	06071	33.9729714	-117.6918388	San Bernardino County
123204	Fee-for-Service	1699383232	1699383232	1	1	GOODWILL HEALTHCARE SERVICES	10/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	2600 FOOTHILL BLVD	STE 104	LA CRESCENTA	CA	91214	4578	19	06037	34.22121465	-118.2352382	Los Angeles County
123210	Fee-for-Service	1801289905	1801289905	1	2	GREENE, DIANNE L LMFT	11/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27201 TOURNEY RD	225	SANTA CLARITA	CA	91355	1804	19	06037	34.41741018	-118.5770409	Los Angeles County
123217	Fee-for-Service	1669910584	1669910584	1	1	GURTIS, AMANDA PSYD	6/19/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12530 10TH ST	STE C	CHINO	CA	91710	3520	36	06071	34.0258983	-117.6869086	San Bernardino County
123221	Fee-for-Service	1639166523	1639166523	1	1	GROVER, ATUL MD INC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	55575	05	Anesthesiology	0	In state provider	None	1720 TERMINO AVE	None	LONG BEACH	CA	90804	2104	19	06037	33.78889871	-118.1458784	Los Angeles County
123222	Fee-for-Service	1003045915	1003045915	1	1	GRAY, MICHAEL MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112324	41	Internal Medicine	0	In state provider	None	16300 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.66115075	-117.7742405	Orange County
123253	Fee-for-Service	1801979018	1801979018	1	1	GHOVANLOU, PARISSA MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94378	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
123296	Fee-for-Service	1154362028	1154362028	1	1	GARFIELD BEACH CVS, LLC	9/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1101 S. MISSION RD.	None	FALLBROOK	CA	92028	3224	37	06073	33.37270834	-117.2535155	San Diego County
123311	Fee-for-Service	1073661039	1073661039	1	1	GAMBRIOLI, CHRISTOPHER R	4/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88269	08	Family Practice	0	In state provider	MD	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
123361	Fee-for-Service	1477837748	1477837748	1	2	GREWAL, PAVITTAR MD	5/4/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	130169	08	Family Practice	0	In state provider	None	7413 N CEDAR AVE	SUITE 101	FRESNO	CA	93720	3833	10	06019	36.84381154	-119.7568868	Fresno County
123384	Fee-for-Service	1528138260	1528138260	1	1	GAN-YONG, ELAINE A MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	77596	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
123420	Fee-for-Service	1841203825	1841203825	1	1	GRAY, ROBERT F MD	1/31/1995	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	83766	47	Miscellaneous	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
123451	Fee-for-Service	1104820562	1104820562	1	1	GHC OF SAN JOSE, LLC	5/1/1998	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	VISTA MANOR NURSING CTR	120 JOSE FIGUERES AVE	None	SAN JOSE	CA	95116	1528	43	06085	37.35982865	-121.8492783	Santa Clara County
123455	Fee-for-Service	1265770101	1265770101	1	1	GJELTEMA, TREVOR P LMFT	5/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
123493	Fee-for-Service	1699383232	1699383232	1	1	GOODWILL HEALTHCARE SERVICES	10/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	2600 FOOTHILL BLVD	STE 104	LA CRESCENTA	CA	91214	4578	19	06037	34.22121465	-118.2352382	Los Angeles County
123532	Fee-for-Service	1679770689	1679770689	1	1	GONZALEZ, CHRISTINE A LMFT	11/7/2019	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
123551	Fee-for-Service	1003955493	1003955493	1	1	GONZALEZ, DENISE R MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	68931	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
123552	Fee-for-Service	1144865437	1144865437	1	1	GREENE, KATHRYN H LCSW	4/17/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
123554	Fee-for-Service	1568695641	1568695641	1	1	GEORGE, SPENCER M MD	12/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151799	20	Orthopedic Surgery	0	In state provider	None	6620 COYLE AVE	STE 212	SACRAMENTO	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento
123577	Fee-for-Service	1477647964	1477647964	1	1	GALFAIAN, ANAIT MD	6/30/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AMERICARE MEDICAL CTR	445 W BROADWAY	None	GLENDALE	CA	91204	1208	19	06037	34.14684551	-118.2633525	Los Angeles County
123617	Fee-for-Service	1669435889	1669435889	1	1	GOWRI BALACHANDAR,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	401 W SPRING CREEK	PKWY 400	PLANO	TX	75024	4601	00	None	33.05768493	-96.70023093	Collin County
123621	Fee-for-Service	1770927824	1770927824	1	1	GUTIERREZ, LAURA A LMFT	8/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	33	06065	33.994269	-117.3485375	Riverside County
123629	Fee-for-Service	1295764405	1295764405	1	1	GUSTAFSON, CAITLYN 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 STATE ST	None	MCCALL	ID	83638	3704	00	None	44.90904704	-116.1097318	Valley County
123653	Fee-for-Service	1952142754	1952142754	1	1	GOLDEN, DANIEL OD	12/30/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
123657	Fee-for-Service	1295121895	1295121895	1	1	GALLEGOS, MOISES H MD	6/7/2019	207P00000X	NA	Other	026	PHYSICIANS	160952	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
123665	Fee-for-Service	1912013533	1912013533	1	1	GAITAN, SCOTT A MD	11/1/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65333	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
123726	Fee-for-Service	1962680421	1962680421	1	8	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E102	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
123759	Fee-for-Service	1841819133	1841819133	1	1	GANDHI, SANI DO	3/14/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	22676	13	Neurology (M.D. only)	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
123767	Fee-for-Service	1073830105	1073830105	1	1	GARG, SACHIN K MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126906	41	Internal Medicine	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
123795	Fee-for-Service	1013262104	1013262104	1	1	GROB, SEANNA R MD	7/26/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	148069	18	Ophthalmology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
123805	Fee-for-Service	1407233265	1407233265	1	1	GRUZMAN, DANIEL DO	10/9/2020	207P00000X	NA	Other	026	PHYSICIANS	18341	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
123845	Fee-for-Service	1861404535	1861404535	1	3	GHODSIAN, SHAHROUZ MD	4/26/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	82527	-	NOT APPLICABLE	0	In state provider	None	2521 LONG BEACH AVE	None	LOS ANGELES	CA	90058	1324	19	06037	34.01372454	-118.2432255	Los Angeles County
123857	Fee-for-Service	1871168518	1871168518	1	1	GAMINO FAMILY THERAPY GROUP	8/23/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	1616 W SHAW AVE	SUITE D1	FRESNO	CA	93711	3513	10	06019	36.8084467	-119.8224562	Fresno County
123861	Fee-for-Service	1215137815	1215137815	1	1	GUPTA, SANDEEP MD	6/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100278	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3200 KEARNEY STREET	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
123893	Fee-for-Service	1447604426	1447604426	1	1	GARCIA, DIEGO R LMFT	4/16/2020	106H00000X	NA	Mental Health Outpatient Services	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
123895	Fee-for-Service	1689364721	1689364721	1	2	GEM MEDICAL GROUP CORPORATIO	5/20/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	N	900 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4716	19	06037	34.049623	-118.1388014	Los Angeles County
123899	Fee-for-Service	1609149624	1609149624	1	2	GRAIL, CELIA E LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
123900	Fee-for-Service	1437237021	1437237021	1	1	GANESH, SRINIVAS MD	10/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79799	08	Family Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
123910	Fee-for-Service	1952939787	1952939787	1	1	GIDDENS, NICOLE K MD	6/23/2024	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
123933	Fee-for-Service	1841611902	1841611902	2	2	GREYWELL PHARMACY INC	7/19/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10672 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91602	2319	19	06037	34.1522159	-118.3636496	Los Angeles County
123944	Fee-for-Service	1538653415	1538653415	1	1	GROSSMAN, SAMUEL MD	2/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164155	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
123952	Fee-for-Service	1174789911	1174789911	1	1	GHORI, SAIMA MD	3/5/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	119 S LOCUST ST	STE B	VISALIA	CA	93291	6251	54	06107	36.329382	-119.2937355	Tulare County
123982	Fee-for-Service	1609350909	1609350909	1	1	GORDON, CRISTINA L MD	7/29/2019	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	157992	01	General Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
123989	Fee-for-Service	1205330354	1205330354	1	1	GARCIA CABRERA, ANA T MD	7/31/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	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
123995	Fee-for-Service	1750644290	1750644290	1	1	GONZALEZ, TYLER A MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148608	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
124008	Fee-for-Service	1033627179	1033627179	1	1	GREATER FRESNO HEALTH	4/9/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4770 N CEDAR AVENUE	None	FRESNO	CA	93726	1065	10	06019	36.804717	-119.754103	Fresno County
124011	Fee-for-Service	1114280443	1114280443	1	1	GLENN, BRITTANY C DO	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15745	None	None	0	In state provider	None	800 S MAIN STREET	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
124015	Fee-for-Service	1962680421	1962680421	1	8	GOLDEN VALLEY HEALTH CENTERS	7/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	401 PARADISE ROAD	SUITE E102	MODESTO	CA	95350	0000	50	06099	37.62692973	-121.0131742	Stanislaus County
124040	Fee-for-Service	1114929494	1114929494	1	1	GRAYSON COUNTY HOSPITAL	4/16/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	910 WALLACE AVE	None	LEITCHFIELD	KY	42754	1418	00	None	37.47279163	-86.28675735	Grayson County
124076	Fee-for-Service	1013144187	1013144187	2	1	GLOBAL HEALTHCARE, INC	4/13/2017	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	5901 W OLYMPIC BLVD	STE 500	LOS ANGELES	CA	90036	4667	19	06037	34.05764121	-118.3603115	Los Angeles County
124079	Fee-for-Service	1679308399	1679308399	1	1	GARCIA, KIMBERLY	11/5/2024	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
124103	Fee-for-Service	1508901927	1508901927	1	1	GROVER, GEETA MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	67016	40	Pediatrics	0	In state provider	None	30131 TOWN CENTER DR	STE 130	LAGUNA NIGUEL	CA	92677	2010	30	06059	33.52530096	-117.7148334	Orange County
124121	Fee-for-Service	1083669600	1083669600	1	1	GADE, GEORGE F MD	2/23/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	32809	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
124132	Fee-for-Service	1457337347	1457337347	1	1	GARABEDIAN, WENDY R MD	6/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92421	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
124133	Fee-for-Service	1902420490	1902420490	1	1	GUIDING HOPE HOME HEALTH	8/18/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12500 RIVERSIDE DR	STE 210	VALLEY VILLAGE	CA	91607	3435	19	06037	34.15758653	-118.4056605	Los Angeles County
124144	Fee-for-Service	1366189870	1366189870	1	1	GUTIERREZ, ELENA NP	6/28/2024	367A00000X	NA	Certified Nurse Midwife	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
124149	Fee-for-Service	1962438564	1962438564	1	1	GIRARD ORTHOPAEDIC	3/29/2023	174400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SURGEONS MEDICAL GRP INC	9333 GENESSE AVE	STE 350	SAN DIEGO	CA	92121	2103	37	06073	32.875668	-117.2139225	San Diego County
124189	Fee-for-Service	1295960508	1295960508	1	1	GEVORGYAN, ANNA R MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104829	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E 28TH ST	STE 212	LONG BEACH	CA	90806	2774	19	06037	33.80803441	-118.1847137	Los Angeles County
124205	Fee-for-Service	1407936768	1407936768	1	1	GREGG,VICTORIA 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	6621 FANNIN ST	None	HOUSTON	TX	77030	0000	00	None	29.70724683	-95.4026169	Harris County
124215	Fee-for-Service	1962997239	1962997239	1	1	GORDON, CAITLIN E NP	9/28/2018	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
124244	Fee-for-Service	1033439906	1033439906	1	1	GOLDMAN, ROBIN S MD	7/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131335	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
124261	Fee-for-Service	1700041217	1700041217	1	1	GHATAN, ANDREW C MD	10/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132066	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
124297	Fee-for-Service	1033627179	1033627179	1	1	GREATER FRESNO HEALTH	4/9/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4770 N CEDAR AVENUE	None	FRESNO	CA	93726	1065	10	06019	36.804717	-119.754103	Fresno County
124329	Fee-for-Service	1114929494	1114929494	1	1	GRAYSON COUNTY HOSPITAL	4/16/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	910 WALLACE AVE	None	LEITCHFIELD	KY	42754	1418	00	None	37.47279163	-86.28675735	Grayson County
124339	Fee-for-Service	1184650962	1184650962	1	1	GORDON, MAYUMI LAC	9/11/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	24335 VICTORY BOULEVARD	SUITE D	WEST HILLS	CA	91307	2849	19	06037	34.18465641	-118.6554687	Los Angeles County
124340	Fee-for-Service	1003991779	1003991779	1	1	GOLDFIEN, ROBERT D MD	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49527	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
124347	Fee-for-Service	1548705734	1548705734	1	1	GARFIELD BEACH CVS LLC	1/16/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	180 DONAHUE STREET	None	SAUSALITO	CA	94965	1250	21	06041	37.87389855	-122.5116437	Marin County
124354	Fee-for-Service	1710909403	1710909403	2	1	GARFIELD BEACH CVS LLC	10/5/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 W EMPIRE AVE	None	BURBANK	CA	91504	3403	19	06037	34.189101	-118.330731	Los Angeles County
124360	Fee-for-Service	1326218686	1326218686	1	1	GANDHI, SHAILESH MD	1/11/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53284	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
124398	Fee-for-Service	1477187615	1477187615	1	1	GENOA HEALTHCARE, LLC	6/25/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	245 11TH ST	STE P1	SAN FRANCISCO	CA	94103	3732	38	06075	37.77258144	-122.4148605	San Francisco County
124409	Fee-for-Service	1861033375	1861033375	1	1	GOLDEN BIRD HOME HEALTH CARE	8/14/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	464 N ROGERS AVE	STE 101	CLOVIS	CA	93611	0330	10	06019	36.8389699	-119.7031767	Fresno County
124438	Fee-for-Service	1962438564	1962438564	1	1	GIRARD ORTHOPAEDIC	3/1/1980	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SURGEONS MEDICAL GRP INC	9333 GENESSE AVE	STE 350	SAN DIEGO	CA	92121	2103	37	06073	32.875668	-117.2139225	San Diego County
124466	Fee-for-Service	1396824132	1396824132	1	1	GERARDO O PASCUAL	11/28/2001	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	G&E CARE HOME	19244 E ELBERLAND ST	None	WEST COVINA	CA	91792	2803	19	06037	34.00916186	-117.8805497	Los Angeles County
124493	Fee-for-Service	1326715087	1326715087	1	1	GOLDEN CARE LIVING INC	8/21/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1308 HICKORY AVE	None	TORRANCE	CA	90503	6053	19	06037	33.83506658	-118.334616	Los Angeles County
124511	Fee-for-Service	1659170702	1659170702	1	1	GARCIA, XOCHITL R	4/24/2025	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	44	06087	0	0	None
124514	Fee-for-Service	1629458773	1629458773	1	1	GUIANG, NELSON R E	3/25/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3626 E CHAPMAN AVE	None	ORANGE	CA	92869	3847	30	06059	33.78777248	-117.8148531	Orange County
124545	Fee-for-Service	1669413605	1669413605	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2831 E EASTLAND CTR DR	None	WEST COVINA	CA	91791	1624	19	06037	34.07303329	-117.8837557	Los Angeles County
124548	Fee-for-Service	1992883748	1992883748	1	1	GAINES, JADE E MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60100	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
124564	Fee-for-Service	1770229924	1770229924	1	2	GRACE HOME CARE INC	9/8/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	35591 ATHENA CT	None	WINCHESTER	CA	92596	9011	33	06065	33.60404403	-117.0888232	Riverside County
124567	Fee-for-Service	1902405707	1902405707	1	1	GENESIS HOSPICE INC	9/27/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	905 S LAKE ST	STE 203	BURBANK	CA	91502	2436	19	06037	34.1695314	-118.3061352	Los Angeles County
124606	Fee-for-Service	1366402836	1366402836	1	1	GOEBEL,JAMES 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	2720 STONE PARK RD	None	SIOUX CITY	IA	51102	0000	00	None	42.51879554	-96.40625864	Woodbury County
124609	Fee-for-Service	1952626178	1952626178	1	1	GUILLEN, ERNESTINA LMFT	1/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	282 LANDIS AVE	None	CHULA VISTA	CA	91910	2627	37	06073	32.64168665	-117.0812298	San Diego County
124612	Fee-for-Service	1558832741	1558832741	1	1	GRAND AVENUE SURGERY CENTER	2/19/2021	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	1400 S GRAND AVENUE	SUITE 700	LOS ANGELES	CA	90015	3068	19	06037	34.03692236	-118.2655238	Los Angeles County
124618	Fee-for-Service	1164009973	1164009973	1	1	GUIRGUIS, MARK T MD	4/11/2025	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
124636	Fee-for-Service	1790715381	1790715381	1	1	GWINNETT HOSP SYSTEM	1/5/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3620 HOWELL FERRY RD	None	DULUTH	GA	30096	3223	00	None	34.00025451	-84.16568493	Gwinnett County
124670	Fee-for-Service	1982101382	1982101382	1	1	GEIER, ANNE W MD	8/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165260	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
124681	Fee-for-Service	1588817985	1588817985	1	1	GRIFFIN, IVY C LMFT	3/17/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1909 CAPITOL AVE	STE 302	SACRAMENTO	CA	95811	4242	34	06067	38.573937	-121.4820675	Sacramento County
124682	Fee-for-Service	1740356278	1740356278	1	1	GREEN, ANDREA C PT	4/17/2020	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
124725	Fee-for-Service	1962438564	1962438564	1	1	GIRARD ORTHOPAEDIC	2/13/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	SURGEONS MEDICAL GRP INC	9333 GENESSE AVE	STE 350	SAN DIEGO	CA	92121	2103	37	06073	32.875668	-117.2139225	San Diego County
124736	Fee-for-Service	1548465057	1548465057	1	1	GARBER, ALEXANDER C MD	10/8/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	2	Out of state provider	None	3382 WAIALAE AVE	None	HONOLULU	HI	96816	2637	00	None	21.2853424	-157.804115	Honolulu County
124790	Fee-for-Service	1972956787	1972956787	1	1	GILLESPIE, ROCHELLE LMFT	8/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
124791	Fee-for-Service	1497132765	1497132765	1	1	G AND C SWAN INC	1/22/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	MENT CENTER	3286 E GUASTI RD	100 & 110	ONTARIO	CA	91761	8645	36	06071	34.063848	-117.579366	San Bernardino County
124818	Fee-for-Service	1548486715	1548486715	1	1	GRISCHKAN, JONATHAN M MD	8/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	04	Otology, Laryngology, Rhinology	2	Out of state provider	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
124836	Fee-for-Service	1558312108	1558312108	1	2	GROBLEWSKI, JOHN P CRNA	12/17/2007	No Taxonomy Provided	NA	None	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
124846	Fee-for-Service	1417275967	1417275967	1	2	GLECO LLC	6/11/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11665 CIBOLA RD	None	APPLE VALLEY	CA	92308	5922	36	06071	34.46355432	-117.2025842	San Bernardino County
124853	Fee-for-Service	1902405707	1902405707	1	1	GENESIS HOSPICE INC	9/27/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	905 S LAKE ST	STE 203	BURBANK	CA	91502	2436	19	06037	34.1695314	-118.3061352	Los Angeles County
124913	Fee-for-Service	1750572822	1750572822	1	1	GOLDMAN, EUGENE E MD	9/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101760	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
124919	Fee-for-Service	1790715381	1790715381	1	1	GWINNETT HOSP SYSTEM	1/5/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3620 HOWELL FERRY RD	None	DULUTH	GA	30096	3223	00	None	34.00025451	-84.16568493	Gwinnett County
124941	Fee-for-Service	1740598689	1740598689	1	1	GARFIELD BEACH CVS LLC	1/19/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14426 PALMDALE RD	None	VICTORVILLE	CA	92392	2743	36	06071	34.50673453	-117.347436	San Bernardino County
124955	Fee-for-Service	1215463948	1215463948	1	1	GOBRIAL, MONICA N DO	11/3/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17946	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
124968	Fee-for-Service	1841334521	1841334521	1	1	GORDON, SHELLEY M MD	8/15/1986	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	54122	77	Infectious Disease	0	In state provider	None	3838 CALIFORNIA ST	RM 305	SAN FRANCISCO	CA	94118	1505	38	06075	37.78591809	-122.4575439	San Francisco County
124994	Fee-for-Service	1245940139	1245940139	1	1	GAMMADA, EMNET Z PHD	12/9/2022	103T00000X	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
125014	Fee-for-Service	1275149668	1275149668	1	1	GARVER, PATRICIA N	10/2/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2085 NATALIE DR.	None	ROSAMOND	CA	93560	6855	15	06029	34.87234952	-118.1686157	Kern County
125027	Fee-for-Service	1366120784	1366120784	1	1	GENOA HEALTHCARE LLC	3/8/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	STE 144	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
125036	Fee-for-Service	1700015161	1700015161	1	1	GOODLOW, GALE K MD	12/28/2022	207L00000X	NA	Other	026	PHYSICIANS	181302	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
125057	Fee-for-Service	1093030504	1093030504	1	1	GRIFFIN DIALYSIS LLC	7/22/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8243 E STOCKTON BLVD	STE 100	SACRAMENTO	CA	95828	8200	34	06067	38.459565	-121.409235	Sacramento County
125070	Fee-for-Service	1497762355	1497762355	1	1	GUPTA, POOJA DO	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8214	08	Family Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
125085	Fee-for-Service	1427341577	1427341577	1	1	GHOSH, ANKONA MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142915	04	Otology, Laryngology, Rhinology	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
125104	Fee-for-Service	1831394113	1831394113	1	1	GREENFIELD, MARC J LCSW	6/13/2017	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
125151	Fee-for-Service	1174967079	1174967079	1	1	GUARDIAN SLEEP CLINIC, LLC	12/23/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	315 PIERCY RD	None	SAN JOSE	CA	95138	1403	43	06085	37.25672171	-121.7830985	Santa Clara County
125169	Fee-for-Service	1508823469	1508823469	1	1	GLASSMAN, JEREL H DO	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	5877	25	Physical Medicine and Rehabilitation	0	In state provider	None	2235 HAYES ST	None	SAN FRANCISCO	CA	94117	1012	38	06075	37.77302045	-122.4529717	San Francisco County
125175	Fee-for-Service	1497077739	1497077739	1	1	GLENDORA GRAND INCORPORATED	7/22/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	805 W ARROW HIGHWAY	None	GLENDORA	CA	91740	5413	19	06037	34.10553987	-117.8765895	Los Angeles County
125185	Fee-for-Service	1184878357	1184878357	1	1	GRANADO, YADIRA B LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
125205	Fee-for-Service	1194111070	1194111070	1	1	GHAZI, FARANAK C MD	3/18/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151220	None	None	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
125250	Fee-for-Service	1518187319	1518187319	1	1	GOLDEN VALLEY HLTH CTR	3/1/1997	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LOS BANOS	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	24	06047	37.06376226	-120.860675	Merced County
125301	Fee-for-Service	1275149668	1275149668	1	1	GARVER, PATRICIA N	10/2/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2085 NATALIE DR.	None	ROSAMOND	CA	93560	6855	15	06029	34.87234952	-118.1686157	Kern County
125302	Fee-for-Service	1568414878	1568414878	1	1	GRILL,JEFFERY 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	9225 N 3RD ST	STE 200 B	PHOENIX	AZ	85020	0000	00	None	33.57054	-112.0692465	Maricopa County
125331	Fee-for-Service	1063601383	1063601383	1	1	GIVENS, LYNN M LCSW	10/7/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
125341	Fee-for-Service	1205968237	1205968237	1	1	GASCON, PERLA G MD INC	3/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	40840	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
125368	Fee-for-Service	1912293838	1912293838	1	1	GLENN, NICOLE C MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122582	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
125378	Fee-for-Service	1699321802	1699321802	1	1	GROMAN, SARAH PT	2/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
125441	Fee-for-Service	1649768060	1649768060	1	1	GONZALEZ, ALEXANDER LMFT	10/3/2024	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
125446	Fee-for-Service	1023418597	1023418597	1	1	GLIDDEN, MATTHEW C PSYD	11/16/2023	103T00000X	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
125517	Fee-for-Service	1699796649	1699796649	2	1	GILBERT RX INC	7/5/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9240 GARDEN GROVE BLVD	STE 20	GARDEN GROVE	CA	92844	1400	30	06059	33.77385717	-117.9712457	Orange County
125530	Fee-for-Service	1861713141	1861713141	1	1	GARG, RAJAN MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134588	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9918 KATELLA AVE	STE C	ANAHEIM	CA	92804	6465	30	06059	33.80307047	-117.959688	Orange County
125532	Fee-for-Service	1164606604	1164606604	1	1	GRIMM, JOHN P MD	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90306	30	Radiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
125562	Fee-for-Service	1134625593	1134625593	1	1	GRAY, EVAN L DO	7/1/2022	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	17616	None	None	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
125564	Fee-for-Service	1275895849	1275895849	1	1	GIBONEY, JENNIFER C MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130768	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
125565	Fee-for-Service	1023059219	1023059219	1	1	GOKHALE, MANDAAR A MD	2/1/1999	193400000X	NA	Other	026	PHYSICIANS	84628	41	Internal Medicine	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
125576	Fee-for-Service	1356319388	1356319388	1	1	GOLDBERG,JOHN M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6644 E BAYWOOD	None	MESA	AZ	85206	0000	00	None	33.411159	-111.688686	Maricopa County
125589	Fee-for-Service	1659792125	1659792125	1	1	GERNEZ, YAEL G MD	12/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133624	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
125594	Fee-for-Service	1750319125	1750319125	1	1	GINGRICH JR, TED F MD	10/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86049	05	Anesthesiology	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
125619	Fee-for-Service	1811792054	1811792054	1	1	GARVEY, SARAH I AU	3/4/2025	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	10200 TRINITY PARKWAY	STE 201	STOCKTON	CA	95219	7286	39	06077	38.04745959	-121.3721294	San Joaquin County
125640	Fee-for-Service	1184283608	1184283608	1	1	GAPS HEALTH CA CORP	8/28/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	19929 GREENLEY RD	None	SONORA	CA	95370	5996	55	06109	37.9837971	-120.366851	Tuolumne County
125680	Fee-for-Service	1427166453	1427166453	1	1	GREGORY, PAUL R JR MD	5/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85411	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
125694	Fee-for-Service	1508963893	1508963893	1	1	GOUNDER PRABHU P MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85017	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
125714	Fee-for-Service	1922238864	1922238864	1	1	GOH, CHOON HWA MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117797	41	Internal Medicine	0	In state provider	None	2200 OFARRELL STREET	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
125752	Fee-for-Service	1659039055	1659039055	1	1	GARCIA, RACHEL CCC-SLP	11/20/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
125817	Fee-for-Service	1861713141	1861713141	1	1	GARG, RAJAN MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134588	41	Internal Medicine	0	In state provider	None	9918 KATELLA AVE	STE C	ANAHEIM	CA	92804	6465	30	06059	33.80307047	-117.959688	Orange County
125819	Fee-for-Service	1831441153	1831441153	1	1	GALURA, KRISTINA E MD	12/18/2018	2080P0006X	NA	Psychiatry	026	PHYSICIANS	137123	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
125829	Fee-for-Service	1902339203	1902339203	1	1	GUILLAUME, TIANA M MD	11/10/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	157210	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
125832	Fee-for-Service	1578021960	1578021960	1	1	GREENWAY, JENNIFER CNP	7/29/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
125842	Fee-for-Service	1588760565	1588760565	1	1	GUNTHORPE, HELEN E MD	4/30/1980	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	35927	41	Internal Medicine	0	In state provider	None	2656 LARKIN ST	None	SAN FRANCISCO	CA	94109	1513	38	06075	37.80251986	-122.4213152	San Francisco County
125854	Fee-for-Service	1023059219	1023059219	1	1	GOKHALE, MANDAAR A MD	2/1/1999	193400000X	NA	Other	026	PHYSICIANS	84628	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
125877	Fee-for-Service	1659792125	1659792125	1	1	GERNEZ, YAEL G MD	12/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133624	03	Allergy	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
125903	Fee-for-Service	1992007710	1992007710	1	1	GINZBURG, MICHAEL OT	8/15/2023	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 RIVER PARK	STE 2000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
125924	Fee-for-Service	1033131818	1033131818	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13200 JAMBOREE RD	None	IRVINE	CA	92602	2307	30	06059	33.726753	-117.785601	Orange County
125942	Fee-for-Service	1790126555	1790126555	1	1	GEER, REBECCA M MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133819	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
125967	Fee-for-Service	1427166453	1427166453	1	1	GREGORY, PAUL R JR MD	5/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85411	20	Orthopedic Surgery	0	In state provider	None	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
126026	Fee-for-Service	1346370327	1346370327	1	1	GINSBURG, EMILY H MD	8/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94160	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
126070	Fee-for-Service	1841235736	1841235736	1	1	GARFIELD BEACH CVS LLC	5/17/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5200 UNIVERSITY PKWY	None	SAN BERNARDINO	CA	92407	7042	36	06071	34.17648227	-117.3307922	San Bernardino County
126072	Fee-for-Service	1235284738	1235284738	1	1	GAINEY, JOHN C MD	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92606	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
126097	Fee-for-Service	1972525053	1972525053	1	1	GRACIA, CARLOS R MD	9/12/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	45842	02	General Surgery	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 210	PLEASANTON	CA	94588	5802	01	06001	37.69214859	-121.8796532	Alameda County
126155	Fee-for-Service	1093182255	1093182255	1	1	GORDON PSYCHOLOGY GROUP, PC	4/14/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7545 IRVINE CENTER DR	STE 200	IRVINE	CA	92618	2933	30	06059	33.662781	-117.75096	Orange County
126164	Fee-for-Service	1336106541	1336106541	1	1	GEORGE, JOHN MD	11/1/2019	207R00000X	NA	Other	026	PHYSICIANS	53477	08	Family Practice	0	In state provider	None	8325 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2244	15	06029	35.36875951	-119.0959206	Kern County
126166	Fee-for-Service	1255530697	1255530697	1	1	GRANGER, ANTHONY BRIAN PT	5/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7737 MEANY AVE	B5-7	BAKERSFIELD	CA	93308	5266	15	06029	35.39423549	-119.0882835	Kern County
126203	Fee-for-Service	1043378045	1043378045	1	1	GAEDE, DON H MD	3/21/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	35060	41	Internal Medicine	0	In state provider	None	7191 N MILLBROOK AVE	STE 115	FRESNO	CA	93720	3365	10	06019	36.84006763	-119.7653359	Fresno County
126250	Fee-for-Service	1942030879	1942030879	1	1	GREENFIELD, JACOB P PT	2/10/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
126257	Fee-for-Service	1932127156	1932127156	1	1	GALLIA, LOUIS J MD	6/7/2024	1223S0112X	NA	Dental Provider	026	PHYSICIANS	None	84	Surgery-Head and Neck	0	In state provider	None	87 SCRIPPS DR	112	SACRAMENTO	CA	95825	6379	34	06067	38.572092	-121.410261	Sacramento County
126258	Fee-for-Service	1245616762	1245616762	1	1	GILMORE, DUNYA H LMFT	4/5/2021	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
126262	Fee-for-Service	1386387827	1386387827	1	1	GUSHULAK, ASHLEY M CRNA	6/9/2022	207L00000X	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
126304	Fee-for-Service	1063179422	1063179422	1	1	GOLDBERG, JOSHUA S PHD	11/30/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
126326	Fee-for-Service	1427323575	1427323575	1	1	GADGIL, RUCHA MD	7/2/2019	207P00000X	NA	Other	026	PHYSICIANS	163152	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1245 16TH ST	STE 204	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
126346	Fee-for-Service	1598376113	1598376113	1	1	GONZALEZ, LIZETH OD	11/17/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4560 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90022	1117	19	06037	34.04057653	-118.167318	Los Angeles County
126386	Fee-for-Service	1972525053	1972525053	1	1	GRACIA, CARLOS R MD	9/12/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	45842	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 210	PLEASANTON	CA	94588	5802	01	06001	37.69214859	-121.8796532	Alameda County
126396	Fee-for-Service	1093888588	1093888588	1	1	GAITHER, MAIA A MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75502	40	Pediatrics	0	In state provider	None	7128 PACIFIC BLVD	FL 2A	HUNTINGTON PARK	CA	90255	4776	19	06037	33.97494243	-118.2251099	Los Angeles County
126445	Fee-for-Service	1376529867	1376529867	1	1	GREENBERG, BRUCE D MD	1/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32040	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
126487	Fee-for-Service	1154655983	1154655983	2	1	GOLDENBERG, LAUREN P DO	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11516	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
126500	Fee-for-Service	1114955408	1114955408	1	1	GEE, ESMOND MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64659	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	# 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
126512	Fee-for-Service	1104429992	1104429992	1	1	GSG HOSPICE INC	5/17/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	SUITE 293	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
126523	Fee-for-Service	1396952164	1396952164	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2195 GLENDALE GALLERIA	None	GLENDALE	CA	91210	2101	19	06037	34.142976	-118.2591325	Los Angeles County
126582	Fee-for-Service	1699296863	1699296863	1	1	GOON, STEPHEN C NP	10/14/2020	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
126593	Fee-for-Service	1144307091	1144307091	1	1	GREENE, STUART MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34197	18	Ophthalmology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
126597	Fee-for-Service	1356862684	1356862684	1	1	GAHNG, SARAH M MD	4/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164415	08	Family Practice	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
126598	Fee-for-Service	1952306946	1952306946	1	1	GILLOCK, 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	6839 S CANTON AVE	None	TULSA	OK	74136	3402	00	None	36.06314853	-95.91874143	Tulsa County
126612	Fee-for-Service	1427323575	1427323575	1	1	GADGIL, RUCHA MD	7/2/2019	207P00000X	NA	Other	026	PHYSICIANS	163152	41	Internal Medicine	0	In state provider	None	1245 16TH ST	STE 204	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
126621	Fee-for-Service	1679693923	1679693923	1	1	GOTTLIEB, BERNARD MD INC	3/1/1980	207ND0900X	NA	Dermatology	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LAB	1666 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5113	36	06071	34.129395	-117.2788075	San Bernardino County
126647	Fee-for-Service	1528127008	1528127008	1	1	GRIFFITH, JOHN R 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
126684	Fee-for-Service	1093888588	1093888588	1	1	GAITHER, MAIA A MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75502	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7128 PACIFIC BLVD	FL 2A	HUNTINGTON PARK	CA	90255	4776	19	06037	33.97494243	-118.2251099	Los Angeles County
126737	Fee-for-Service	1013478833	1013478833	1	1	GU, CATHERINE C MD	3/4/2024	208800000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
126745	Fee-for-Service	1376664037	1376664037	1	1	GONZALES, CHARLES D MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75816	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
126750	Fee-for-Service	1437245289	1437245289	1	1	GORDON, IAN MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55350	02	General Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
126800	Fee-for-Service	1104429992	1104429992	1	1	GSG HOSPICE INC	5/17/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	SUITE 293	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
126824	Fee-for-Service	1669763413	1669763413	1	1	GARDNER, FRANCINA MD	2/23/2023	207LP3000X	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
126850	Fee-for-Service	1699936328	1699936328	1	1	GARDNER, GREGORY C MD	12/1/2020	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
126886	Fee-for-Service	1023579380	1023579380	1	1	GENILO, ELYZA	11/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20117	None	None	0	In state provider	None	447 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74338833	-121.432305	San Joaquin County
126900	Fee-for-Service	1427323575	1427323575	1	1	GADGIL, RUCHA MD	7/2/2019	207P00000X	NA	Other	026	PHYSICIANS	163152	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1245 16TH ST	STE 204	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
126912	Fee-for-Service	1194156430	1194156430	1	1	GARFIELD BEACH CVS LLC	3/25/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6265 E 2ND ST	STE 101	LONG BEACH	CA	90803	4651	19	06037	33.75784169	-118.1125041	Los Angeles County
126967	Fee-for-Service	1538781539	1538781539	1	1	GOSSAIN, SUMEET	12/1/2023	208M00000X	NA	Other	026	PHYSICIANS	191733	None	None	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
126972	Fee-for-Service	1467420802	1467420802	1	1	GOLDBLATT, WILLIAM G DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	319 N SAN DIMAS AVE	STE D	SAN DIMAS	CA	91773	2658	19	06037	34.110432	-117.807158	Los Angeles County
126974	Fee-for-Service	1669625612	1669625612	1	1	GEE, SARAH N MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119404	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	8344	19	06037	34.06527974	-118.4462792	Los Angeles County
126989	Fee-for-Service	1851767834	1851767834	1	1	GAYLE, MICHELLE LMFT	8/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20200 REDWOOD RD	5	CASTRO VALLEY	CA	94546	4313	01	06001	37.698075	-122.0739205	Alameda County
127019	Fee-for-Service	1609852854	1609852854	1	1	GOODHUE, ANGELIQUE D MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136423	36	Psychiatry	0	In state provider	None	1660 E ROSEVILLE PKWY	BLDG C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
127020	Fee-for-Service	1497321541	1497321541	1	1	GARCIA, RITA M	7/8/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3504 E PRINCETON AVE	None	FRESNO	CA	93703	1341	10	06019	36.7755084	-119.7657742	Fresno County
127035	Fee-for-Service	1376664037	1376664037	1	1	GONZALES, CHARLES D MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75816	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
127048	Fee-for-Service	1114931250	1114931250	1	1	GILES, GREGORY E OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8007 LA MESA BLVD	None	LA MESA	CA	91941	6434	37	06073	32.76370542	-117.0247794	San Diego County
127050	Fee-for-Service	1326252693	1326252693	1	1	GOLDEN VALLEY HEALTH CTR	8/15/1996	207R00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
127076	Fee-for-Service	1053317305	1053317305	1	1	GREGORY M KNORR MD	8/7/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1910 SOUTH AVE	None	LA CROSSE	WI	54601	5467	00	None	43.79473653	-91.24623835	La Crosse County
127083	Fee-for-Service	1104462175	1104462175	1	1	GILLINS, LADARIEN J LCSW	10/12/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
127117	Fee-for-Service	1568481414	1568481414	1	1	GATES, RICHARD N MD	9/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	70608	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1310 W STEWART DR	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
127145	Fee-for-Service	1023070265	1023070265	1	1	GAJJAR, NUPOOR A MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76807	22	Pathology (M.D. only)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
127165	Fee-for-Service	1508000886	1508000886	1	1	GIBBS, KIMBERLY M LMFT	9/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4433 E VILLAGE ROAD	SUITE H	LONG BEACH	CA	90808	1538	19	06037	33.83397238	-118.1408189	Los Angeles County
127183	Fee-for-Service	1750339586	1750339586	1	1	GRIER, CANDAGE 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	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
127211	Fee-for-Service	1952176240	1952176240	1	1	GOLDEN HORIZON HOME HEALTH	3/8/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE	4711 OAKWOOD AVE	STE 202A	LOS ANGELES	CA	90004	2471	19	06037	34.07729413	-118.3096899	Los Angeles County
127214	Fee-for-Service	1346327285	1346327285	1	1	GOTMARE, SONALI S MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81488	41	Internal Medicine	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
127223	Fee-for-Service	1063190288	1063190288	1	1	GEORGE CHAUX M D INC	6/12/2024	261QM2500X	NA	Other	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	STE 507	LOS ANGELES	CA	90067	2008	19	06037	34.05887194	-118.4122914	Los Angeles County
127268	Fee-for-Service	1750643136	1750643136	1	1	GLASER, SCOTT M MD	8/1/2017	390200000X	NA	Other	026	PHYSICIANS	147996	30	Radiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
127275	Fee-for-Service	1073684064	1073684064	1	1	GYSENS, SABINE PHD	2/29/2008	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	45 CASTRO ST	STE 200	SAN FRANCISCO	CA	94114	1038	38	06075	37.76829732	-122.4357056	San Francisco County
127306	Fee-for-Service	1306495908	1306495908	1	1	GLOBAL GRACE MEDICAL SERVICE	4/22/2021	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	S INC	2204 TORRANCE BLVD,	102	TORRANCE	CA	90501	0502	19	06037	33.83638629	-118.3217142	Los Angeles County
127311	Fee-for-Service	1497321541	1497321541	1	1	GARCIA, RITA M	7/8/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3504 E PRINCETON AVE	None	FRESNO	CA	93703	1341	10	06019	36.7755084	-119.7657742	Fresno County
127320	Fee-for-Service	1659518900	1659518900	1	1	GERMAIN, ROULA LMFT	9/4/2018	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
127338	Fee-for-Service	1326252693	1326252693	1	1	GOLDEN VALLEY HEALTH CTR	8/15/1996	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
127356	Fee-for-Service	1720035561	1720035561	1	1	GRASS VALLEY HEMATOLOGY/	5/24/1994	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	ONCOLOGY MED GROUP INC	155 GLASSON WAY	STE L10	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
127372	Fee-for-Service	1801967062	1801967062	1	1	GRACELIGHT COMMUNITY HEALTH	2/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	19	06037	34.12374025	-118.2188529	Los Angeles County
127386	Fee-for-Service	1053542258	1053542258	1	1	GARCIA, ELSA R MD	12/11/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	109511	01	General Practice	0	In state provider	None	2597 PINE AVENUE	SUITE B	LONG BEACH	CA	90806	3035	19	06037	33.8041414	-118.1925903	Los Angeles County
127404	Fee-for-Service	1568481414	1568481414	1	1	GATES, RICHARD N MD	9/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	70608	33	Thoracic Surgery	0	In state provider	None	1310 W STEWART DR	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
127418	Fee-for-Service	1780915553	1780915553	1	1	GEORGIEV, SHEELA R	7/18/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1576 STILLMAN AVENUE	None	REDLANDS	CA	92374	4176	36	06071	34.06130703	-117.148643	San Bernardino County
127457	Fee-for-Service	1437441904	1437441904	1	1	GRUBER, JOSHUA J MD	3/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122149	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
127465	Fee-for-Service	1710257704	1710257704	1	1	GRANITE WELLNESS CENTERS	11/18/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	12183 LOCKSLEY LANE	SUITE 101, 102, 103, 104	AUBURN	CA	95603	2004	31	06061	38.9503293	-121.0966898	Placer County
127509	Fee-for-Service	1831570225	1831570225	1	1	GRINDLE, JENNA N MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151053	01	General Practice	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
127538	Fee-for-Service	1306988019	1306988019	1	1	GROENEWALD, CORNELIUS B MD	11/13/2023	207L00000X	NA	Other	026	PHYSICIANS	191676	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
127588	Fee-for-Service	1093863029	1093863029	1	1	GUTIERREZ, LORAINE M	5/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64798	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
127590	Fee-for-Service	1447323613	1447323613	1	1	GLUZMAN, IRIS MD	9/13/2019	208M00000X	NA	Other	026	PHYSICIANS	87953	41	Internal Medicine	0	In state provider	None	3460 KATELLA AVE	None	LOS ALAMITOS	CA	90720	2334	30	06059	33.8029707	-118.073517	Orange County
127605	Fee-for-Service	1003994740	1003994740	1	1	GURMAI, ELMER E MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69066	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
127636	Fee-for-Service	1720035561	1720035561	1	1	GRASS VALLEY HEMATOLOGY/	5/24/1994	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	ONCOLOGY MED GROUP INC	155 GLASSON WAY	STE L10	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
127644	Fee-for-Service	1588062442	1588062442	1	1	GRUENDL, ASHLEY B	6/7/2016	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
127649	Fee-for-Service	1841426343	1841426343	1	1	GIVRAD, SOUDABEH MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130769	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
127659	Fee-for-Service	1801967062	1801967062	1	1	GRACELIGHT COMMUNITY HEALTH	2/1/2002	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	19	06037	34.12374025	-118.2188529	Los Angeles County
127683	Fee-for-Service	1619082849	1619082849	1	1	GRAY, RICHARD N MD	11/30/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	37138	30	Radiology	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
127704	Fee-for-Service	1780915553	1780915553	1	1	GEORGIEV, SHEELA R	7/18/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1576 STILLMAN AVENUE	None	REDLANDS	CA	92374	4176	36	06071	34.06130703	-117.148643	San Bernardino County
127708	Fee-for-Service	1629052220	1629052220	1	1	GORIN, FREDRIC A MD	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	44069	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
127712	Fee-for-Service	1114143757	1114143757	1	1	GADE, SHEELA L MD	4/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106042	26	Psychiatry (child)	0	In state provider	None	4125 BANGS AVENUE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
127808	Fee-for-Service	1619505666	1619505666	1	1	GOMEZ, RAHUL DO	7/25/2023	207R00000X	NA	Other	026	PHYSICIANS	20573	None	None	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
127820	Fee-for-Service	1447203096	1447203096	1	1	GREEP, NANCY C MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	33021	67	Endocrinology	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
127848	Fee-for-Service	1437703329	1437703329	1	1	GARFIELD HEALTH CENTER	3/12/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	701 S ATLANTIC BLVD	STE 202	MONTEREY PARK	CA	91754	3845	19	06037	34.05382447	-118.1363489	Los Angeles County
127879	Fee-for-Service	1548679145	1548679145	1	1	GUZMAN, CRYSTAL LMFT	7/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
127890	Fee-for-Service	1477793859	1477793859	1	1	GRIFFIN, SETH CRNA	3/10/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
127927	Fee-for-Service	1003996901	1003996901	1	1	GRAHAM, JONATHAN C DPM	1/25/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3416	21	06041	38.00450116	-122.5540001	Marin County
127935	Fee-for-Service	1841426343	1841426343	1	1	GIVRAD, SOUDABEH MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130769	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
127948	Fee-for-Service	1801967062	1801967062	1	1	GRACELIGHT COMMUNITY HEALTH	2/1/2002	261Q00000X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	19	06037	34.12374025	-118.2188529	Los Angeles County
127974	Fee-for-Service	1376703033	1376703033	1	1	GOMEZ GONZALEZ, MILEIDYS MD	12/7/2022	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	117697	-	NOT APPLICABLE	0	In state provider	None	1218 EAST COMPTON BLVD	None	COMPTON	CA	90221	3310	19	06037	33.89599454	-118.209798	Los Angeles County
127990	Fee-for-Service	1265497333	1265497333	1	1	GRAY, 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	650 ADDISON AVE W	None	TWIN FALLS	ID	83301	5444	00	None	42.56415243	-114.4940357	Twin Falls County
128049	Fee-for-Service	1326669318	1326669318	1	1	GONZALEZ, NATHAN S CRNA	6/3/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
128062	Fee-for-Service	1750081899	1750081899	1	1	GONZALEZ, MIREYA BIRTH DOUL	9/16/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
128101	Fee-for-Service	1083958292	1083958292	1	1	GONZALEZ, PATRICIA 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
128105	Fee-for-Service	1457757031	1457757031	1	1	GARCIA, EVELYN LMFT	11/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
128107	Fee-for-Service	1992881429	1992881429	1	1	GOLER, NANCY MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60349	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
128108	Fee-for-Service	1679963128	1679963128	1	1	GREEN, MEREDITH MD	9/4/2018	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139978	09	Gynecology (D.O. only)	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
128135	Fee-for-Service	1548282247	1548282247	2	1	GARFIELD BEACH CVS LLC	10/30/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9846 MISSION GORGE RD	None	SANTEE	CA	92071	3834	37	06073	32.842395	-116.982477	San Diego County
128138	Fee-for-Service	1437703329	1437703329	1	1	GARFIELD HEALTH CENTER	3/12/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	701 S ATLANTIC BLVD	STE 202	MONTEREY PARK	CA	91754	3845	19	06037	34.05382447	-118.1363489	Los Angeles County
128160	Fee-for-Service	1982909222	1982909222	1	1	GOMEZ, SARAH E CNM	2/3/2014	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
128166	Fee-for-Service	1386889632	1386889632	1	1	GAITAN, PATRICIA L MD	2/17/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	54922	None	None	0	In state provider	None	11411 BROOKSHIRE AVE	STE 305	DOWNEY	CA	90241	5005	19	06037	33.93667091	-118.1309273	Los Angeles County
128204	Fee-for-Service	1861433740	1861433740	1	1	GARFIELD BEACH CVS, LLC	5/11/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1479 FOOTHILL BLVD	None	LA VERNE	CA	91750	3451	19	06037	34.11688113	-117.7754654	Los Angeles County
128224	Fee-for-Service	1639495807	1639495807	1	1	GRAFF-BAKER, AMANDA N MD	12/30/2018	2086X0206X	NA	General Surgery	026	PHYSICIANS	141704	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
128232	Fee-for-Service	1285815464	1285815464	1	1	GONZALEZ, WILLIAM LCSW	10/1/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	33030 MISSION TRL	None	WILDOMAR	CA	92595	8423	33	06065	33.64104518	-117.2910774	Riverside County
128240	Fee-for-Service	1346557246	1346557246	1	1	GREEN, DAVID M LCSW	10/19/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1225 MARIN AVE	None	ALBANY	CA	94706	2065	01	06001	37.88749614	-122.2940527	Alameda County
128260	Fee-for-Service	1457659682	1457659682	1	1	GLADIOLUS HOLDINGS LLC	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1040 MARSHALL WAY	None	PLACERVILLE	CA	95667	5607	09	06017	38.72616862	-120.7928905	El Dorado County
128267	Fee-for-Service	1992714257	1992714257	1	1	GARRETT, CARLOS R MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	58607	41	Internal Medicine	0	In state provider	None	16300 ROSCOE BLVD	STE 1A	VAN NUYS	CA	91406	1258	19	06037	34.22128033	-118.4884471	Los Angeles County
128318	Fee-for-Service	1639113905	1639113905	2	1	GARFIELD BEACH CVS, LLC	9/3/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	102 NORTH MAIN ST	None	SANTA ANA	CA	92701	5259	30	06059	33.746058	-117.867668	Orange County
128393	Fee-for-Service	1679963128	1679963128	1	1	GREEN, MEREDITH MD	9/4/2018	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139978	15	Obstetrics (D.O. only)	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
128394	Fee-for-Service	1922652403	1922652403	1	1	GOGOS, ANDREW J MD	9/17/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
128426	Fee-for-Service	1982927729	1982927729	1	2	GOLD, JUNE-ANNE MD	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	109685	40	Pediatrics	0	In state provider	None	11370 ANDERSON STREET	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
128429	Fee-for-Service	1720016439	1720016439	1	1	GUTH, RONALD E MD	1/2/2014	207L00000X	NA	Other	026	PHYSICIANS	44960	05	Anesthesiology	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
128441	Fee-for-Service	1487798534	1487798534	1	1	GAVIA, FERNANDO M MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	98156	05	Anesthesiology	0	In state provider	None	531 W COLLEGE ST	None	LOS ANGELES	CA	90012	2315	19	06037	34.0645892	-118.2391033	Los Angeles County
128479	Fee-for-Service	1376032888	1376032888	1	1	GRECO, JUSTIN M MD	10/1/2024	208C00000X	NA	General Surgery	026	PHYSICIANS	None	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
128486	Fee-for-Service	1174504757	1174504757	2	1	GAINOR, GRETCHEN C MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79066	40	Pediatrics	0	In state provider	CHILDRENS CLNC LA JOLLA	5726 LA JOLLA BLVD	STE 107	LA JOLLA	CA	92037	7342	37	06073	32.81639594	-117.2711804	San Diego County
128487	Fee-for-Service	1669869848	1669869848	1	1	GUPTA, ANKUR S MD	8/14/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	188582	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
128498	Fee-for-Service	1992703706	1992703706	1	1	GIESEKE, TIMOTHY L MD	8/6/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	34398	41	Internal Medicine	0	In state provider	INC	4702 HOEN AVE	None	SANTA ROSA	CA	95405	7824	49	06097	38.441016	-122.664483	Sonoma County
128514	Fee-for-Service	1447825054	1447825054	1	1	GOLDEN PAVILION OPERATIONS	4/8/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	99 ESCUELA DRIVE	None	DALY CITY	CA	94015	4003	41	06081	37.67441047	-122.4762435	San Mateo County
128527	Fee-for-Service	1073055612	1073055612	1	2	GOLDEN STATE URGENT CARE PRO	12/23/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3967 E THOUSAND OAKS BLV	None	THOUSAND OAKS	CA	91362	3628	56	06111	34.16162541	-118.823888	Ventura County
128642	Fee-for-Service	1609898493	1609898493	2	1	GARFIELD BEACH CVS LLC	5/22/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12300 SEAL BEACH BLVD	None	SEAL BEACH	CA	90740	2709	30	06059	33.78303	-118.069389	Orange County
128687	Fee-for-Service	1912037474	1912037474	1	1	GONZALEZ, MARIA E LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
128703	Fee-for-Service	1982091617	1982091617	1	1	GENESIS REFERENCE LABORATORI	8/28/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	ES, LLC	7924 FOREST CITY RD	STE 210	ORLANDO	FL	32810	2925	00	None	28.629108	-81.41516549	Orange County
128714	Fee-for-Service	1982927729	1982927729	1	2	GOLD, JUNE-ANNE MD	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	109685	38	Geriatrics	0	In state provider	None	11370 ANDERSON STREET	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
128739	Fee-for-Service	1255442240	1255442240	1	1	GLINDER, KELLEN MD	8/10/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76166	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
128750	Fee-for-Service	1538174198	1538174198	1	1	GANAN, KEAN S DO	5/8/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	3146	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
128753	Fee-for-Service	1245734268	1245734268	1	1	GORONGA, FAITH MD	7/9/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	173762	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
128759	Fee-for-Service	1295882769	1295882769	1	1	GILL, KULDIP S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61538	41	Internal Medicine	0	In state provider	None	108 CATHERINE LN	STE A	GRASS VALLEY	CA	95945	5701	29	06057	39.23037706	-121.0468239	Nevada County
128769	Fee-for-Service	1144858390	1144858390	1	1	GERMANOS, GEORGE	3/26/2024	207R00000X	NA	Other	026	PHYSICIANS	186747	None	None	0	In state provider	None	100 MISSION BLVD	STE 2800	JACKSON	CA	95642	2536	03	06005	38.35163001	-120.7670107	Amador County
128780	Fee-for-Service	1508217357	1508217357	1	1	GARCIA, CRYSTAL C LCSW	5/23/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23470 OLIVE WOOD PLAZA D	110	MORENO VALLEY	CA	92553	5264	33	06065	33.94013493	-117.2532525	Riverside County
128782	Fee-for-Service	1114313087	1114313087	1	1	GALAN, IGOR MD	4/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134887	25	Physical Medicine and Rehabilitation	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93454	4607	42	06083	34.92484952	-120.4374645	Santa Barbara County
128827	Fee-for-Service	1649201823	1649201823	1	1	GOEL, KRISHAN K MD INC	3/15/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1100 DELBON AVE	None	TURLOCK	CA	95382	2021	50	06099	37.5106124	-120.8356611	Stanislaus County
128833	Fee-for-Service	1740445725	1740445725	1	1	GUNN, PAUL W MD	7/18/2016	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
128838	Fee-for-Service	1801289905	1801289905	1	1	GREENE, DIANNE L LMFT	10/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23480 PARK SORRENTO	209A	CALABASAS	CA	91302	1306	19	06037	34.15596723	-118.6400253	Los Angeles County
128869	Fee-for-Service	1356344170	1356344170	2	1	GARCIA, MARTIN A MD	2/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	35253	24	Plastic Surgery	0	In state provider	None	5451 LA PALMA AVE	STE 32	LA PALMA	CA	90623	1731	30	06059	33.84643146	-118.038843	Orange County
128878	Fee-for-Service	1184124448	1184124448	1	1	GISIN, INNA NP	8/11/2022	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
128902	Fee-for-Service	1003172859	1003172859	1	1	GROVHOUG, CARLY A MD	10/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128377	01	General Practice	0	In state provider	None	111 MAIN STREET	STE B	WINTERS	CA	95694	1930	57	06113	38.52102175	-121.9712187	Yolo County
128932	Fee-for-Service	1780870626	1780870626	1	1	GORHAM, THOMAS P	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52623	-	NOT APPLICABLE	0	In state provider	None	1931 CENTER STREET	None	BERKELEY	CA	94704	1105	01	06001	37.86983853	-122.2717273	Alameda County
128934	Fee-for-Service	1134396419	1134396419	1	1	GARCIA, LISA M MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117050	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
128953	Fee-for-Service	1578977997	1578977997	1	1	GRAVES, CASEY R MD	3/18/2019	207P00000X	NA	Other	026	PHYSICIANS	159798	08	Family Practice	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
128959	Fee-for-Service	1043084965	1043084965	1	1	GATEWAYS HOSPITAL AND MENTAL	1/12/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	AND ADDICTION RECOVERY	1891 EFFIE ST	None	LOS ANGELES	CA	90026	1711	19	06037	34.08461594	-118.2570874	Los Angeles County
128963	Fee-for-Service	1528487725	1528487725	1	1	GEORGE, ANU S MD	10/8/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154068	40	Pediatrics	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
129015	Fee-for-Service	1588714380	1588714380	1	1	GROSS, SUSAN H MD	9/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85535	08	Family Practice	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
129027	Fee-for-Service	1215661608	1215661608	1	1	GILL, ANJENA K MD	8/14/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179804	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
129061	Fee-for-Service	1184649832	1184649832	1	2	GOODMAN, ALLAN H MD INC	1/1/1996	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
129122	Fee-for-Service	1912070673	1912070673	1	1	GAO, ER-KAI MD INC	5/15/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71659	None	None	0	In state provider	None	8851 CENTER DR	STE 603	LA MESA	CA	91942	3063	37	06073	32.78189749	-117.0075062	San Diego County
129232	Fee-for-Service	1376346742	1376346742	1	2	GOLDEN HOUSE RESIDENCE LLC	4/9/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	24 VIA LARGA VIS	None	BONSALL	CA	92003	4021	37	06073	33.2927133	-117.2069779	San Diego County
129242	Fee-for-Service	1578977997	1578977997	1	1	GRAVES, CASEY R MD	3/18/2019	207P00000X	NA	Other	026	PHYSICIANS	159798	66	Emergency Medicine (Urgent Care)	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
129250	Fee-for-Service	1558411579	1558411579	1	1	GOODMAN, SUZANNE L OD	1/31/1986	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5722 TELEPHONE RD	STE 19	VENTURA	CA	93003	5320	56	06111	34.26489851	-119.2152357	Ventura County
129276	Fee-for-Service	1851747455	1851747455	1	1	GRAY, AUDREY MD	11/19/2018	390200000X	NA	Other	026	PHYSICIANS	152356	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
129288	Fee-for-Service	1104976794	1104976794	2	1	GABRIELS CARE HOMES INC	10/19/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2155 W ELM ST	None	LODI	CA	95242	2822	39	06077	38.13629815	-121.3011306	San Joaquin County
129304	Fee-for-Service	1275654824	1275654824	1	1	GAISER, PAUL F PSYD	8/20/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
129327	Fee-for-Service	1093716896	1093716896	1	1	GORDON-BALDRIDGE, KG MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70402	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	# 705A	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
129373	Fee-for-Service	1265565493	1265565493	1	1	GASTON, WINDY R LCSW	9/8/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	29655	-	NOT APPLICABLE	0	In state provider	None	1619 S MANHATTAN PL	None	LOS ANGELES	CA	90019	4702	19	06037	34.04361845	-118.3102001	Los Angeles County
129375	Fee-for-Service	1609149624	1609149624	1	1	GRAIL, CELIA E LMFT	11/17/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50770	-	NOT APPLICABLE	0	In state provider	None	9140 VAN NUYS BLVD	SUITE 211	PANORAMA CITY	CA	91402	6727	19	06037	34.236603	-118.4502215	Los Angeles County
129381	Fee-for-Service	1811032105	1811032105	1	1	GARNER,KATHI	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8268 164TH ST	None	JAMAICA	NY	11432	1121	00	None	40.717917	-73.804086	Queens County
129407	Fee-for-Service	1104969138	1104969138	1	1	GOH, MARK S MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	78713	05	Anesthesiology	0	In state provider	None	1328 22ND STREET	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
129425	Fee-for-Service	1982874897	1982874897	1	1	GARDENA ANESTHESIA	7/16/2008	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL SERVICES INC	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
129432	Fee-for-Service	1922025857	1922025857	1	1	GABRIEL, SAN A MD	8/28/2013	207R00000X	NA	Other	026	PHYSICIANS	95909	None	None	0	In state provider	None	3152 N MILLBROOK AVE	STE C	FRESNO	CA	93703	1459	10	06019	36.779166	-119.7634925	Fresno County
129433	Fee-for-Service	1336626639	1336626639	1	1	GAN, GABRIELLE E OD	5/4/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14550 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	2200	19	06037	34.43539863	-118.39023	Los Angeles County
129448	Fee-for-Service	1316353758	1316353758	1	1	GOLDSTEIN, PHILIP J MD	9/16/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	163042	77	Infectious Disease	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
129504	Fee-for-Service	1316445950	1316445950	1	1	GUTIERREZ, SUSANNE LCSW	1/20/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
129506	Fee-for-Service	1568774073	1568774073	1	1	GAFFNEY, BRENDA L PSYD	4/1/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
129522	Fee-for-Service	1235125337	1235125337	1	1	GOLDBERG, RONALD K MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	65437	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 455	LA MESA	CA	91942	3073	37	06073	32.77978322	-117.0094766	San Diego County
129558	Fee-for-Service	1033131982	1033131982	1	1	GAMIE, SHERIEF H MD	12/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83959	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
129573	Fee-for-Service	1700267960	1700267960	1	1	GOLSHAHI, BAHAR DPM	9/24/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 420	MISSION VIEJO	CA	92691	8038	30	06059	33.56286021	-117.6673449	Orange County
129616	Fee-for-Service	1467523225	1467523225	1	1	GNANARATNEM, JEEVARATHI	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61624	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
129653	Fee-for-Service	1871914291	1871914291	1	1	GRAND GI & ENDOSCOPY GROUP	11/18/2015	261QE0800X	NA	Other	026	PHYSICIANS	92866	10	Gastroenterology (M.D. only)	0	In state provider	INC	505 S VIRGIL AVE	STE 104	LOS ANGELES	CA	90020	1407	19	06037	34.064883	-118.287086	Los Angeles County
129673	Fee-for-Service	1003839390	1003839390	2	1	GARFIELD BEACH CVS LLC	5/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10621 CARMENITA RD	None	SANTA FE SPRINGS	CA	90670	4017	19	06037	33.937686	-118.046607	Los Angeles County
129680	Fee-for-Service	1750356754	1750356754	1	2	GOODWIN, LAWRENCE T JR	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40581	18	Ophthalmology	0	In state provider	None	21840 NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
129705	Fee-for-Service	1164059424	1164059424	1	1	GOMES, CAMILLA MD	6/19/2023	208600000X	NA	General Surgery	026	PHYSICIANS	178529	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
129709	Fee-for-Service	1407105067	1407105067	1	1	GALLEGOS, VALERIE M MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131059	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
129737	Fee-for-Service	1255958476	1255958476	1	1	GOLDEN STATE MEDICAL GROUP	9/15/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4959 PALO VERDE ST	SUITE 206A-5	MONTCLAIR	CA	91763	2342	36	06071	34.08129954	-117.6966135	San Bernardino County
129762	Fee-for-Service	1811937980	1811937980	1	1	GOODMAN, ALEX L MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	77226	05	Anesthesiology	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
129765	Fee-for-Service	1598966186	1598966186	1	1	GUR, ILIA MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107317	02	General Surgery	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
129781	Fee-for-Service	1376655936	1376655936	1	1	GILMAN, JEFFREY W MD	12/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 SEVENTH AVE	None	FORT WORTH	TX	76104	0000	00	None	32.73710364	-97.3419336	Tarrant County
129810	Fee-for-Service	1235125337	1235125337	1	1	GOLDBERG, RONALD K MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	65437	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 455	LA MESA	CA	91942	3073	37	06073	32.77978322	-117.0094766	San Diego County
129863	Fee-for-Service	1285642264	1285642264	1	1	GOODWEIN, SHELLEY N MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	71790	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
129874	Fee-for-Service	1568521201	1568521201	1	1	GARDNER, IMANI W MD	3/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95108	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
129901	Fee-for-Service	1124278437	1124278437	2	1	GARFIELD BEACH CVS LLC	5/30/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1415 MAIN ST	None	WATSONVILLE	CA	95076	3755	44	06087	36.914958	-121.7741895	Santa Cruz County
129903	Fee-for-Service	1467523225	1467523225	1	1	GNANARATNEM, JEEVARATHI	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61624	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
129921	Fee-for-Service	1225012750	1225012750	1	1	GO, VERA S MD	6/11/2008	207R00000X	NA	Other	026	PHYSICIANS	88736	77	Infectious Disease	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
129933	Fee-for-Service	1275054728	1275054728	1	1	GARABET DIRAMERIAN, LIZA MD	9/16/2020	207LC0200X	NA	Other	026	PHYSICIANS	165982	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
129967	Fee-for-Service	1750356754	1750356754	1	2	GOODWIN, LAWRENCE T JR	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40581	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
129971	Fee-for-Service	1508020009	1508020009	1	1	GHOSH, DIPANKAR DO	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	10082	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
129984	Fee-for-Service	1568526952	1568526952	1	1	GRAHAM, TERESA R MD	2/7/1996	207W00000X	NA	Ophthalmology	026	PHYSICIANS	-	18	Ophthalmology	1	Border provider	None	1000 PINE ST	None	KLAMATH FALLS	OR	97601	5899	00	None	42.22773409	-121.78051	Klamath County
129985	Fee-for-Service	1033555453	1033555453	1	1	GU, PAYAL K MD	7/17/2019	2084N0402X	NA	Neurology	026	PHYSICIANS	155723	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
130006	Fee-for-Service	1689748790	1689748790	1	1	GAREY DIALYSIS CENTER	1/6/1987	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	150 E ARROW HWY	None	POMONA	CA	91767	2104	19	06037	34.0898731	-117.7480418	Los Angeles County
130104	Fee-for-Service	1811997877	1811997877	1	1	GOLKAR, LINDA MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86257	07	Dermatology	0	In state provider	None	11370 ANDERSON ST	STE 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
130119	Fee-for-Service	1598832172	1598832172	1	1	GERICARE PODIATRY GROUP	11/30/1990	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
130156	Fee-for-Service	1932578028	1932578028	1	3	GASTROINTESTINAL AND LIVER C	2/16/2023	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	ONSULTANTS, INC.	710 EUCLID ST	210	ANAHEIM	CA	92801	4122	30	06059	33.8420837	-117.9415765	Orange County
130175	Fee-for-Service	1619903713	1619903713	1	1	GARCIA, ADA K MD	6/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103978	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
130194	Fee-for-Service	1598788523	1598788523	1	1	GUY J CONNELL MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
130215	Fee-for-Service	1568913937	1568913937	1	1	GARFIELD BEACH CVS LLC	5/5/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11900 BALBOA BLVD	None	GRANADA HILLS	CA	91344	2755	19	06037	34.28647789	-118.5020317	Los Angeles County
130270	Fee-for-Service	1366422131	1366422131	1	1	GUANGMING GUO	10/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 S CRISMON RD	None	MESA	AZ	85209	3767	00	None	33.391494	-111.611862	Maricopa County
130280	Fee-for-Service	1043519531	1043519531	1	1	GHEVARIYA, VISHAL D MD	6/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123392	10	Gastroenterology (M.D. only)	0	In state provider	None	19845 LAKE CHABOT RD	STE 104	CASTRO VALLEY	CA	94546	4055	01	06001	37.69995352	-122.087795	Alameda County
130397	Fee-for-Service	1639949340	1639949340	1	1	GALEN INPATIENT PHYSICIANS P	3/5/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1100 MAGELLAN DR	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
130408	Fee-for-Service	1114656204	1114656204	1	1	GHANDOUR, JIHAD MD	7/22/2022	207R00000X	NA	Other	026	PHYSICIANS	55880	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
130473	Fee-for-Service	1457577751	1457577751	1	1	GURLEY, DAVID R MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56074	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT ROAD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
130478	Fee-for-Service	1851620041	1851620041	1	1	GILLESPIE, BETTY M LMFT	6/30/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1523 LONGBRANCH AVE	None	GROVER BEACH	CA	93433	2508	40	06079	35.11917729	-120.6126498	San Luis Obispo County
130488	Fee-for-Service	1104004258	1104004258	1	1	GELBERG, ANNA MD	5/11/2010	390200000X	NA	Other	026	PHYSICIANS	105308	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
130529	Fee-for-Service	1336169283	1336169283	1	1	GANCHAN, RICHARD P MD	7/14/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	85 KIRMAN AVE	STE 202	RENO	NV	89502	1341	00	None	39.52624763	-119.7984127	Washoe County
130580	Fee-for-Service	1740290709	1740290709	1	2	GRIFFIN, WILLIAM L MD	6/8/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	38967	None	None	0	In state provider	. MD	6181 N THESTA ST	SUITE 101	FRESNO	CA	93710	8604	10	06019	36.826191	-119.7831295	Fresno County
130653	Fee-for-Service	1134563372	1134563372	1	1	GREENWALD, DAVID T MD	9/10/2021	208800000X	NA	Other	026	PHYSICIANS	172235	None	None	0	In state provider	None	2911 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98821335	-121.978125	Santa Cruz County
130677	Fee-for-Service	1629835301	1629835301	1	1	GOURGY, ANNE S RCP	9/3/2024	2279C0205X	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
130687	Fee-for-Service	1639949340	1639949340	1	1	GALEN INPATIENT PHYSICIANS P	3/5/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1100 MAGELLAN DR	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
130691	Fee-for-Service	1699063719	1699063719	1	1	GENDREAU, ANDREEA M LMFT	1/8/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	88183	-	NOT APPLICABLE	0	In state provider	None	5190 ATLANTIC AVE	None	LONG BEACH	CA	90805	6510	19	06037	33.850449	-118.1848215	Los Angeles County
130700	Fee-for-Service	1316259724	1316259724	1	1	GOLLAPUDI, SAI N MD	1/28/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145189	None	None	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
130746	Fee-for-Service	1255674495	1255674495	1	1	GRIFFITH, QYANA K MD	3/23/2023	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	134168	-	NOT APPLICABLE	0	In state provider	None	2910 H STREET	SUITES 106,109,112,205	EUREKA	CA	95501	4408	12	06023	40.78177748	-124.1613638	Humboldt County
130749	Fee-for-Service	1831114800	1831114800	1	1	GALE, IAN A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	20767	34	Urology and Urological Surgery	0	In state provider	None	7301 MEDICAL CENTER DR	None	CANOGA PARK	CA	91307	1904	19	06037	34.20285756	-118.6294575	Los Angeles County
130769	Fee-for-Service	1366633638	1366633638	1	1	GEORGE L MEE MEM HOSP	11/3/1999	261QR1300X	NA	Rural Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CLINIC	467 EL CAMINO REAL	None	GREENFIELD	CA	93927	4915	27	06053	36.32573265	-121.2475971	Monterey County
130777	Fee-for-Service	1699797381	1699797381	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 SARATOGA AVE	STE 601	SAN JOSE	CA	95129	5101	43	06085	37.29354596	-121.9898068	Santa Clara County
130794	Fee-for-Service	1932397601	1932397601	1	1	GILL, KULDIP MD PC	8/2/2016	193400000X	NA	Other	026	PHYSICIANS	61538	41	Internal Medicine	0	In state provider	None	280 SIERRA COLLEGE DR	SUITE 205	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
130815	Fee-for-Service	1346461332	1346461332	1	1	GOVINDARAJAN, GOPAL MD INC	3/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30202	41	Internal Medicine	0	In state provider	None	1640 W 3RD STREET	None	LOS ANGELES	CA	90017	1102	19	06037	34.06044834	-118.2669485	Los Angeles County
130825	Fee-for-Service	1225049257	1225049257	1	1	GALLO, JOHN L MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36010	40	Pediatrics	0	In state provider	None	895 SEQUOIA CIR	None	FORT BRAGG	CA	95437	5422	23	06045	39.4300159	-123.8024883	Mendocino County
130854	Fee-for-Service	1356554356	1356554356	1	1	GILL, JASMEET K MD	8/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99494	40	Pediatrics	0	In state provider	None	2750 E WASHINGTON BLVD	STE 360	PASADENA	CA	91107	6203	19	06037	34.1680038	-118.0943955	Los Angeles County
130921	Fee-for-Service	1790728137	1790728137	1	1	GOTTSCHALK, ALEXANDER MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64899	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
130927	Fee-for-Service	1245488246	1245488246	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3308 N DINUBA BLVD	None	VISALIA	CA	93291	8718	54	06107	36.358884	-119.2951845	Tulare County
131017	Fee-for-Service	1164433413	1164433413	1	1	GHISELLI, ROBERT W.	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70255	22	Pathology (M.D. only)	0	In state provider	None	COUNTY RD. 99	None	DAVIS	CA	95616	0000	57	06113	38.57575978	-121.7859718	Yolo County
131030	Fee-for-Service	1255674495	1255674495	1	1	GRIFFITH, QYANA K MD	3/16/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	134168	None	None	0	In state provider	None	2910 H STREET	SUITES 106,109,112,205	EUREKA	CA	95501	4408	12	06023	40.78177748	-124.1613638	Humboldt County
131036	Fee-for-Service	1215047469	1215047469	1	1	GULBRANSEN, HAROLD J MD	4/6/2000	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 1	LA MESA	CA	91942	3000	37	06073	32.77978322	-117.0094766	San Diego County
131105	Fee-for-Service	1346461332	1346461332	1	1	GOVINDARAJAN, GOPAL MD INC	3/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30202	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1640 W 3RD STREET	None	LOS ANGELES	CA	90017	1102	19	06037	34.06044834	-118.2669485	Los Angeles County
131124	Fee-for-Service	1639366784	1639366784	1	1	GUTHRIE, TODD B MD APC	5/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	60880	20	Orthopedic Surgery	0	In state provider	None	635 LASSEN LN	None	MOUNT SHASTA	CA	96067	9003	47	06093	41.31928889	-122.3275083	Siskiyou County
131126	Fee-for-Service	1568550176	1568550176	1	1	GENERAL SURGEONS OF LONG	6/25/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	BEACH	1045 ATLANTIC AVE	SUITE 712	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
131140	Fee-for-Service	1457435430	1457435430	1	1	GUERRY, THOMAS L MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47233	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
131155	Fee-for-Service	1861428567	1861428567	1	2	GENTIVA CERTIFIED HEALTHCARE	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CORP	805 AEROVISTA PLACE	SUITE 204	SAN LUIS OBISPO	CA	93401	7920	40	06079	35.24101691	-120.643055	San Luis Obispo County
131224	Fee-for-Service	1245278506	1245278506	1	1	GREKIN, ROY C MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	51012	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	# 316	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
131239	Fee-for-Service	1265923189	1265923189	1	1	GOODRUM, JASON MD	8/1/2023	390200000X	NA	Other	026	PHYSICIANS	185155	None	None	0	In state provider	None	1139 THIRD STREET	None	SOUTH LAKE TAHOE	CA	96150	3465	09	06017	38.91323462	-119.9965999	El Dorado County
131267	Fee-for-Service	1467764605	1467764605	1	1	GOUNDAN, POORANI N	10/15/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	141805	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
131284	Fee-for-Service	1811198906	1811198906	1	1	GROSSO, GEORGE J PHD	2/8/2015	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	24100 SORREL CT	None	TEHACHAPI	CA	93561	7268	15	06029	35.17075138	-118.6207423	Kern County
131307	Fee-for-Service	1427657402	1427657402	1	1	GEMS HOSPICE AND PALLIATIVE	2/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	315 ARDEN AVE	STE 02	GLENDALE	CA	91203	1164	19	06037	34.15852735	-118.2587759	Los Angeles County
131322	Fee-for-Service	1063154631	1063154631	1	1	GILL, CYNTHIA CNP	10/11/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
131333	Fee-for-Service	1295012235	1295012235	1	1	GAMBOA, CRISTINA MD	9/26/2014	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	118272	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	45 NIELSEN STREET	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7925859	Santa Cruz County
131354	Fee-for-Service	1306018692	1306018692	1	1	GUINTU, RODELIO C MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92216	30	Radiology	0	In state provider	None	3001 SILLECT AVE	None	SAN DIEGO	CA	92123	2701	37	06073	0	0	None
131375	Fee-for-Service	1588283279	1588283279	1	1	GENOA HEALTHCARE, LLC	7/8/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11721 EAST TELEGRAPH ROA	UNIT I	SANTA FE SPRINGS	CA	90670	6833	19	06037	33.94629336	-118.0832752	Los Angeles County
131399	Fee-for-Service	1558629493	1558629493	1	1	GAHAGAN, JOHN V MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126753	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
131471	Fee-for-Service	1194940171	1194940171	1	1	GARBEFF, PETER J MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	46827	34	Urology and Urological Surgery	0	In state provider	None	534 E MAPLE ST	None	STOCKTON	CA	95204	6112	39	06077	37.96948196	-121.28765	San Joaquin County
131479	Fee-for-Service	1780605097	1780605097	1	1	GOLDYN, LAWRENCE M MD	9/30/1989	207R00000X	NA	Other	026	PHYSICIANS	67575	01	General Practice	0	In state provider	None	2300 CALIFORNIA ST	STE 306	SAN FRANCISCO	CA	94115	2754	38	06075	37.78910083	-122.4323944	San Francisco County
131507	Fee-for-Service	1538734603	1538734603	1	1	GROTE, LORNA ANNE	6/8/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1215 EUREKA AVE	None	DAVIS	CA	95616	1924	57	06113	38.5545722	-121.750116	Yolo County
131512	Fee-for-Service	1720308612	1720308612	1	1	GINESTA, ARLENNE MD	6/22/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	124266	-	NOT APPLICABLE	0	In state provider	None	40925 COUNTY CENTER DR	SUITE 100 AND 200	TEMECULA	CA	92591	6037	33	06065	33.52802214	-117.1605544	Riverside County
131552	Fee-for-Service	1104283423	1104283423	1	1	GVK ASSOCIATES INC	5/19/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7461 VISTA DEL MONTE AVE	None	VAN NUYS	CA	91405	1950	19	06037	34.20628407	-118.450515	Los Angeles County
131568	Fee-for-Service	1760011597	1760011597	1	1	GRIMES, ANDREW T MD	7/31/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
131592	Fee-for-Service	1528647302	1528647302	1	1	GIAP, BOSCO MD	9/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
131594	Fee-for-Service	1427657402	1427657402	1	1	GEMS HOSPICE AND PALLIATIVE	2/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	315 ARDEN AVE	STE 02	GLENDALE	CA	91203	1164	19	06037	34.15852735	-118.2587759	Los Angeles County
131667	Fee-for-Service	1942793732	1942793732	1	1	GILL, HARKIRAN K DO	10/22/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18939	None	None	0	In state provider	None	14135 MAIN ST	301	HESPERIA	CA	92345	8092	36	06071	34.42669852	-117.354483	San Bernardino County
131673	Fee-for-Service	1275995649	1275995649	1	1	GOLDBERG, ROBERT MD	4/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151573	None	None	0	In state provider	None	1730 COLLEGE AVE	None	DINUBA	CA	93618	2812	54	06107	36.53059064	-119.3858421	Tulare County
131702	Fee-for-Service	1144309261	1144309261	1	1	GILLESPIE, THOMAS 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	222 W THOMAS RD	STE 300	PHOENIX	AZ	85013	4422	00	None	33.480558	-112.077027	Maricopa County
131728	Fee-for-Service	1518385087	1518385087	1	1	GILYARD, SARAH M MD	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138086	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
131787	Fee-for-Service	1275699456	1275699456	1	1	GARCIA-BLAKE, GLORIA I	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
131795	Fee-for-Service	1538734603	1538734603	1	1	GROTE, LORNA ANNE	6/8/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1215 EUREKA AVE	None	DAVIS	CA	95616	1924	57	06113	38.5545722	-121.750116	Yolo County
131816	Fee-for-Service	1821308149	1821308149	1	1	GANDHI, SAMITA MD	5/5/2014	2084P0800X	NA	Psychiatry	026	PHYSICIANS	112368	36	Psychiatry	0	In state provider	None	7400 24TH STREET	None	SACRAMENTO	CA	95822	5350	34	06067	38.489436	-121.481172	Sacramento County
131818	Fee-for-Service	1861725988	1861725988	1	1	GARING, APRIL LOURDES A MD	9/1/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	172329	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
131821	Fee-for-Service	1912929019	1912929019	1	1	GIANGIACOMO, ANNETTE MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91112	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
131824	Fee-for-Service	1386858751	1386858751	1	1	GARCIA, LUIS J MD	1/23/2022	208600000X	NA	General Surgery	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
131845	Fee-for-Service	1124470547	1124470547	1	1	GOMEZ, LINA MD	1/12/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167503	None	None	0	In state provider	None	7237 E SOUTHGATE DR	STE A	SACRAMENTO	CA	95823	2631	34	06067	38.494629	-121.435686	Sacramento County
131857	Fee-for-Service	1760011597	1760011597	1	1	GRIMES, ANDREW T MD	7/31/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
131891	Fee-for-Service	1114376209	1114376209	1	1	GUPTA, VISHAL DO	4/26/2023	390200000X	NA	Other	026	PHYSICIANS	19840	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
131921	Fee-for-Service	1568474757	1568474757	1	1	GILBERT, WILLARD V MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34625	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
131981	Fee-for-Service	1730121369	1730121369	1	1	GASIOR, BARBARA L MD	2/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	62884	05	Anesthesiology	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06287152	-118.2029433	Los Angeles County
131984	Fee-for-Service	1508171786	1508171786	1	1	GOLDEN CARE PHARMACY INC	2/25/2019	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4128 S BROADWAY	None	LOS ANGELES	CA	90037	2221	19	06037	34.008525	-118.2783445	Los Angeles County
131991	Fee-for-Service	1780154872	1780154872	1	1	GIGANTE, NEMARCO P RCP	7/10/2020	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
132016	Fee-for-Service	1093133738	1093133738	1	1	GORUKANTI, KAVYA MD	3/14/2022	208M00000X	NA	Other	026	PHYSICIANS	173227	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
132039	Fee-for-Service	1477598472	1477598472	1	1	GARFIELD BEACH CVS, LLC	1/31/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1401 S BALDWIN	None	ARCADIA	CA	91006	2021	19	06037	34.1236254	-118.0551738	Los Angeles County
132055	Fee-for-Service	1346262037	1346262037	2	1	GARFIELD BEACH CVS LLC	1/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5740 N BLACKSTONE AVE	None	FRESNO	CA	93710	5006	10	06019	36.821691	-119.7878535	Fresno County
132056	Fee-for-Service	1720368665	1720368665	1	1	GREENSTEIN, YANINA MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116499	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
132067	Fee-for-Service	1073654232	1073654232	1	1	GOLDEN GATE RADIOLOGY	3/20/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
132092	Fee-for-Service	1033297536	1033297536	1	1	GILBERT, DAVID D MD	4/29/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	90202	18	Ophthalmology	0	In state provider	None	112 LA CASA VIA	# 2060	WALNUT CREEK	CA	94598	3068	07	06013	37.91229899	-122.0423696	Contra Costa County
132100	Fee-for-Service	1861445348	1861445348	1	1	GARMANGER, KIRK K. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGIC MED SERV PC	500 E. MARKET ST	None	IOWA CITY	IA	52245	0000	00	None	41.664114	-91.5284205	Johnson County
132126	Fee-for-Service	1669830568	1669830568	1	1	GARFIELD BEACH CVS LLC	6/14/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6201 HOLLYWOOD BLVD	STE 126	LOS ANGELES	CA	90028	5363	19	06037	34.10167805	-118.3247423	Los Angeles County
132131	Fee-for-Service	1336305309	1336305309	1	1	GREENWOOD, HEATHER I MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125033	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
132226	Fee-for-Service	1407994429	1407994429	1	1	GIBBS, IRIS C MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61589	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
132248	Fee-for-Service	1457712184	1457712184	1	1	GARCIA, ANDRES H LCSW	11/29/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
132308	Fee-for-Service	1679576607	1679576607	1	1	GENESIS HOME HEALTH INC	2/18/1994	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1687 ERRINGER ROAD	SUITE 202	SIMI VALLEY	CA	93065	6509	56	06111	34.268886	-118.761426	Ventura County
132380	Fee-for-Service	1790838480	1790838480	1	1	GUZMAN-BERBANO, CLAIRE	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
132387	Fee-for-Service	1578635223	1578635223	1	1	GREEN, CHERYL E MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79677	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
132395	Fee-for-Service	1740226703	1740226703	1	1	GATH, SHELLEY DPM	11/5/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	550 W DUARTE RD STE 5	None	ARCADIA	CA	91007	7365	19	06037	34.12657349	-118.0511514	Los Angeles County
132467	Fee-for-Service	1548897903	1548897903	1	1	GOUBERT, RONALD P MD	6/30/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
132495	Fee-for-Service	1366436917	1366436917	1	2	GUERRIERI, DENNIS J OD	1/28/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	231 C STREET	None	DAVIS	CA	95616	4521	57	06113	38.54382636	-121.7435602	Yolo County
132512	Fee-for-Service	1700084860	1700084860	1	1	GILMARTIN, MATTHEW A MD	8/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93851	08	Family Practice	0	In state provider	None	1286 NOE STREET	None	SAN FRANCISCO	CA	94114	3720	38	06075	37.74843471	-122.4315925	San Francisco County
132513	Fee-for-Service	1407994429	1407994429	1	1	GIBBS, IRIS C MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61589	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
132634	Fee-for-Service	1023147717	1023147717	1	1	GUERRERO, DAVID A MD	9/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61755	01	General Practice	0	In state provider	COMPTON FAMILY MEDICAL C	2210 E COMPTON BLVD	None	COMPTON	CA	90221	3556	19	06037	33.89606807	-118.1991683	Los Angeles County
132724	Fee-for-Service	1861404535	1861404535	1	1	GHODSIAN, SHAHROUZ Y	2/23/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	82527	45	Nephrology (Renal-Kidney)	0	In state provider	None	432 E 10TH STREET	None	LONG BEACH	CA	90813	4424	19	06037	33.77896118	-118.186862	Los Angeles County
132747	Fee-for-Service	1346766128	1346766128	1	1	GUARDIAN FLIGHT LLC	8/15/2021	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	607 AIRPORT DR	None	SITKA	AK	99835	9436	00	None	57.05362001	-135.36527	City and Borough of Sitka
132750	Fee-for-Service	1932264801	1932264801	1	1	GURTCH, TIM MD INC	2/10/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	835 3RD AVE	STE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
132757	Fee-for-Service	1578859757	1578859757	1	1	GANDHIR, GARIMA DO	10/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13362	41	Internal Medicine	0	In state provider	None	2220 GLADSTONE DRIVE	SUITE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
132785	Fee-for-Service	1033668223	1033668223	1	1	GONZALEZ, ARIANNA LMFT	3/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
132794	Fee-for-Service	1528123692	1528123692	1	1	GORDON, AMY S MD	4/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	67379	01	General Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	4633	07	06013	38.00771973	-122.1331484	Contra Costa County
132798	Fee-for-Service	1851456727	1851456727	1	1	GHARIB, NEGAR B OD	10/16/2017	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16542 VENTURA BLVD	STE 115	ENCINO	CA	91436	4590	19	06037	34.15773086	-118.493868	Los Angeles County
132799	Fee-for-Service	1891324315	1891324315	1	1	GONZALEZ CARDONA, JAIME JOSE	7/17/2023	208M00000X	NA	Other	026	PHYSICIANS	185578	None	None	0	In state provider	MD	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
132816	Fee-for-Service	1285252049	1285252049	1	1	GABRIELLE HOSPICE CARE INC	8/18/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	238 S ORANGE AVE	SUITE 201	BREA	CA	92821	4997	30	06059	33.91656831	-117.8989031	Orange County
132821	Fee-for-Service	1932385747	1932385747	1	1	GROSSMONT SPRING VALLEY	2/1/1999	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	FAMILY HEALTH CTR	8788 JAMACHA RD	None	SPRING VALLEY	CA	91977	4035	37	06073	32.71482507	-117.0098243	San Diego County
132824	Fee-for-Service	1477713048	1477713048	1	3	GOBER, BRIANNE C MD	8/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145392	None	None	0	In state provider	None	235 NUTMEG ST	None	SAN DIEGO	CA	92103	6201	37	06073	32.7334185	-117.1627515	San Diego County
132857	Fee-for-Service	1962555045	1962555045	1	1	GALT JOINT UNION ELEM SD	4/24/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1018 C ST	STE 210	GALT	CA	95632	1733	34	06067	38.252565	-121.297671	Sacramento County
132911	Fee-for-Service	1043528979	1043528979	1	1	GALINA QUINTERO, DORIS S MD	10/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129475	45	Nephrology (Renal-Kidney)	0	In state provider	None	2222 EAST ST	STE 305	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
132918	Fee-for-Service	1932578028	1932578028	1	1	GASTROINTESTINAL AND LIVER C	1/27/2020	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	ONSULTANTS, INC.	2621 S BRISTOL ST	202	SANTA ANA	CA	92704	5766	30	06059	33.711876	-117.885371	Orange County
132924	Fee-for-Service	1023147717	1023147717	1	1	GUERRERO, DAVID A MD	9/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61755	08	Family Practice	0	In state provider	COMPTON FAMILY MEDICAL C	2210 E COMPTON BLVD	None	COMPTON	CA	90221	3556	19	06037	33.89606807	-118.1991683	Los Angeles County
132927	Fee-for-Service	1003993247	1003993247	1	1	GREENBERG, JAMES Y MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55519	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	2299 POST ST	STE 205	SAN FRANCISCO	CA	94115	3473	38	06075	37.78434298	-122.4392033	San Francisco County
132931	Fee-for-Service	1578951745	1578951745	1	1	GOODARZI BABHADI, AMIR H MD	7/14/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	140838	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
132933	Fee-for-Service	1255067856	1255067856	1	1	GATES, KIERSTYN NP	11/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
132949	Fee-for-Service	1598773582	1598773582	1	1	GRANNIS, FREDERIC W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36693	02	General Surgery	0	In state provider	None	612 W DUARTE RD	STE 603	ARCADIA	CA	91007	9242	19	06037	34.12647805	-118.051994	Los Angeles County
132983	Fee-for-Service	1417122292	1417122292	1	1	GRASSLE, LISA V LMFT	8/30/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 MILLER ST	121	SANTA MARIA	CA	93454	5205	42	06083	34.950501	-120.431509	Santa Barbara County
133007	Fee-for-Service	1629497797	1629497797	1	1	GOLSHANI, GOL M MD	1/26/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	170977	None	None	0	In state provider	None	3300 E SOUTH ST	STE 304	LONG BEACH	CA	90805	4549	19	06037	33.86018093	-118.1537163	Los Angeles County
133012	Fee-for-Service	1861404535	1861404535	1	1	GHODSIAN, SHAHROUZ Y	2/23/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	82527	41	Internal Medicine	0	In state provider	None	432 E 10TH STREET	None	LONG BEACH	CA	90813	4424	19	06037	33.77896118	-118.186862	Los Angeles County
133024	Fee-for-Service	1104269992	1104269992	1	1	GALLAGHER-ZATE, HOLLIE DO	11/22/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	21698	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
133027	Fee-for-Service	1033884473	1033884473	1	1	GREY PINE HOLDINGS, LLC	7/29/2022	314000000X	NA	Skilled Nursing Facility	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2765 MITCHELL DR	None	WALNUT CREEK	CA	94598	1601	07	06013	37.92969934	-122.0239134	Contra Costa County
133030	Fee-for-Service	1417959370	1417959370	1	1	GARCIA, CARLOS M MD	9/10/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42509	40	Pediatrics	0	In state provider	None	1392 E PALOMAR ST	STE 501	CHULA VISTA	CA	91913	1895	37	06073	32.62360793	-116.9969964	San Diego County
133090	Fee-for-Service	1841466471	1841466471	1	1	GARG, ANUJA MD	10/16/2023	207R00000X	NA	Other	026	PHYSICIANS	108416	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
133107	Fee-for-Service	1285252049	1285252049	1	1	GABRIELLE HOSPICE CARE INC	8/18/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	238 S ORANGE AVE	SUITE 201	BREA	CA	92821	4997	30	06059	33.91656831	-117.8989031	Orange County
133108	Fee-for-Service	1285403915	1285403915	1	1	GALEN INPATIENT PHYSICIANS P	3/5/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
133117	Fee-for-Service	1023044310	1023044310	1	1	GAUTHIER, LAURA A LCSW	7/30/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1230 HIGH ST	STE 121	AUBURN	CA	95603	5044	31	06061	38.89478358	-121.0744248	Placer County
133136	Fee-for-Service	1518980838	1518980838	2	1	GARFIELD BEACH CVS LLC	7/3/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20200 BLOOMFIELD AVE	None	CERRITOS	CA	90703	7821	19	06037	33.84689633	-118.0633624	Los Angeles County
133137	Fee-for-Service	1184669087	1184669087	1	1	GARFIELD BEACH CVS, LLC	12/28/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2900 SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
133235	Fee-for-Service	1598773582	1598773582	1	1	GRANNIS, FREDERIC W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36693	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	612 W DUARTE RD	STE 603	ARCADIA	CA	91007	9242	19	06037	34.12647805	-118.051994	Los Angeles County
133253	Fee-for-Service	1477641967	1477641967	1	1	GARLAPATI, ANITHA R MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83701	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
133271	Fee-for-Service	1235366337	1235366337	1	1	GREEN, JENNIFER S MD	5/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108240	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
133279	Fee-for-Service	1922414986	1922414986	1	1	GAL, LAURA CRNA	10/12/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
133317	Fee-for-Service	1528074812	1528074812	1	1	GOLCHINI, KEIVAN MD	4/30/1994	207R00000X	NA	Other	026	PHYSICIANS	48800	41	Internal Medicine	0	In state provider	None	9100 WILSHIRE BLVD	STE 245	BEVERLY HILLS	CA	90212	3401	19	06037	34.06703047	-118.390212	Los Angeles County
133320	Fee-for-Service	1417959370	1417959370	1	1	GARCIA, CARLOS M MD	9/10/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42509	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1392 E PALOMAR ST	STE 501	CHULA VISTA	CA	91913	1895	37	06073	32.62360793	-116.9969964	San Diego County
133374	Fee-for-Service	1225178759	1225178759	1	1	GERBER, ERIC W MD	1/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97148	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
133381	Fee-for-Service	1740060466	1740060466	1	1	GRANT, PERRIETTE DOULA	10/16/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
133398	Fee-for-Service	1285403915	1285403915	1	1	GALEN INPATIENT PHYSICIANS P	3/5/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
133428	Fee-for-Service	1629380308	1629380308	1	1	GULATI, ABHISHEK MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146063	10	Gastroenterology (M.D. only)	0	In state provider	None	290 N WAYTE LN	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
133429	Fee-for-Service	1659391894	1659391894	1	1	GRABOW, REED M MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84761	None	None	0	In state provider	None	410 N TAYLOR ST	None	WEAVERVILLE	CA	96093	0000	53	06105	40.74021082	-122.9387157	Trinity County
133438	Fee-for-Service	1740623834	1740623834	1	1	GOODRICH, DANIELLE E MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131886	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
133453	Fee-for-Service	1124051545	1124051545	1	1	GRANDONE, CHERYL 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	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
133498	Fee-for-Service	1841215613	1841215613	1	1	GRANT, SOPHIA R MD	5/13/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66209	40	Pediatrics	0	In state provider	None	11631 VICTORY BLVD	STE 101	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
133523	Fee-for-Service	1598773582	1598773582	1	1	GRANNIS, FREDERIC W MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36693	33	Thoracic Surgery	0	In state provider	None	612 W DUARTE RD	STE 603	ARCADIA	CA	91007	9242	19	06037	34.12647805	-118.051994	Los Angeles County
133541	Fee-for-Service	1134286362	1134286362	1	1	GREENFIELD UNION SCH DIST	8/1/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	493 EL CAMINO REAL	None	GREENFIELD	CA	93927	4915	27	06053	36.32616423	-121.2479503	Monterey County
133557	Fee-for-Service	1235647728	1235647728	1	1	GOODMAN, CAROLYN NP	4/3/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11800 WILSHIRE BLVD	None	LOS ANGELES	CA	90025	6606	19	06037	34.0475456	-118.4632671	Los Angeles County
133606	Fee-for-Service	1528074812	1528074812	1	1	GOLCHINI, KEIVAN MD	4/30/1994	207R00000X	NA	Other	026	PHYSICIANS	48800	10	Gastroenterology (M.D. only)	0	In state provider	None	9100 WILSHIRE BLVD	STE 245	BEVERLY HILLS	CA	90212	3401	19	06037	34.06703047	-118.390212	Los Angeles County
133607	Fee-for-Service	1417959370	1417959370	1	1	GARCIA, CARLOS M MD	9/10/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42509	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1392 E PALOMAR ST	STE 501	CHULA VISTA	CA	91913	1895	37	06073	32.62360793	-116.9969964	San Diego County
133617	Fee-for-Service	1083895379	1083895379	2	1	GARCIA-ROJAS, XAVIER MD	1/21/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	153827	None	None	0	In state provider	None	12602 AMARGOSA RD	STE F	VICTORVILLE	CA	92392	7640	36	06071	34.47936072	-117.3397257	San Bernardino County
133618	Fee-for-Service	1578580445	1578580445	1	1	GREWALL, PAM K MD	8/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78443	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
133651	Fee-for-Service	1699326835	1699326835	1	1	GONZALEZ, SONYA R	3/5/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	5293 PROSPECT RD	STE D	SAN JOSE	CA	95129	5037	43	06085	37.29226153	-121.9955301	Santa Clara County
133660	Fee-for-Service	1578759585	1578759585	1	1	GUERRERO, EMMANUEL J MD	7/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97461	05	Anesthesiology	0	In state provider	None	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
133704	Fee-for-Service	1134460587	1134460587	1	2	GUERRERO, SUSAN J PHD	6/21/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25585	-	NOT APPLICABLE	0	In state provider	None	6666 OWENS DR	None	PLEASANTON	CA	94588	3334	01	06001	37.69743706	-121.9098578	Alameda County
133717	Fee-for-Service	1629380308	1629380308	1	1	GULATI, ABHISHEK MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146063	41	Internal Medicine	0	In state provider	None	290 N WAYTE LN	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
133719	Fee-for-Service	1467895326	1467895326	1	1	GANDHI, KAVITA MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144000	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
133732	Fee-for-Service	1992912810	1992912810	2	1	GARFIELD BEACH CVS LLC	3/2/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1061 COCHRANE RD	None	MORGAN HILL	CA	95037	9305	43	06085	37.157661	-121.654377	Santa Clara County
133754	Fee-for-Service	1639142243	1639142243	1	1	GILBERT, JAMES N MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	52747	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65817286	-121.6460674	Monterey County
133788	Fee-for-Service	1841215613	1841215613	1	1	GRANT, SOPHIA R MD	5/13/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66209	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11631 VICTORY BLVD	STE 101	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
133804	Fee-for-Service	1376824383	1376824383	1	1	GIAMONA, KRISTEN PSYD	4/20/2024	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
133808	Fee-for-Service	1760701767	1760701767	1	1	GAVAZZA, PABLO D MD	7/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102933	05	Anesthesiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
133828	Fee-for-Service	1851785976	1851785976	1	1	GRAY, BRADLEY W MD	11/18/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159315	08	Family Practice	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
133837	Fee-for-Service	1912616657	1912616657	1	1	GENO, MATTHEW E	11/18/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
133838	Fee-for-Service	1457709248	1457709248	1	1	GAYHART, MATTHEW G MD	8/30/2022	207ZP0102X	NA	Other	026	PHYSICIANS	168733	None	None	0	In state provider	None	4500 BROCKTON AVE	STE 317	RIVERSIDE	CA	92501	4028	33	06065	33.97785263	-117.3836152	Riverside County
133843	Fee-for-Service	1083751366	1083751366	1	1	GROSSMAN, JEFFREY W MD	12/13/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	157231	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
133895	Fee-for-Service	1700291804	1700291804	1	1	GARCIA TOME, RODRIGO E MD	3/16/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	155205	None	None	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	19	06037	34.02773198	-118.4862675	Los Angeles County
133897	Fee-for-Service	1215140843	1215140843	1	1	GOLDEN STATE ADULT DAY	4/15/2002	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE, INC	738 LA PLAYA ST	None	SAN FRANCISCO	CA	94121	3262	38	06075	37.77453744	-122.5101139	San Francisco County
133898	Fee-for-Service	1104076785	1104076785	1	1	GROYSMAN, LEONID I MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112765	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
133904	Fee-for-Service	1245783687	1245783687	1	1	GUIDICATTI, KELSEY LMFT	8/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	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
133926	Fee-for-Service	1407287576	1407287576	1	1	GALLANT MEDICAL SUPPLY INC	7/24/2013	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	27740 ENCANTO DR	None	SUN CITY	CA	92586	4521	33	06065	33.71834072	-117.1885492	Riverside County
133938	Fee-for-Service	1851603559	1851603559	1	1	GOODMAN, AARON M MD	7/19/2017	207RH0003X	NA	Oncology	026	PHYSICIANS	130400	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
133962	Fee-for-Service	1891841219	1891841219	1	1	GABBARD, JOHANNA PT	8/24/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2103 E GONZALES RD	None	OXNARD	CA	93030	3757	56	06111	34.2189506	-119.151337	Ventura County
133980	Fee-for-Service	1578049128	1578049128	1	1	GILL, HARMEET K NP	7/13/2021	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
134003	Fee-for-Service	1912193301	1912193301	1	1	GIANFORTUNE, RACHEL M MD	4/15/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	94327	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
134004	Fee-for-Service	1215310750	1215310750	1	1	GETACHEW, RUTH T MD	11/30/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145361	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
134051	Fee-for-Service	1003127242	1003127242	1	1	GROVER, CASEY A MD	2/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117699	41	Internal Medicine	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
134060	Fee-for-Service	1407242373	1407242373	1	1	GARDNER, KEVIN MD	8/1/2018	390200000X	NA	Other	026	PHYSICIANS	147618	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
134111	Fee-for-Service	1275571028	1275571028	1	1	GEISSE, JOHN K MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	58478	07	Dermatology	0	In state provider	None	635 ANDERSON RD	STE 17	DAVIS	CA	95616	3505	57	06113	38.5487623	-121.7587554	Yolo County
134120	Fee-for-Service	1023071404	1023071404	1	1	GIRLING, LOUIS E JR MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	47959	40	Pediatrics	0	In state provider	None	225 CABRILLO HWY S	STE 100A	HALF MOON BAY	CA	94019	1738	41	06081	37.46542425	-122.4337617	San Mateo County
134126	Fee-for-Service	1770568347	1770568347	1	1	GOLDEN VALLEY HEALTH CTR	11/10/2022	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	301 HOWARD RD	None	WESTLEY	CA	95387	0000	50	06099	37.54449453	-121.1984213	Stanislaus County
134131	Fee-for-Service	1780616177	1780616177	1	1	GREENBERG, ARNOLD J MD	2/3/1998	2084N0400X	NA	Neurology	026	PHYSICIANS	53456	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
134149	Fee-for-Service	1871526640	1871526640	1	1	GULUMA, KAMA Z MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75763	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
134186	Fee-for-Service	1124111562	1124111562	1	1	GARLO CORPORATION	11/1/2001	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SO LOW DRUGS	11270 LOS ALAMITOS BLVD	None	LOS ALAMITOS	CA	90720	3958	30	06059	33.798969	-118.071802	Orange County
134226	Fee-for-Service	1194048884	1194048884	1	1	GENESIS CLINICA DE LA MUJER	3/30/2010	193200000X	NA	Other	026	PHYSICIANS	75190	None	None	0	In state provider	INC	244 N JACKSON AVE	STE 209	SAN JOSE	CA	95116	1604	43	06085	37.36405837	-121.8488656	Santa Clara County
134238	Fee-for-Service	1790856680	1790856680	1	1	GUERRERO, MARGARET P NP	2/27/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1188 N EUCLID STREET	None	ANAHEIM	CA	92801	1900	30	06059	33.850314	-117.9416115	Orange County
134250	Fee-for-Service	1922175751	1922175751	1	1	GREEN, DAVID A MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72807	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
134271	Fee-for-Service	1285994491	1285994491	1	1	GONZALEZ, ROBERT S JR LCSW	3/19/2018	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
134312	Fee-for-Service	1982824785	1982824785	1	1	GOLDEN VALLEY HEALTH CTR	11/18/2005	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	127 WEST PORTAL	STE B	MERCED	CA	95348	3137	24	06047	37.32672529	-120.4697151	Merced County
134321	Fee-for-Service	1689101578	1689101578	1	1	GRANDHE, SUNDEEP MD	10/3/2019	390200000X	NA	Other	026	PHYSICIANS	165414	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
134334	Fee-for-Service	1669709929	1669709929	1	1	GILLISPIE, ZOE PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
134384	Fee-for-Service	1215980461	1215980461	1	1	GOULD, RICHARD B MD	11/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131467	10	Gastroenterology (M.D. only)	0	In state provider	None	2702 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23678474	-122.0847463	Solano County
134401	Fee-for-Service	1528083680	1528083680	1	1	GARCIA, MICHAEL A MD	3/25/2008	207RE0101X	NA	Endocrinology	026	PHYSICIANS	76266	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
134407	Fee-for-Service	1023071404	1023071404	1	1	GIRLING, LOUIS E JR MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	47959	01	General Practice	0	In state provider	None	225 CABRILLO HWY S	STE 100A	HALF MOON BAY	CA	94019	1738	41	06081	37.46542425	-122.4337617	San Mateo County
134411	Fee-for-Service	1598847808	1598847808	1	1	GREENE, DAMON MD	10/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82704	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
134413	Fee-for-Service	1447249495	1447249495	1	1	GUPTA, ASHOK K MD	9/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	SUITE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
134418	Fee-for-Service	1780616177	1780616177	1	1	GREENBERG, ARNOLD J MD	2/3/1998	2084N0400X	NA	Neurology	026	PHYSICIANS	53456	13	Neurology (M.D. only)	0	In state provider	None	5810 JAMESON CT	STE 1	CARMICHAEL	CA	95608	0881	34	06067	38.650878	-121.329036	Sacramento County
134429	Fee-for-Service	1417106980	1417106980	1	1	GIRON FRANCO, BLESSY M LCSW	12/26/2014	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16415 S COLORADO AVE	SUITE 305	PARAMOUNT	CA	90723	5053	19	06037	33.8853075	-118.1614695	Los Angeles County
134431	Fee-for-Service	1679538516	1679538516	1	1	GLESER, ROBERT MD	4/22/2020	207R00000X	NA	Other	026	PHYSICIANS	36072	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
134440	Fee-for-Service	1629001078	1629001078	1	1	GOLDKORN, RONEN MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64321	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5301 F ST	STE 117	SACRAMENTO	CA	95819	3220	34	06067	38.571354	-121.4368695	Sacramento County
134469	Fee-for-Service	1265708929	1265708929	1	1	GENDELBERG, DAVID MD	7/19/2021	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	170574	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
134502	Fee-for-Service	1174534358	1174534358	1	1	GLATZER CLIFFORD	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
134512	Fee-for-Service	1154374718	1154374718	1	1	GHANI, MAZEN MD	8/23/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173199	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
134514	Fee-for-Service	1760501894	1760501894	1	1	GILLGRASS, SHEILA SWAN	1/25/2007	163WH0200X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2973 LAWYER DRIVE	None	PLACERVILLE	CA	95667	9058	09	06017	38.78660046	-120.716532	El Dorado County
134526	Fee-for-Service	1730101379	1730101379	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	533 COLEMAN AVE	None	SAN JOSE	CA	95110	2047	43	06085	37.338678	-121.9044375	Santa Clara County
134532	Fee-for-Service	1477753457	1477753457	1	1	GEORGE, AMY MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132099	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
134559	Fee-for-Service	1093746836	1093746836	1	1	GHOBRIAL-SEDKY, KARIM W MD	5/31/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	119201	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
134570	Fee-for-Service	1962439141	1962439141	1	1	GOMEZ-AROSTEGUI, JULIANA	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	76083	40	Pediatrics	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
134573	Fee-for-Service	1134116080	1134116080	1	1	GIBBS, PAUL M MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	72703	22	Pathology (M.D. only)	0	In state provider	None	9888 GENESEE AVE	LJ112	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
134614	Fee-for-Service	1831154418	1831154418	2	1	GUILLERMO, GEMMA G MD	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	61066	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
134642	Fee-for-Service	1023879814	1023879814	1	1	GOATES, SHELBY L BIRTH DOULA	3/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	23	06045	0	0	None
134679	Fee-for-Service	1477728103	1477728103	1	1	GELFAND, AMY A MD	3/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103286	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
134690	Fee-for-Service	1528083680	1528083680	1	1	GARCIA, MICHAEL A MD	3/25/2008	207RE0101X	NA	Endocrinology	026	PHYSICIANS	76266	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
134801	Fee-for-Service	1760501894	1760501894	1	1	GILLGRASS, SHEILA SWAN	1/25/2007	163WH0200X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2973 LAWYER DRIVE	None	PLACERVILLE	CA	95667	9058	09	06017	38.78660046	-120.716532	El Dorado County
134866	Fee-for-Service	1376614131	1376614131	1	1	GOLEMBESKI, DAVID MD	2/28/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63111	40	Pediatrics	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
134911	Fee-for-Service	1932578028	1932578028	1	2	GASTROINTESTINAL AND LIVER C	1/28/2020	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	ONSULTANTS INC.	1400 REYNOLDS AVE	STE 100	IRVINE	CA	92614	5562	30	06059	33.6957272	-117.8542013	Orange County
134978	Fee-for-Service	1871670083	1871670083	1	1	GRANADA HILLS	6/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CONVALESCENT HOSP, INC	16123 CHATSWORTH ST	None	GRANADA HILLS	CA	91344	7045	19	06037	34.26467942	-118.4835917	Los Angeles County
135101	Fee-for-Service	1598720542	1598720542	1	1	GOLDSMITH, DANIEL L MD	1/31/1995	207P00000X	NA	Other	026	PHYSICIANS	54885	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
135143	Fee-for-Service	1306036785	1306036785	1	1	GHATALI, MOHAMMAD A MD	9/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112108	08	Family Practice	0	In state provider	None	43839 15TH ST WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
135152	Fee-for-Service	1801057161	1801057161	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	38019 47TH ST E	None	PALMDALE	CA	93552	3103	19	06037	34.574022	-118.0485135	Los Angeles County
135175	Fee-for-Service	1265866164	1265866164	1	1	GANDHI, CHIRAG H DO	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13566	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
135177	Fee-for-Service	1588668370	1588668370	1	1	GUNLOCK, MICHAEL G MD	5/14/2023	2085R0204X	NA	Other	026	PHYSICIANS	184238	None	None	0	In state provider	None	830 2ND ST	STE A	SANTA ROSA	CA	95404	4620	49	06097	38.440746	-122.7085605	Sonoma County
135183	Fee-for-Service	1316012784	1316012784	1	1	GORDON, MARY E LMFT	6/25/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3 WILLIAMSBURG LANE	None	CHICO	CA	95926	2225	04	06007	39.75207408	-121.856255	Butte County
135191	Fee-for-Service	1467474064	1467474064	2	1	GARFIELD BEACH CVS LLC	11/14/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9725 LAUREL CANYON BLVD	None	ARLETA	CA	91331	4100	19	06037	34.24594726	-118.4185839	Los Angeles County
135214	Fee-for-Service	1578343778	1578343778	1	1	GILL, GIA L MD	10/16/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	186662	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
135238	Fee-for-Service	1699003376	1699003376	1	1	GORDON, WILLIAM PHD	4/14/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7545 IRVINE CENTER DR	STE 200	IRVINE	CA	92618	2933	30	06059	33.662781	-117.75096	Orange County
135295	Fee-for-Service	1285261040	1285261040	1	1	GORTI, ALEKHYA MD	12/27/2023	207R00000X	NA	Other	026	PHYSICIANS	186726	None	None	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
135319	Fee-for-Service	1265716930	1265716930	1	1	GARCIA, SANDRA LCSW	9/18/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	70920	-	NOT APPLICABLE	0	In state provider	None	5850 S MAIN ST	RM 1017,2010,2017, 203	LOS ANGELES	CA	90003	1215	19	06037	33.988536	-118.2739135	Los Angeles County
135344	Fee-for-Service	1366962292	1366962292	1	1	GREWAL, SUNGAT K MD	10/14/2022	207R00000X	NA	Other	026	PHYSICIANS	162721	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
135365	Fee-for-Service	1932142007	1932142007	1	1	GRAYMAN, GLEN MD	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	29724	08	Family Practice	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
135373	Fee-for-Service	1689695124	1689695124	1	1	GARCIA, FRANCISCO A MD	7/19/2011	173000000X	NA	Other	026	PHYSICIANS	38541	18	Ophthalmology	0	In state provider	None	2480 MISSION ST	STE 101	SAN FRANCISCO	CA	94110	2458	38	06075	37.75745685	-122.418984	San Francisco County
135379	Fee-for-Service	1215025242	1215025242	1	1	GILL & BISLA INTERNAL	10/4/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MED ASSOCIATES	151 N SUNRISE AVE	STE 613	ROSEVILLE	CA	95661	2926	31	06061	38.74746043	-121.2655348	Placer County
135398	Fee-for-Service	1215375076	1215375076	1	1	GURBANI, MALA N DO	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14612	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
135402	Fee-for-Service	1477713048	1477713048	1	4	GOBER, BRIANNE C MD	8/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145392	None	None	0	In state provider	None	902 EUCLID	None	NATIONAL CITY	CA	91950	3808	37	06073	32.68175008	-117.0818924	San Diego County
135435	Fee-for-Service	1720018476	1720018476	1	1	GUITERAS, LISA A OT	11/1/2018	225XH1200X	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
135436	Fee-for-Service	1346776234	1346776234	1	1	GALZOTE-CARINO, ROSANNA M MD	11/19/2021	390200000X	NA	Other	026	PHYSICIANS	157347	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
135464	Fee-for-Service	1225611106	1225611106	1	1	GLOVER, GAVIN DPM	6/6/2024	211D00000X	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
135488	Fee-for-Service	1083609101	1083609101	1	1	GIBSON, DUANE P O.D.	10/31/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4 JEAN ST	STE 1	VALLEY SPRINGS	CA	95252	8867	05	06009	38.19022472	-120.8274791	Calaveras County
135516	Fee-for-Service	1578655544	1578655544	1	1	GUERRA, RACHAEL PHD	10/4/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
135532	Fee-for-Service	1306821822	1306821822	1	1	GOULD, JOHN E MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	55692	34	Urology and Urological Surgery	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
135540	Fee-for-Service	1538744925	1538744925	1	1	GOLDEN HEALTH CARDIOLOGY COR	5/21/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	P.	333 MERCY AVE	None	MERCED	CA	95382	2011	24	06047	37.33875148	-120.467457	Merced County
135584	Fee-for-Service	1386733947	1386733947	1	1	GALINDO, JORGE E MD	10/29/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	39465	01	General Practice	0	In state provider	None	222 W EULALIA ST	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
135657	Fee-for-Service	1932142007	1932142007	1	1	GRAYMAN, GLEN MD	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	29724	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
135716	Fee-for-Service	1467257568	1467257568	1	1	GHANEM, MARIAM K NP	3/18/2025	363LP0222X	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
135729	Fee-for-Service	1770918005	1770918005	1	1	GARCIA, RAISA K PHD	10/10/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
135754	Fee-for-Service	1730347154	1730347154	1	1	GONIK, ABBY M MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103136	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
135759	Fee-for-Service	1871593954	1871593954	1	1	GAO, HUA MD	7/1/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	67339	18	Ophthalmology	0	In state provider	None	8833 MONTEREY RD	STE D	GILROY	CA	95020	7200	43	06085	37.02446941	-121.5774161	Santa Clara County
135777	Fee-for-Service	1538198916	1538198916	1	1	GALLAGHER, LILY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL STREET	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
135793	Fee-for-Service	1740579994	1740579994	1	1	GU, WENDY J MD	7/1/2014	390200000X	NA	Other	026	PHYSICIANS	124115	41	Internal Medicine	0	In state provider	None	1850 S AZUSA AVENUE	SUITE 205	HACIENDA HEIGHTS	CA	91745	6853	19	06037	33.98895597	-117.9322797	Los Angeles County
135794	Fee-for-Service	1467467092	1467467092	1	1	GARNER, BRIAN T	12/8/2003	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	HENDRICKS PHARMACY	137 HARVARD AVE	None	CLAREMONT	CA	91711	4717	19	06037	34.09524	-117.716418	Los Angeles County
135809	Fee-for-Service	1053551853	1053551853	1	1	GAUL, JANEEN C NP	8/9/2022	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
135821	Fee-for-Service	1306821822	1306821822	1	1	GOULD, JOHN E MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	55692	70	Clinic (mixed specialty)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
135824	Fee-for-Service	1871528471	1871528471	1	1	GANZ, PATRICIA A MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	27102	None	None	0	In state provider	None	10833 LE CONTE AVE	# 32220	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
135854	Fee-for-Service	1013026848	1013026848	1	1	GARFIELD BEACH CVS LLC	9/12/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	31771 RANCHO CALIFORNIA	None	TEMECULA	CA	92591	2997	33	06065	33.51430726	-117.1040821	Riverside County
135856	Fee-for-Service	1932399441	1932399441	1	1	GUPTA, ARUNA MD APC	7/1/2007	193400000X	NA	Other	026	PHYSICIANS	88415	None	None	0	In state provider	None	6850 BROCKTON AVE	STE 108	RIVERSIDE	CA	92506	3816	33	06065	33.9493261	-117.3967206	Riverside County
135892	Fee-for-Service	1922481829	1922481829	1	1	GABRIEL, NIKKI C 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
135903	Fee-for-Service	1942417670	1942417670	1	1	GEOFFREY JACKSON MCKINZIE, M	5/1/2012	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
135916	Fee-for-Service	1538336482	1538336482	1	1	GIDWANI, NISHA H MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106996	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
135922	Fee-for-Service	1861404535	1861404535	1	2	GHODSIAN, SHAHROUZ Y MD	5/1/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	82527	-	NOT APPLICABLE	0	In state provider	None	11000 WILSHIRE BLVD	None	LOS ANGELES	CA	90024	3601	19	06037	34.05725072	-118.4490984	Los Angeles County
135945	Fee-for-Service	1437310059	1437310059	1	1	GUPTA, SUNIL T DO	8/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	1264	41	Internal Medicine	0	In state provider	None	15 MAREBLU STREET	SUITE 100	ALISO VIEJO	CA	92656	3015	30	06059	33.5729913	-117.703431	Orange County
135969	Fee-for-Service	1619050242	1619050242	2	1	GARFIELD BEACH CVS LLC	11/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	950 GROVELAND LN	None	LINCOLN	CA	95648	7415	31	06061	38.87018849	-121.3025256	Placer County
135976	Fee-for-Service	1659194306	1659194306	1	1	GREENAN, KEARA D	11/13/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
136024	Fee-for-Service	1740509710	1740509710	1	1	GREWAL, KHUSHDEEP K MD	5/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139099	None	None	0	In state provider	None	1165 MONTGOMERY DRIVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
136043	Fee-for-Service	1730347154	1730347154	1	1	GONIK, ABBY M MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103136	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
136047	Fee-for-Service	1033322672	1033322672	1	1	GOLDEN VALLEY HEALTH CTR	7/31/1991	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	WEST MODESTO MEDICAL	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
136053	Fee-for-Service	1518980671	1518980671	1	1	GREEN, DONALD J MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52258	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
136131	Fee-for-Service	1477552958	1477552958	1	1	GABRIELLE ADAMS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SW GASTROENTEROLOGY ASSC	7788 JEFFERSON NE	None	ALBUQUERQUE	NM	87106	0000	00	None	35.17051067	-106.5890655	Bernalillo County
136153	Fee-for-Service	1912925611	1912925611	1	2	GYNECOLOGIC ONCOLOGY	6/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ASSOCIATES	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
136203	Fee-for-Service	1881091551	1881091551	1	1	GILDERSLEEVE, SANDRA S MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129639	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
136204	Fee-for-Service	1538336482	1538336482	1	1	GIDWANI, NISHA H MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106996	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
136251	Fee-for-Service	1710391040	1710391040	1	1	GORDON, BRENT K MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141358	66	Emergency Medicine (Urgent Care)	0	In state provider	None	726 FOURTH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
136264	Fee-for-Service	1013377555	1013377555	1	1	GOINS, STEVEN F CRNA	10/17/2016	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
136278	Fee-for-Service	1134166416	1134166416	1	1	GOMEZ, MARY H	10/8/2004	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	550 WATER ST	STE B	SANTA CRUZ	CA	95060	4127	44	06087	36.98046158	-122.018718	Santa Cruz County
136313	Fee-for-Service	1932324449	1932324449	1	2	GOLDEN VALLEY HEALTH CENTERS	9/12/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2752 RANCHERO LANE	None	MERCED	CA	95348	3503	24	06047	37.32811736	-120.536333	Merced County
136322	Fee-for-Service	1770055543	1770055543	1	1	GONZALEZ, CLAUDIA LCSW	9/11/2024	104100000X	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
136339	Fee-for-Service	1497876239	1497876239	2	1	GW TRANSPORT, INC.	8/24/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	11957 BIGHORN PEAK COURT	None	RANCHO CUCAMONGA	CA	91739	2355	36	06071	34.14018864	-117.5439819	San Bernardino County
136349	Fee-for-Service	1366805590	1366805590	1	1	GLOVACI, DIANA DO	10/6/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	15851	None	None	0	In state provider	None	5300 KATELLA AVE	None	LOS ALAMITOS	CA	90720	2808	30	06059	33.80291117	-118.0403489	Orange County
136381	Fee-for-Service	1033345426	1033345426	1	1	GROVES, DANIEL W MD	6/1/2018	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
136386	Fee-for-Service	1336216654	1336216654	1	1	GONSIER, PAUL LCSW	5/26/2017	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
136443	Fee-for-Service	1912925611	1912925611	1	2	GYNECOLOGIC ONCOLOGY	6/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	ASSOCIATES	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
136481	Fee-for-Service	1033555024	1033555024	1	1	GOODWIN, CHRISTINA M MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140665	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 DOYLE PARK DR	SUITE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
136517	Fee-for-Service	1801890405	1801890405	1	1	GALA, KIRIT V MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	35360	68	Hematology	0	In state provider	None	850 S ATLANTIC BLVD	STE 102	MONTEREY PARK	CA	91754	6701	19	06037	34.05097684	-118.1379979	Los Angeles County
136532	Fee-for-Service	1093137648	1093137648	1	1	GLEASON, DEBRA LMFT	6/9/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27851 BRADLEY RD	155	MENIFEE	CA	92586	2244	33	06065	33.71630969	-117.1904696	Riverside County
136545	Fee-for-Service	1053741124	1053741124	1	1	GONZALES, MIRNA LMFT	12/30/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
136550	Fee-for-Service	1902971757	1902971757	1	1	GRAMA, JOHN JEFFREY	1/1/1982	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7083 HOLLYWOOD BLVD	STE 302	LOS ANGELES	CA	90028	8906	19	06037	34.10155173	-118.3443674	Los Angeles County
136562	Fee-for-Service	1477713048	1477713048	1	2	GOBER, BRIANNE C MD	8/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145392	None	None	0	In state provider	None	3022 45TH	None	SAN DIEGO	CA	92105	4302	37	06073	32.73721899	-117.0978722	San Diego County
136574	Fee-for-Service	1710419064	1710419064	1	1	GILL, EVAN MD	7/9/2020	207P00000X	NA	Other	026	PHYSICIANS	166411	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
136602	Fee-for-Service	1932324449	1932324449	1	2	GOLDEN VALLEY HEALTH CENTERS	9/12/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2752 RANCHERO LANE	None	MERCED	CA	95348	3503	24	06047	37.32811736	-120.536333	Merced County
136607	Fee-for-Service	1063447571	1063447571	1	1	GINIER, PAULETTE MD	4/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	34955	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
136637	Fee-for-Service	1205644465	1205644465	1	1	GARCIA, MARIA DOULA	3/19/2025	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
136668	Fee-for-Service	1033345426	1033345426	1	1	GROVES, DANIEL W MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
136764	Fee-for-Service	1093279259	1093279259	1	1	GREEN, DAMON A NP	4/13/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
136808	Fee-for-Service	1801890405	1801890405	1	1	GALA, KIRIT V MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	35360	78	Neoplastic Diseases/Oncology	0	In state provider	None	850 S ATLANTIC BLVD	STE 102	MONTEREY PARK	CA	91754	6701	19	06037	34.05097684	-118.1379979	Los Angeles County
136826	Fee-for-Service	1659791614	1659791614	1	1	GONZALEZ, REYNA T MD	9/16/2021	208600000X	NA	General Surgery	026	PHYSICIANS	161994	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
136835	Fee-for-Service	1902971757	1902971757	1	1	GRAMA, JOHN JEFFREY	3/1/1983	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	7083 HOLLYWOOD BLVD	STE 302	LOS ANGELES	CA	90028	8906	19	06037	34.10155173	-118.3443674	Los Angeles County
136844	Fee-for-Service	1669402764	1669402764	1	1	GOLDBERG, MICHAEL D MD	3/7/2008	207R00000X	NA	Other	026	PHYSICIANS	49409	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95716	7603	43	06085	37.36217918	-121.8472051	Santa Clara County
136884	Fee-for-Service	1184049793	1184049793	1	2	GREATER FRESNO HEALTH	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4929 E KINGS CANYON RD	None	FRESNO	CA	93727	3812	10	06019	36.73603152	-119.730573	Fresno County
136898	Fee-for-Service	1790476158	1790476158	1	1	GARFIELD BEACH CVS, L.L.C.	11/29/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1670 E 4TH ST	STE D	ONTARIO	CA	91764	2605	36	06071	34.0767	-117.61857	San Bernardino County
136909	Fee-for-Service	1104183060	1104183060	1	1	GUPTA, VEENU G MD	8/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132028	41	Internal Medicine	0	In state provider	None	2220 GLADSTONE DRIVE	SUITE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
136910	Fee-for-Service	1366464968	1366464968	2	1	GARFIELD BEACH CVS LLC	5/15/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2295 N IMPERIAL AVE	None	EL CENTRO	CA	92243	1335	13	06025	32.8146204	-115.5697238	Imperial County
136921	Fee-for-Service	1922118157	1922118157	1	1	GORNO TEMPINI, MARIA LUISA	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105391	13	Neurology (M.D. only)	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
136950	Fee-for-Service	1851455141	1851455141	1	1	GARCIA, EILEEN M	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
136972	Fee-for-Service	1134748189	1134748189	1	1	GOLAUB, AISHA	9/2/2024	390200000X	NA	Other	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1552 COFFEE RD	1ST FLOOR	MODESTO	CA	95355	3107	50	06099	37.666872	-120.975684	Stanislaus County
136983	Fee-for-Service	1053687319	1053687319	1	1	GLEICHER, SHARI LCSW	3/1/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1918 BONITA AVE	STE 200	BERKELEY	CA	94704	1014	01	06001	37.87279926	-122.2720479	Alameda County
136992	Fee-for-Service	1295871358	1295871358	1	1	GUAGENTI, JOHN J MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	32900	07	Dermatology	0	In state provider	None	1510 S CENTRAL AVE	STE 470	GLENDALE	CA	91204	2514	19	06037	34.12709764	-118.2577911	Los Angeles County
137049	Fee-for-Service	1245302926	1245302926	1	1	GLAZE, ELIZABETH D	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
137082	Fee-for-Service	1962442624	1962442624	1	1	GOLDFIEN, STEVEN D MD	11/1/1994	207L00000X	NA	Other	026	PHYSICIANS	40270	05	Anesthesiology	0	In state provider	CPMC	CLAY & BUCHANAN	None	SAN FRANCISCO	CA	94120	0000	38	06075	37.791126	-122.4309105	San Francisco County
137102	Fee-for-Service	1265466957	1265466957	1	1	GETTYSBURG HOSPITAL	6/16/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	147 GETTYS ST	None	GETTYSBURG	PA	17325	2534	00	None	39.82331418	-77.23442592	Adams County
137120	Fee-for-Service	1760431902	1760431902	1	1	GOTTLIEB, ROY MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	6254	None	None	0	In state provider	None	2393 TOWNSGATE RD	STE 202	WESTLAKE VILLAGE	CA	91361	2517	56	06111	34.16103602	-118.834026	Ventura County
137126	Fee-for-Service	1619217544	1619217544	1	1	GOLDEN STATE RX PARTNERS LLC	4/15/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8408 BEVERLY BLVD	None	LOS ANGELES	CA	90048	3402	19	06037	34.07601949	-118.373409	Los Angeles County
137136	Fee-for-Service	1669402764	1669402764	1	1	GOLDBERG, MICHAEL D MD	3/7/2008	207R00000X	NA	Other	026	PHYSICIANS	49409	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95716	7603	43	06085	37.36217918	-121.8472051	Santa Clara County
137142	Fee-for-Service	1164689535	1164689535	1	1	GELMAN, RONY MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120927	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
137170	Fee-for-Service	1184049793	1184049793	1	2	GREATER FRESNO HEALTH	10/14/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4929 E KINGS CANYON RD	None	FRESNO	CA	93727	3812	10	06019	36.73603152	-119.730573	Fresno County
137226	Fee-for-Service	1376588269	1376588269	1	1	GARFIELD BEACH CVS, LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3911 S BRISTOL ST	None	SANTA ANA	CA	92704	7427	30	06059	33.695613	-117.8853415	Orange County
137240	Fee-for-Service	1275569089	1275569089	1	1	GILLUM, LESLIE A MD	5/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83111	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
137264	Fee-for-Service	1134748189	1134748189	1	1	GOLAUB, AISHA	9/2/2024	390200000X	NA	Other	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	1552 COFFEE RD	1ST FLOOR	MODESTO	CA	95355	3107	50	06099	37.666872	-120.975684	Stanislaus County
137367	Fee-for-Service	1144205329	1144205329	1	1	GENTRY, JULIENE C MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52000	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
137374	Fee-for-Service	1962513291	1962513291	1	1	GORDON, JODY MD	7/14/1986	207R00000X	NA	Other	026	PHYSICIANS	57777	41	Internal Medicine	0	In state provider	None	2615 I ST	None	SACRAMENTO	CA	95816	4395	34	06067	38.575656	-121.470867	Sacramento County
137375	Fee-for-Service	1396842001	1396842001	1	1	GOTTLIEB, LAURA M MD	11/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54363	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
137391	Fee-for-Service	1265466957	1265466957	1	1	GETTYSBURG HOSPITAL	6/16/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	147 GETTYS ST	None	GETTYSBURG	PA	17325	2534	00	None	39.82331418	-77.23442592	Adams County
137411	Fee-for-Service	1275646333	1275646333	1	1	GUEFEN, URI MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	38335	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
137422	Fee-for-Service	1902071772	1902071772	1	1	GETUBIG, AMELIA P LMFT	9/18/2018	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
137428	Fee-for-Service	1992292767	1992292767	1	1	GAMAYO, ASHLEY C MD	10/23/2023	390200000X	NA	Other	026	PHYSICIANS	176512	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
137430	Fee-for-Service	1699041566	1699041566	1	5	GARDNER FAMILY HEALTH	1/14/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	43	06085	37.36514449	-121.8292446	Santa Clara County
137435	Fee-for-Service	1619591989	1619591989	1	1	GRACIA, JANEL MD	12/4/2023	390200000X	NA	Other	026	PHYSICIANS	184594	None	None	0	In state provider	None	5823 YORK BLVD	STE 1	LOS ANGELES	CA	90042	2634	19	06037	34.11850913	-118.1915335	Los Angeles County
137458	Fee-for-Service	1285833871	1285833871	1	1	GRANZOW, EVA G MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94605	None	None	0	In state provider	None	5151 F ST	2-SOUTH	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
137469	Fee-for-Service	1619035672	1619035672	1	1	GOLD COAST NEONATAL	7/1/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SERVICES, AMC	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
137491	Fee-for-Service	1730307448	1730307448	1	1	GOLDEN CASTLE ADHC CTR	7/7/2003	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	INC	3803 E BAYSHORE ROAD	None	PALO ALTO	CA	94303	0000	43	06085	37.43221354	-122.1050175	Santa Clara County
137553	Fee-for-Service	1447274782	1447274782	1	1	GANJUANPOUR, RAMIN MD	2/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75503	20	Orthopedic Surgery	0	In state provider	None	11550 INDIAN HILLS RD	STE 241	MISSION HILLS	CA	91345	1202	19	06037	34.28024575	-118.4588775	Los Angeles County
137589	Fee-for-Service	1295034833	1295034833	1	1	GRAHAM, BRUCE MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	34644	05	Anesthesiology	0	In state provider	None	400 W MINERAL KING	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
137601	Fee-for-Service	1255353041	1255353041	2	1	GARFIELD BEACH CVS LLC	3/2/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 COUNTRYSIDE DR	None	TURLOCK	CA	95380	8402	50	06099	37.520775	-120.878325	Stanislaus County
137605	Fee-for-Service	1710939749	1710939749	1	1	GIONIS EMERG MED GRP INC	1/1/2006	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	A PROFESSIONAL MED CORP	13100 STUDEBAKER RD	None	NORWALK	CA	90650	2531	19	06037	33.912594	-118.099152	Los Angeles County
137617	Fee-for-Service	1619260908	1619260908	1	1	GORIPARTHI, SILPA MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134862	01	General Practice	0	In state provider	None	27200 CALAROGA AVENUE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
137651	Fee-for-Service	1083684997	1083684997	1	1	GOLU, CRISTIANA MD	12/1/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70568	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
137655	Fee-for-Service	1144205329	1144205329	1	1	GENTRY, JULIENE C MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52000	40	Pediatrics	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
137657	Fee-for-Service	1871363457	1871363457	1	1	GUARDIAN TRANSPORTATION INC	5/1/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10007 BERRYESSA DR	None	STOCKTON	CA	95219	7122	39	06077	38.0470637	-121.3827575	San Joaquin County
137715	Fee-for-Service	1912430802	1912430802	1	1	GARABET DIRAMERIAN, LINDA L	4/25/2023	2080P0205X	NA	Endocrinology	026	PHYSICIANS	167151	None	None	0	In state provider	MD	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
137716	Fee-for-Service	1699041566	1699041566	1	5	GARDNER FAMILY HEALTH	1/14/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	43	06085	37.36514449	-121.8292446	Santa Clara County
137736	Fee-for-Service	1912280421	1912280421	1	1	GILL, PARDIP K CNP	1/5/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
137764	Fee-for-Service	1457330300	1457330300	1	1	GROSSMONT HOSPITAL CORP	6/29/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SHARP CENTRAL PHARMACY	3558 RUFFIN ROAD SOUTH	None	SAN DIEGO	CA	92123	2596	37	06073	32.80776165	-117.1289246	San Diego County
137777	Fee-for-Service	1104455526	1104455526	1	1	GONZALEZ HUERTA, ROBERTO MD	10/11/2023	207R00000X	NA	Other	026	PHYSICIANS	179259	None	None	0	In state provider	None	4702 HOEN AVE	None	SANTA ROSA	CA	95405	7824	49	06097	38.441016	-122.664483	Sonoma County
137823	Fee-for-Service	1518989300	1518989300	2	1	GARFIELD BEACH CVS LLC	4/16/2018	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3471 W CENTURY BLVD	None	INGLEWOOD	CA	90301	1218	19	06037	33.948414	-118.333494	Los Angeles County
137828	Fee-for-Service	1952758260	1952758260	1	1	GANTZ, OLIVER H MD	7/13/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	147332	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
137834	Fee-for-Service	1275640906	1275640906	1	1	GILL, JOHN CLIFTON MD	4/24/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49443	01	General Practice	0	In state provider	None	7755 FAY AVE	STE I	LA JOLLA	CA	92037	4314	37	06073	32.84426468	-117.2750261	San Diego County
137907	Fee-for-Service	1942354337	1942354337	1	1	GERY, MARK R LMFT	3/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10061 TALBERT AVE	200	FOUNTAIN VALLEY	CA	92708	5159	30	06059	33.70179254	-117.953191	Orange County
137937	Fee-for-Service	1841200565	1841200565	1	1	GARREN, LLOYD R MD	1/1/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81024	66	Emergency Medicine (Urgent Care)	0	In state provider	None	833 CASS ST	STE A	MONTEREY	CA	93940	2904	27	06053	36.59409362	-121.8954238	Monterey County
137949	Fee-for-Service	1417002841	1417002841	1	1	GODFREY, STEPHEN C OD	11/8/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1003 3RD STREET	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97206283	-122.5276983	Marin County
137986	Fee-for-Service	1427310887	1427310887	1	1	GONZALEZ, LETICIA LCSW	8/28/2017	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
138105	Fee-for-Service	1740717875	1740717875	1	1	GENOVA, TIFFANY W MD	2/20/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	191022	04	Otology, Laryngology, Rhinology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
138120	Fee-for-Service	1982770434	1982770434	1	1	GINSBERG, HELENE C LCSW	5/5/2009	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	341 BROADWAY	STE 400B	CHICO	CA	95928	5343	04	06007	39.72853436	-121.8398597	Butte County
138128	Fee-for-Service	1932324449	1932324449	1	1	GOLDEN VALLEY HEALTH CENTERS	7/31/1991	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6862	24	06047	37.28825369	-120.4963159	Merced County
138202	Fee-for-Service	1386873370	1386873370	1	1	GARG, SONIA MD	10/4/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	115016	70	Clinic (mixed specialty)	0	In state provider	None	350 30TH ST	411	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
138216	Fee-for-Service	1679754873	1679754873	1	1	GOHIL, RAHUL R MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99375	02	General Surgery	0	In state provider	None	655 EUCLID AVE	None	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
138225	Fee-for-Service	1841200565	1841200565	1	1	GARREN, LLOYD R MD	1/1/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81024	10	Gastroenterology (M.D. only)	0	In state provider	None	833 CASS ST	STE A	MONTEREY	CA	93940	2904	27	06053	36.59409362	-121.8954238	Monterey County
138230	Fee-for-Service	1184972200	1184972200	1	1	GALANOI, NEDA MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130796	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
138307	Fee-for-Service	1417909573	1417909573	1	1	GHADISHAH, DELARAM MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70084	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
138322	Fee-for-Service	1588289250	1588289250	1	1	GAYHART, KATHRYN L NP	7/13/2020	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
138382	Fee-for-Service	1679604417	1679604417	1	2	GALDAMEZ, LUIS A MD	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	48644	01	General Practice	0	In state provider	None	2955 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5836	19	06037	33.97333678	-118.2163277	Los Angeles County
138385	Fee-for-Service	1699782516	1699782516	1	1	GARCIA, JEFFREY	7/1/1995	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	162 WEST D STREET	None	LEMOORE	CA	93245	2612	16	06031	36.302089	-119.7831008	Kings County
138394	Fee-for-Service	1184176158	1184176158	1	1	GONZALES MEDICAL CENTER INC	3/16/2017	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	18 FOURTH ST	None	GONZALES	CA	93926	0808	27	06053	36.50698522	-121.4443339	Monterey County
138401	Fee-for-Service	1134482805	1134482805	1	1	GUENTHART, ANDREW D MD	6/23/2021	208600000X	NA	General Surgery	026	PHYSICIANS	168013	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
138414	Fee-for-Service	1902973894	1902973894	1	1	GATES, JAMES V MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25419	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
138415	Fee-for-Service	1932324449	1932324449	1	1	GOLDEN VALLEY HEALTH CENTERS	7/31/1991	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6862	24	06047	37.28825369	-120.4963159	Merced County
138442	Fee-for-Service	1023310836	1023310836	1	1	GARFIELD BEACH CVS LLC	6/23/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3335 S FIGUEROA ST	UNIT Q	LOS ANGELES	CA	90007	3840	19	06037	34.02334742	-118.2790932	Los Angeles County
138455	Fee-for-Service	1740697556	1740697556	1	1	GULYAS, CHLOE LCSW	2/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
138459	Fee-for-Service	1164434270	1164434270	1	1	GENNADIL BILITCH	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
138464	Fee-for-Service	1093757361	1093757361	1	1	GIRAGOSIAN, SHERRI L NP	8/3/2016	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
138465	Fee-for-Service	1285611244	1285611244	1	1	GIBB, CHRISTOPHER E MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121433	05	Anesthesiology	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
138471	Fee-for-Service	1891432852	1891432852	1	1	GOOD SHEPHERD MANOR LLC	6/3/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	302 NORDINA ST	None	REDLANDS	CA	92373	6022	36	06071	34.05227772	-117.1788695	San Bernardino County
138505	Fee-for-Service	1679754873	1679754873	1	1	GOHIL, RAHUL R MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99375	24	Plastic Surgery	0	In state provider	None	655 EUCLID AVE	None	NATIONAL CITY	CA	91950	2957	37	06073	32.68353398	-117.082625	San Diego County
138543	Fee-for-Service	1598141384	1598141384	1	1	GONZALEZ, PRISILA NP	7/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
138559	Fee-for-Service	1063747137	1063747137	1	1	GABICHVADZE, MINDIA	7/21/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9713 SANTA MONICA BLVD	STE 202	BEVERLY HILLS	CA	90210	4237	19	06037	34.06835061	-118.4076858	Los Angeles County
138574	Fee-for-Service	1730422189	1730422189	1	1	GHIYA, DEEPTI MD	12/18/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151119	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
138597	Fee-for-Service	1316335896	1316335896	1	1	GENERATION CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	516 PENNSFIELD PLACE	SUITE 109	THOUSAND OAKS	CA	91360	5576	56	06111	34.18541413	-118.8741371	Ventura County
138608	Fee-for-Service	1194766006	1194766006	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6840 LINCOLN AVE	None	RIVERSIDE	CA	92506	4256	33	06065	33.9358635	-117.3871468	Riverside County
138656	Fee-for-Service	1194108571	1194108571	1	1	GOSLING, MEAGHAN L LPCC	1/21/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9605 LORD DR	None	WINDSOR	CA	95492	8045	49	06097	38.55282679	-122.819687	Sonoma County
138660	Fee-for-Service	1336161025	1336161025	2	1	GARFIELD BEACH CVS LLC	3/21/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2626 COLORADO BLVD	None	LOS ANGELES	CA	90041	1070	19	06037	34.14236825	-118.2236654	Los Angeles County
138672	Fee-for-Service	1356387021	1356387021	1	1	GIUDICE, LINDA C MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50709	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
138692	Fee-for-Service	1609041904	1609041904	1	1	GAINSBURY, MELANIE L MD	1/7/2021	208600000X	NA	General Surgery	026	PHYSICIANS	134932	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
138723	Fee-for-Service	1942388749	1942388749	1	1	GUYER, MARION L MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66859	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
138727	Fee-for-Service	1710383187	1710383187	1	1	GREENBERG, JUSTIN M DO	6/15/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	14267	40	Pediatrics	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
138752	Fee-for-Service	1801806567	1801806567	1	1	GARREN, MARY L MD	5/1/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81025	10	Gastroenterology (M.D. only)	0	In state provider	None	833 CASS ST	STE A	MONTEREY	CA	93940	2904	27	06053	36.59409362	-121.8954238	Monterey County
138786	Fee-for-Service	1942268487	1942268487	1	1	GAMBURD, ROBERT S MD	11/9/2022	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	48453	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
138820	Fee-for-Service	1972609808	1972609808	1	1	GIBRALTAR CONV HOSP INC	1/13/1978	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3136 N DEL MAR AVE	None	ROSEMEAD	CA	91770	2326	19	06037	34.06546988	-118.0994866	Los Angeles County
138852	Fee-for-Service	1720787864	1720787864	1	1	GAIL GARCIA, LICENSED CLINIC	10/26/2023	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1294 E FIRST AVE	120	CHICO	CA	95926	1572	04	06007	39.75048481	-121.8251162	Butte County
138854	Fee-for-Service	1336107648	1336107648	1	1	GANAPAVARAPU, SREEKANTH MD	7/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82967	41	Internal Medicine	0	In state provider	None	18564 US HIGHWAY 18	STE 105	APPLE VALLEY	CA	92307	2320	36	06071	34.53926652	-117.2592564	San Bernardino County
138863	Fee-for-Service	1417925330	1417925330	1	1	GREGORY COONS	3/14/2018	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
138879	Fee-for-Service	1538523980	1538523980	1	1	GONZALEZ-FALERO, ANDREA M MD	8/23/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	162810	None	None	0	In state provider	None	2801 K ST	STE 220	SACRAMENTO	CA	95816	5118	34	06067	38.572947	-121.46904	Sacramento County
138885	Fee-for-Service	1316335896	1316335896	1	1	GENERATION CARE INC	5/12/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	516 PENNSFIELD PLACE	SUITE 109	THOUSAND OAKS	CA	91360	5576	56	06111	34.18541413	-118.8741371	Ventura County
138951	Fee-for-Service	1548234289	1548234289	1	1	GASTROENTEROLOGY CONSULT	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL GROUP INC	8120 TIMBERLAKE WAY	STE 202	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
138956	Fee-for-Service	1881613305	1881613305	1	1	GATOF, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	LONGMONT UNITED HOSP	382 S ARTHUR AVE	None	LOUISVILLE	CO	80501	3094	00	None	39.96537281	-105.1247735	Boulder County
138976	Fee-for-Service	1215010962	1215010962	1	1	GOLDSTEIN, DAVID N MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	75368	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
138979	Fee-for-Service	1750322798	1750322798	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2169 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3625	19	06037	33.88612083	-118.3166227	Los Angeles County
139009	Fee-for-Service	1942388749	1942388749	1	1	GUYER, MARION L MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66859	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
139025	Fee-for-Service	1760709141	1760709141	1	1	GERHARDT, NELS J MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128869	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
139032	Fee-for-Service	1386724110	1386724110	1	1	GORODETSKY, GALINA M MD	3/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38916	36	Psychiatry	0	In state provider	None	2000 VAN NESS AVE	STE 710	SAN FRANCISCO	CA	94109	3015	38	06075	37.79415339	-122.422986	San Francisco County
139041	Fee-for-Service	1801806567	1801806567	1	1	GARREN, MARY L MD	5/1/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81025	66	Emergency Medicine (Urgent Care)	0	In state provider	None	833 CASS ST	STE A	MONTEREY	CA	93940	2904	27	06053	36.59409362	-121.8954238	Monterey County
139068	Fee-for-Service	1912085937	1912085937	1	1	GREENBERG JOSEPH HM	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	35289	07	Dermatology	0	In state provider	None	750 LAS GALLINAS AVE	STE 205	SAN RAFAEL	CA	94903	3432	21	06041	38.00688138	-122.5463961	Marin County
139087	Fee-for-Service	1821284449	1821284449	1	1	GURTCH, SHOTA P MD	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101612	41	Internal Medicine	0	In state provider	None	835 3RD AVENUE	STE A	CHULA VISTA	CA	91911	1352	37	06073	32.62293517	-117.0726661	San Diego County
139113	Fee-for-Service	1134244718	1134244718	1	1	GLASSER DAS, ANDRIA R PSYD	7/1/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16800 DEVONSHIRE ST	212	GRANADA HILLS	CA	91344	7403	19	06037	34.25745651	-118.4982159	Los Angeles County
139122	Fee-for-Service	1720276884	1720276884	1	1	GONZALEZ-RANGEL, JESSICA NP	2/11/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
139143	Fee-for-Service	1720787864	1720787864	1	1	GAIL GARCIA, LICENSED CLINIC	10/26/2023	101Y00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1294 E FIRST AVE	120	CHICO	CA	95926	1572	04	06007	39.75048481	-121.8251162	Butte County
139161	Fee-for-Service	1245212794	1245212794	1	1	GARMAN, STEVEN L PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11800 CENTRAL AVE	STE 125	CHINO	CA	91710	7202	36	06071	34.0388092	-117.689654	San Bernardino County
139177	Fee-for-Service	1780456277	1780456277	1	1	GILL, DILPREET CNP	2/24/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6440 PLATT AVE	None	WEST HILLS	CA	91307	3216	19	06037	34.18784988	-118.6427021	Los Angeles County
139188	Fee-for-Service	1730636754	1730636754	1	1	GARAVAGLIA, MARY A CCC-SLP	7/19/2023	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
139203	Fee-for-Service	1124555057	1124555057	1	1	GIANARIS, NICHOLAS G MD	10/8/2021	390200000X	NA	Other	026	PHYSICIANS	158217	None	None	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
139231	Fee-for-Service	1619169653	1619169653	1	1	GLASS, ELIZABETH A LCSW	8/12/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1090 THIRD ST	STE 1	SOUTH LAKE TAHOE	CA	96150	3485	09	06017	38.91492536	-119.9966528	El Dorado County
139241	Fee-for-Service	1740809318	1740809318	1	1	GRAND GROUP TRANSPORTATION,	9/3/2020	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC.	18305 SHERMAN	SUITE 2	RESEDA	CA	91335	4425	19	06037	34.20121152	-118.5319665	Los Angeles County
139284	Fee-for-Service	1194387670	1194387670	1	1	GONZALEZ, SARAH LCSW	7/26/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	STE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
139304	Fee-for-Service	1871671495	1871671495	1	1	GENDREAU, DAVID P MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	61114	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
139312	Fee-for-Service	1184178212	1184178212	1	1	GOOKIN, KARINA S MD	1/31/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	144232	01	General Practice	0	In state provider	None	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	31	06061	38.93485327	-121.0988193	Placer County
139320	Fee-for-Service	1376030502	1376030502	1	1	GONZALEZ, EMILY S MD	1/27/2023	207R00000X	NA	Other	026	PHYSICIANS	177802	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
139326	Fee-for-Service	1215424502	1215424502	1	1	GUY, MEGAN E MD	7/2/2022	390200000X	NA	Other	026	PHYSICIANS	173905	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
139329	Fee-for-Service	1093219909	1093219909	1	1	GONZALEZ, LUIS	7/11/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166700	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
139336	Fee-for-Service	1538221874	1538221874	1	1	GEBREMEDHIN, GIRMAY Y MD	6/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98285	41	Internal Medicine	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
139339	Fee-for-Service	1912627969	1912627969	1	1	GONZALEZ, BERNADETTE LYNNE A	12/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PT	3400 PANAMA LANE	SUITE R	BAKERSFIELD	CA	93313	3996	15	06029	35.29601148	-119.040507	Kern County
139340	Fee-for-Service	1497012991	1497012991	1	1	GONZALEZ, STEPHANIE MD	4/15/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	127196	None	None	0	In state provider	None	4910 AIRPORT PLAZA DRIVE	SUITE 100	LONG BEACH	CA	90815	1264	19	06037	33.80854316	-118.1359209	Los Angeles County
139355	Fee-for-Service	1235526427	1235526427	1	1	GUZMAN-SUAREZ, EDGAR X MD	8/4/2020	207RC0200X	NA	Other	026	PHYSICIANS	168019	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
139359	Fee-for-Service	1215189683	1215189683	1	1	GENSHAFT, SCOTT J MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103680	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
139372	Fee-for-Service	1821133273	1821133273	1	2	GLEASON, LISA T LMFT	10/14/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1302 LINCOLN AVE	203	SAN JOSE	CA	95125	3015	43	06085	37.3049318	-121.8984659	Santa Clara County
139398	Fee-for-Service	1225339211	1225339211	1	1	GUNATILAKA, C DESMOND MD INC	3/23/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	30340	41	Internal Medicine	0	In state provider	None	393 BLOSSOM HILL RD	STE 260B	SAN JOSE	CA	95123	1655	43	06085	37.25148009	-121.8269584	Santa Clara County
139428	Fee-for-Service	1942547070	1942547070	1	1	GARFIELD BEACH CVS LLC	10/3/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6750 BERNAL AVE	None	PLEASANTON	CA	94566	1218	01	06001	37.65770212	-121.8987018	Alameda County
139430	Fee-for-Service	1669426276	1669426276	1	1	GOODWIN, KIM M MD	6/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75600	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7920 FROST ST	STE 401	SAN DIEGO	CA	92123	4297	37	06073	32.80027449	-117.153846	San Diego County
139465	Fee-for-Service	1720125149	1720125149	1	1	GLOSSBRENNER, DAVID F MD	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50054	41	Internal Medicine	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	3513	16	06031	36.32396253	-119.6688834	Kings County
139475	Fee-for-Service	1720575509	1720575509	1	1	GLASER, LAUREN T MD	12/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164922	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
139556	Fee-for-Service	1497846935	1497846935	1	1	GOLCHINI, HASSAN MD	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55248	41	Internal Medicine	0	In state provider	None	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
139573	Fee-for-Service	1649517152	1649517152	1	1	GIUSTY, LISA M PT	3/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2620 LARKSPUR LANE	SUITE T	REDDING	CA	96002	1043	45	06089	40.5690659	-122.3555361	Shasta County
139589	Fee-for-Service	1689201022	1689201022	1	1	GAUR, KUSH C MD	10/8/2023	207R00000X	NA	Other	026	PHYSICIANS	186199	None	None	0	In state provider	None	3838 CALIFORNIA ST RM 51	RM 510	SAN FRANCISCO	CA	94118	1507	38	06075	37.78591809	-122.4575439	San Francisco County
139595	Fee-for-Service	1548348162	1548348162	1	1	GREGORY, GINA L MD	6/12/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65956	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
139598	Fee-for-Service	1477594398	1477594398	1	1	GARFIELD BEACH CVS, LLC	1/14/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21572 PLANO TRABUCO RD.	None	TRABUCO CANYON	CA	92679	3465	30	06059	33.6492411	-117.5772707	Orange County
139610	Fee-for-Service	1659464089	1659464089	1	1	GODFREY, SCOTT A	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	5999	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
139681	Fee-for-Service	1376654533	1376654533	1	1	GRAY, THOMAS L MD	2/28/1987	207P00000X	NA	Other	026	PHYSICIANS	37386	01	General Practice	0	In state provider	None	3890 N CEDAR AVE	None	FRESNO	CA	93726	5269	10	06019	36.78833977	-119.7542073	Fresno County
139804	Fee-for-Service	1043285232	1043285232	1	1	GOWDA, PRASHANTH G MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55692	41	Internal Medicine	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
139805	Fee-for-Service	1629404975	1629404975	1	1	GUPTA, NANCY MD	7/20/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	172705	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
139810	Fee-for-Service	1578505640	1578505640	1	1	GRAFF, NANCY R MD	10/31/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	64931	40	Pediatrics	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
139820	Fee-for-Service	1437703329	1437703329	1	2	GARFIELD HEALTH CENTER	8/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	19138 E WALNUT DR NORTH	SUITE 101	ROWLAND HEIGHTS	CA	91748	1432	19	06037	33.99570698	-117.8850338	Los Angeles County
139833	Fee-for-Service	1124195938	1124195938	1	1	GARRETON, GONZALO G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35307	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1101 S DORA ST	None	UKIAH	CA	95482	6341	23	06045	39.13701095	-123.209758	Mendocino County
139852	Fee-for-Service	1669487401	1669487401	1	1	GRIESHOP, NEIL A MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131120	02	General Surgery	0	In state provider	None	5176 HILL RD EAST	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
139855	Fee-for-Service	1750918330	1750918330	1	1	GOMEZ, MARIANA MD	8/19/2024	207L00000X	NA	Other	026	PHYSICIANS	188214	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
139871	Fee-for-Service	1043396567	1043396567	1	1	GARCIA, KAREN B MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	76801	01	General Practice	0	In state provider	None	202 GREEN VALLEY RD	None	FREEDOM	CA	95019	3135	44	06087	36.93777813	-121.7711905	Santa Cruz County
139876	Fee-for-Service	1013341908	1013341908	1	1	GALLMANN, MINDY MARIE	9/16/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3475 LA JOLLA AVE	None	CLOVIS	CA	93619	7268	10	06019	36.78896384	-119.6376795	Fresno County
139884	Fee-for-Service	1548348162	1548348162	1	1	GREGORY, GINA L MD	6/12/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65956	41	Internal Medicine	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
139898	Fee-for-Service	1962443879	1962443879	1	1	GARFIELD BEACH CVS LLC	10/23/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3751 WILSHIRE BLVD	None	LOS ANGELES	CA	90010	2802	19	06037	34.06172398	-118.308195	Los Angeles County
139921	Fee-for-Service	1083844005	1083844005	1	1	GREEN, DALE PT	6/25/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3400 CALLOWAY DR	600	BAKERSFIELD	CA	93312	2513	15	06029	35.39110123	-119.1097878	Kern County
139924	Fee-for-Service	1093737694	1093737694	2	1	GARFIELD BEACH CVS LLC	3/3/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3433 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2606	19	06037	33.8251373	-118.3458426	Los Angeles County
139931	Fee-for-Service	1518983899	1518983899	1	1	GHIASSI, AMIR K MD	11/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52272	None	None	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
139968	Fee-for-Service	1376654533	1376654533	1	1	GRAY, THOMAS L MD	2/28/1987	207P00000X	NA	Other	026	PHYSICIANS	37386	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3890 N CEDAR AVE	None	FRESNO	CA	93726	5269	10	06019	36.78833977	-119.7542073	Fresno County
139989	Fee-for-Service	1164841003	1164841003	1	1	GUTIERREZ, CYNTHIA MD	5/15/2018	207R00000X	NA	Other	026	PHYSICIANS	140716	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
140048	Fee-for-Service	1518311349	1518311349	1	1	GENT, LAUREN C PSYD	8/5/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
140064	Fee-for-Service	1710064944	1710064944	1	1	GAO, ER-KAI MD INC	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71659	13	Neurology (M.D. only)	0	In state provider	None	8851 CENTER DR	STE 603	LA MESA	CA	91942	3063	37	06073	32.78189749	-117.0075062	San Diego County
140072	Fee-for-Service	1720833833	1720833833	1	1	GAFFORD, STEPHEN	5/1/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	206 MARCOS AVE	None	SAN DIMAS	CA	91773	2719	19	06037	34.10899798	-117.7979949	Los Angeles County
140096	Fee-for-Service	1144422056	1144422056	1	1	GREEN, AKIBA E DO	12/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9667	15	Obstetrics (D.O. only)	0	In state provider	None	3883 AIRWAY DRIVE	SUITE 165	SANTA ROSA	CA	95403	1675	49	06097	38.483226	-122.739705	Sonoma County
140106	Fee-for-Service	1215464037	1215464037	1	1	GOHAR, HAMZA DO	10/2/2020	207R00000X	NA	Other	026	PHYSICIANS	18193	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
140109	Fee-for-Service	1437703329	1437703329	1	2	GARFIELD HEALTH CENTER	8/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	19138 E WALNUT DR NORTH	SUITE 101	ROWLAND HEIGHTS	CA	91748	1432	19	06037	33.99570698	-117.8850338	Los Angeles County
140160	Fee-for-Service	1043396567	1043396567	1	1	GARCIA, KAREN B MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	76801	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	202 GREEN VALLEY RD	None	FREEDOM	CA	95019	3135	44	06087	36.93777813	-121.7711905	Santa Cruz County
140191	Fee-for-Service	1033570916	1033570916	1	1	GABRIEL Y. EDERY, D.C. CHIRO	10/24/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	PRACTIC, INC	7439 RESEDA BLVD	None	RESEDA	CA	91335	2819	19	06037	34.205814	-118.536078	Los Angeles County
140198	Fee-for-Service	1336422252	1336422252	1	1	GRAY, KATHLEEN A MD	3/27/2020	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	66152	39	Preventive (M.D. only)	0	In state provider	None	3930 FOURTH AVE	STE 200	SAN DIEGO	CA	92103	3119	37	06073	32.74892723	-117.1616459	San Diego County
140219	Fee-for-Service	1881952562	1881952562	1	1	GAMBILL, LAUREN K MD	6/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143431	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
140222	Fee-for-Service	1922202399	1922202399	1	1	GORSKI, ROBERT M MD	5/22/2020	207P00000X	NA	Other	026	PHYSICIANS	167440	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
140227	Fee-for-Service	1689018004	1689018004	1	1	GASTELUM, ERICA MARIEL T MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133251	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	SC05	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
140277	Fee-for-Service	1134290026	1134290026	1	1	GOLDMAN, STUART P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	16182	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
140292	Fee-for-Service	1134226319	1134226319	1	1	GEORGE, SHARON M MD	6/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	81952	01	General Practice	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
140304	Fee-for-Service	1306138706	1306138706	1	1	GOTT, KERRY N MD INC	5/26/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
140348	Fee-for-Service	1205397841	1205397841	1	1	GREENE, JOHN P MD	6/12/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	179068	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
140350	Fee-for-Service	1528768173	1528768173	1	1	GHAFARI, MARYAM	5/16/2023	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
140351	Fee-for-Service	1710064944	1710064944	1	1	GAO, ER-KAI MD INC	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71659	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8851 CENTER DR	STE 603	LA MESA	CA	91942	3063	37	06073	32.78189749	-117.0075062	San Diego County
140362	Fee-for-Service	1720833833	1720833833	1	1	GAFFORD, STEPHEN	5/1/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	206 MARCOS AVE	None	SAN DIMAS	CA	91773	2719	19	06037	34.10899798	-117.7979949	Los Angeles County
140369	Fee-for-Service	1912085523	1912085523	1	1	GARRETT, SHERYL A MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76995	41	Internal Medicine	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
140374	Fee-for-Service	1447275326	1447275326	1	1	GAEDE, PAUL S OD	6/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
140389	Fee-for-Service	1235795006	1235795006	1	1	GIVENS STALLWORTH, JOYCELYN	10/27/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
140444	Fee-for-Service	1093962284	1093962284	1	1	GINWALLA, RASHNA F MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141075	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
140486	Fee-for-Service	1134640121	1134640121	1	1	GARCIA DIAZ, MAYRA A LCSW	3/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
140507	Fee-for-Service	1104032143	1104032143	1	1	GRUBER, ALLEN B MD	9/15/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	88318	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
140514	Fee-for-Service	1265442727	1265442727	1	1	GWINN, RICHARD G MD	2/28/1983	207P00000X	NA	Other	026	PHYSICIANS	24818	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
140527	Fee-for-Service	1700041837	1700041837	1	1	GRIFFITH, JENNIFER P MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136613	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5151 F STREET	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
140557	Fee-for-Service	1770734105	1770734105	1	1	GRACE, GINA F PHD	8/15/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
140562	Fee-for-Service	1902954308	1902954308	1	1	GREGORY, KATHERINE L MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80994	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 VALENCIA ST	None	SAN FRANCISCO	CA	94110	5013	38	06075	37.74617273	-122.4201514	San Francisco County
140572	Fee-for-Service	1639134877	1639134877	1	1	GIPE, BRUCE MD	11/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	42382	29	Pulmonary Diseases (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
140577	Fee-for-Service	1730567579	1730567579	1	1	GCH MEDICAL GROUP INC	8/1/2015	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1225 WILSHIRE BOULEVARD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
140588	Fee-for-Service	1013971738	1013971738	1	1	GARSHFIELD, GARY N MD	3/31/1987	207ZC0500X	NA	Other	026	PHYSICIANS	50395	22	Pathology (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
140592	Fee-for-Service	1306138706	1306138706	1	1	GOTT, KERRY N MD INC	5/26/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
140598	Fee-for-Service	1639763675	1639763675	1	1	GREENWALT, KATHERINE CNP	7/31/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
140626	Fee-for-Service	1104868058	1104868058	1	1	GREGORY R GALAKATOS M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	621 S NEW BALLAS RD	STE 5015B	SAINT LOUIS	MO	63141	8270	00	None	38.644902	-90.4462065	St. Louis County
140632	Fee-for-Service	1255786604	1255786604	1	1	GARVANOVIC, SAMANTHA H MD	7/1/2020	207L00000X	NA	Other	026	PHYSICIANS	151180	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
140639	Fee-for-Service	1992413157	1992413157	1	2	GAMMA NEURO NETWORK INC	7/8/2024	2084N0600X	NA	Neurology	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
140657	Fee-for-Service	1912085523	1912085523	1	1	GARRETT, SHERYL A MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76995	06	Cardiovascular Disease (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
140662	Fee-for-Service	1528172657	1528172657	1	1	GUNAWARDANA, RAJAH P MD	1/24/2010	207L00000X	NA	Other	026	PHYSICIANS	72389	05	Anesthesiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
140667	Fee-for-Service	1548281322	1548281322	1	1	GISH, ROBERT G MD	4/2/2004	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	45632	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
140680	Fee-for-Service	1609011469	1609011469	1	1	GRATIAN RICHARD W MD	12/15/2008	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1540 FLORIDA AVENUE	SUITE 205	MODESTO	CA	95350	4430	50	06099	37.667115	-120.9962205	Stanislaus County
140683	Fee-for-Service	1366545865	1366545865	1	1	GOLDBERG, STANLEY B MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	7540	41	Internal Medicine	0	In state provider	PROF CORP	3010 COLBY ST	STE 216	BERKELEY	CA	94705	2059	01	06001	37.85492078	-122.2576101	Alameda County
140684	Fee-for-Service	1780606574	1780606574	2	1	GARFIELD BEACH CVS LLC	10/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3121 E COLORADO BLVD	None	PASADENA	CA	91107	3814	19	06037	34.14625145	-118.0851597	Los Angeles County
140696	Fee-for-Service	1194712364	1194712364	1	1	GROSS, BRIAN W MD	3/5/1997	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	555 BLACK OAK DR	STE 200	MEDFORD	OR	97504	8491	00	None	42.318873	-122.835653	Jackson County
140699	Fee-for-Service	1568703262	1568703262	1	1	GJETLEY, JOSHUA A	1/23/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	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
140745	Fee-for-Service	1003446931	1003446931	1	1	GARCIA VALENTE, MARISOL LMF	4/16/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
140768	Fee-for-Service	1194899336	1194899336	1	1	GHALY, AZMY F	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51085	41	Internal Medicine	0	In state provider	None	1720 CESAR CHAVEZ AVE	#ZG-271	LOS ANGELES	CA	90033	0000	19	06037	34.04925	-118.2177405	Los Angeles County
140813	Fee-for-Service	1639270986	1639270986	1	1	GULLION, DAVID S MD	1/1/1992	174400000X	NA	Other	026	PHYSICIANS	16825	41	Internal Medicine	0	In state provider	None	1350 S ELISEO DR	STE 200	GREENBRAE	CA	94904	2018	21	06041	37.94490653	-122.537021	Marin County
140820	Fee-for-Service	1699033738	1699033738	1	1	GARCIA, RENEE M MD	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121059	36	Psychiatry	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
140839	Fee-for-Service	1952338881	1952338881	1	2	GALLERY, CHRISTIAN A MD	11/29/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CHILDREN & FAM MED CARE	746 MAIN ST	None	LIVINGSTON	CA	95334	1308	24	06047	37.38355907	-120.7233542	Merced County
140843	Fee-for-Service	1861061103	1861061103	1	1	GUTIERREZ-DAHER, MELANIE LM	8/13/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
140861	Fee-for-Service	1639134877	1639134877	1	1	GIPE, BRUCE MD	11/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	42382	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
140957	Fee-for-Service	1750442588	1750442588	1	1	GARCIA, MAXIMO A V LCSW	12/18/2015	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
140958	Fee-for-Service	1548281322	1548281322	1	1	GISH, ROBERT G MD	4/2/2004	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	45632	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
140966	Fee-for-Service	1609011469	1609011469	1	1	GRATIAN RICHARD W MD	12/15/2008	2080P0202X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1540 FLORIDA AVENUE	SUITE 205	MODESTO	CA	95350	4430	50	06099	37.667115	-120.9962205	Stanislaus County
140968	Fee-for-Service	1366545865	1366545865	1	1	GOLDBERG, STANLEY B MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	7540	10	Gastroenterology (M.D. only)	0	In state provider	PROF CORP	3010 COLBY ST	STE 216	BERKELEY	CA	94705	2059	01	06001	37.85492078	-122.2576101	Alameda County
140971	Fee-for-Service	1346442902	1346442902	1	1	GOEBEL, BARBARA L NP	7/31/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
140999	Fee-for-Service	1578836300	1578836300	1	1	GONELLA, ELISABETH M LMFT	1/1/2024	101YM0800X	NA	Other	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
141023	Fee-for-Service	1083776512	1083776512	1	1	GEORGE, REKHA NP	8/3/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4725 FIRST STREET	SUITE 100	PLEASANTON	CA	94566	7366	01	06001	37.65692944	-121.8767827	Alameda County
141050	Fee-for-Service	1124057450	1124057450	1	1	GRIFFIS, CHARLES A 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
141088	Fee-for-Service	1982907770	1982907770	2	1	GRAPEVINE EMERGENCY	8/2/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS MEDICAL GROUP	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3577	30	06059	33.75363187	-117.8341886	Orange County
141100	Fee-for-Service	1639270986	1639270986	1	1	GULLION, DAVID S MD	1/1/1992	174400000X	NA	Other	026	PHYSICIANS	16825	01	General Practice	0	In state provider	None	1350 S ELISEO DR	STE 200	GREENBRAE	CA	94904	2018	21	06041	37.94490653	-122.537021	Marin County
141137	Fee-for-Service	1245231018	1245231018	1	1	GIPSMAN, MARC MD	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	49418	05	Anesthesiology	0	In state provider	None	332 S JUNIPER ST	STE 108	ESCONDIDO	CA	92025	4941	37	06073	33.12066536	-117.0770413	San Diego County
141148	Fee-for-Service	1639134877	1639134877	1	1	GIPE, BRUCE MD	11/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	42382	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
141163	Fee-for-Service	1477168250	1477168250	1	1	GALVEZ, ATHENIE PT	3/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1602 A NORTH IMPERIAL AV	None	EL CENTRO	CA	92242	1319	13	06025	32.807745	-115.570006	Imperial County
141166	Fee-for-Service	1942324140	1942324140	1	1	GIBSON, HEATHER L PHD	1/13/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ON PHD	3200 TELEGRAPH RD	None	VENTURA	CA	93003	3232	56	06111	34.27239076	-119.2522635	Ventura County
141196	Fee-for-Service	1437197068	1437197068	1	1	GODOROV, GARY MD	3/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78224	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	0000	19	06037	34.040502	-118.191954	Los Angeles County
141208	Fee-for-Service	1215242656	1215242656	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	809 N AZUSA AVE	None	AZUSA	CA	91702	2510	19	06037	34.136478	-117.907539	Los Angeles County
141241	Fee-for-Service	1720210941	1720210941	1	1	GONZALES-SOLDI, TATIANA A MD	3/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114168	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
141244	Fee-for-Service	1548281322	1548281322	1	1	GISH, ROBERT G MD	4/2/2004	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	45632	08	Family Practice	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
141344	Fee-for-Service	1124129580	1124129580	1	1	GILL, SUKHPAL K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47807	45	Nephrology (Renal-Kidney)	0	In state provider	A MEDICAL CORPORATION	416 W LAS TUNAS DR	STE 200	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
141348	Fee-for-Service	1306407077	1306407077	1	1	GRUNWALD, ZACHARY D MD	7/2/2022	207P00000X	NA	Other	026	PHYSICIANS	177934	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
141361	Fee-for-Service	1710353768	1710353768	1	1	GUZMAN, BLANCA LMFT	1/21/2025	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
141380	Fee-for-Service	1457355075	1457355075	1	1	GRANT,ILHAM 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	4000 COLISEUM DR	STE 350	HAMPTON	VA	23666	0000	00	None	37.057869	-76.389579	Hampton city
141387	Fee-for-Service	1164191417	1164191417	1	2	GLEN L XIONG, MD INC	2/7/2025	207R00000X	NA	Other	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	2120 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1337	34	06067	38.558079	-121.461885	Sacramento County
141420	Fee-for-Service	1649211558	1649211558	1	1	GARFIELD BEACH CVS, LLC	12/14/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	119 S LINCOLN BLVD	None	VENICE	CA	90291	2807	19	06037	34.00225208	-118.4697744	Los Angeles County
141429	Fee-for-Service	1265522569	1265522569	1	1	GOWDA, NANDINI N MD	1/24/2021	207R00000X	NA	Other	026	PHYSICIANS	139583	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
141432	Fee-for-Service	1285351528	1285351528	1	1	GILL, KAMALJEET K NP	4/7/2023	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8150 HAGEMAN RD	None	BAKERSFIELD	CA	93312	1959	15	06029	35.40166449	-119.0933415	Kern County
141438	Fee-for-Service	1629103478	1629103478	1	1	GANS,HAYLEY MD	3/1/1998	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	76241	77	Infectious Disease	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
141453	Fee-for-Service	1316436710	1316436710	1	1	GHOMASHI, MOHAMMADJAVID MD	8/19/2021	207R00000X	NA	Other	026	PHYSICIANS	173986	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
141463	Fee-for-Service	1043957756	1043957756	1	1	GEHR, ADAM CCC-SLP	12/29/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
141483	Fee-for-Service	1811919418	1811919418	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7200 AMADOR PLAZA ROAD	None	DUBLIN	CA	94568	2320	01	06001	37.705887	-121.931469	Alameda County
141504	Fee-for-Service	1346294725	1346294725	1	1	GODDARD, ANDREW W MD	11/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132659	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
141510	Fee-for-Service	1184644858	1184644858	1	1	GARDNER, RICHARD L MD	8/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56202	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
141526	Fee-for-Service	1659507986	1659507986	1	1	GURSES, SERDA C MD	8/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105621	08	Family Practice	0	In state provider	None	18460 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
141542	Fee-for-Service	1528389681	1528389681	1	1	GAMBLE, ALEXANDER P MD	2/21/2023	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	184081	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
141555	Fee-for-Service	1992526974	1992526974	1	1	GOCO, JERICHO G OT	12/2/2024	225X00000X	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
141566	Fee-for-Service	1740225747	1740225747	1	1	GARFIELD BEACH CVS, LLC	11/30/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2101 W IMPERIAL HWY	#C	LA HABRA	CA	90631	6383	30	06059	33.91746046	-117.9691785	Orange County
141625	Fee-for-Service	1609813831	1609813831	2	1	GIAUQUE, ANTHONY MD	12/9/2024	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
141631	Fee-for-Service	1124129580	1124129580	1	1	GILL, SUKHPAL K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47807	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	416 W LAS TUNAS DR	STE 200	SAN GABRIEL	CA	91776	1236	19	06037	34.10243845	-118.1046106	Los Angeles County
141641	Fee-for-Service	1316137862	1316137862	1	1	GREGORY R KEESE M.D.	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1107 W IRONWOOD DR	None	COEUR D ALENE	ID	83814	2604	00	None	47.69682997	-116.800787	Kootenai County
141700	Fee-for-Service	1710909320	1710909320	2	1	GARFIELD BEACH CVS LLC	4/25/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7100 SANTA MONICA BLVD	STE 201	WEST HOLLYWOOD	CA	90046	5896	19	06037	34.0906467	-118.3441472	Los Angeles County
141741	Fee-for-Service	1780005363	1780005363	1	1	GONZALEZ, PRISCILLA I LCSW	8/28/2017	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
141758	Fee-for-Service	1912297169	1912297169	1	1	GE, XUPENG MD	7/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129638	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
141759	Fee-for-Service	1720221658	1720221658	1	1	GILLETT, EMILY S MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116808	29	Pulmonary Diseases (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
141784	Fee-for-Service	1609929306	1609929306	1	1	GONZALEZ, SUZANNA LCSW	9/27/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
141798	Fee-for-Service	1184644858	1184644858	1	1	GARDNER, RICHARD L MD	8/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56202	41	Internal Medicine	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
141823	Fee-for-Service	1518987387	1518987387	1	1	GILL, KAREN RICHARDSON	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	79353	40	Pediatrics	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
141828	Fee-for-Service	1477150787	1477150787	1	1	GODS LOVE OUTREACH MINISTRIE	11/30/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	S	1111 WEST TOKAY STREET	SUITE A	LODI	CA	95240	3965	39	06077	38.1263635	-121.286538	San Joaquin County
141834	Fee-for-Service	1144228180	1144228180	1	1	GROGIN, HARLAN R MD	11/5/2014	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	64014	66	Emergency Medicine (Urgent Care)	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
141928	Fee-for-Service	1790707586	1790707586	2	1	GARFIELD BEACH CVS LLC	9/28/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1050 HUNTINGTON DR	None	DUARTE	CA	91010	2475	19	06037	34.137639	-117.983493	Los Angeles County
141973	Fee-for-Service	1346566411	1346566411	1	1	GUZMAN, PABLO MD	9/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119934	05	Anesthesiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
141976	Fee-for-Service	1245205491	1245205491	1	1	GARCIA, MARIZA D MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140536	36	Psychiatry	0	In state provider	MD	1320 STANDIFORD AVE	SUITE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
142022	Fee-for-Service	1376918698	1376918698	1	1	GHAZIMORADI, CHRISTINE CCC-	11/1/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SLP	3518 JEFFERSON AVE	None	REDWOOD CITY	CA	94062	3136	41	06081	37.46715891	-122.2492205	San Mateo County
142049	Fee-for-Service	1720221658	1720221658	1	1	GILLETT, EMILY S MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116808	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
142089	Fee-for-Service	1376346742	1376346742	1	1	GOLDEN HOUSE RESIDENCE LLC	4/9/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	21 VIA ALTA VISTA	None	BONSALL	CA	92003	0000	37	06073	33.29221401	-117.2051284	San Diego County
142122	Fee-for-Service	1609253392	1609253392	1	1	GLBESC, LLC	8/21/2023	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ICAL CENTER, LONG BEACH	3833 WORSHAM AVE	200	LONG BEACH	CA	90808	1745	19	06037	33.828552	-118.1462755	Los Angeles County
142123	Fee-for-Service	1144228180	1144228180	1	1	GROGIN, HARLAN R MD	11/5/2014	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	64014	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
142172	Fee-for-Service	1407479132	1407479132	1	1	GOOD FELLOWS HOSPICE	9/24/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	1555 N VERDUGO RD	STE 202	GLENDALE	CA	91208	3208	19	06037	34.16965778	-118.2276168	Los Angeles County
142207	Fee-for-Service	1073778551	1073778551	1	1	GHOSH, PRADIPTA MD	8/14/2008	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	93281	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
142209	Fee-for-Service	1255478772	1255478772	1	1	GARCIA, RAMIRO X MD	5/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	68474	41	Internal Medicine	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	0011	01	06001	37.63347961	-122.0897735	Alameda County
142239	Fee-for-Service	1790342814	1790342814	1	1	GARCIA, GEORGINA LMFT	7/1/2023	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
142246	Fee-for-Service	1487879870	1487879870	1	1	GARRETT SCHROEDER MD	10/17/2012	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
142248	Fee-for-Service	1316464530	1316464530	1	1	GLENN, MARA LCSW	3/24/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	145 EAST LIVE OAK	UNIT # F	ARCADIA	CA	91001	5246	19	06037	34.10813818	-118.0259008	Los Angeles County
142273	Fee-for-Service	1285666529	1285666529	1	1	GALT, CYNTHIA CCC-SLP	12/13/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	OF SAN JOSE	3880 S BASCOM AVE STE 11	None	SAN JOSE	CA	95124	2600	43	06085	37.25942826	-121.9471504	Santa Clara County
142299	Fee-for-Service	1255338562	1255338562	1	1	GALANTE, JOSEPH M MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79118	02	General Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
142303	Fee-for-Service	1932658010	1932658010	1	1	GOLDEN STATE HOMES INC	1/10/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1409 N NORMANDIE AVENUE	None	LOS ANGELES	CA	90027	5817	19	06037	34.09702451	-118.3005383	Los Angeles County
142314	Fee-for-Service	1922083401	1922083401	1	1	GUNTHER, PHILLIP MD	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	None	ENGLEWOOD	CO	80112	3861	00	None	39.58449488	-104.8639802	Arapahoe County
142322	Fee-for-Service	1891725438	1891725438	1	1	GENTILE, LANCE A MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	35905	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
142336	Fee-for-Service	1942204409	1942204409	1	1	GHODSIAN, KAMRAN MD	11/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	41039	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3150 BRISTOL ST	STE 100	COSTA MESA	CA	92626	7300	30	06059	33.68601312	-117.8854624	Orange County
142360	Fee-for-Service	1467052282	1467052282	1	1	GRUBB, CRYSTEN CNP	8/23/2022	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
142394	Fee-for-Service	1063519858	1063519858	1	1	GETTYSBURG MEDICAL CLINIC	2/28/1995	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5088 N FRESNO ST	SUITE B	FRESNO	CA	93710	7611	10	06019	36.810081	-119.781342	Fresno County
142424	Fee-for-Service	1548568421	1548568421	1	7	GOLDEN VALLEY HEALTH CENTERS	1/19/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	645 7TH STREET	None	LOS BANOS	CA	93635	3740	24	06047	37.06223492	-120.8451098	Merced County
142434	Fee-for-Service	1477612125	1477612125	1	1	GOCHMAN, GARY A MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59627	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
142461	Fee-for-Service	1407479132	1407479132	1	1	GOOD FELLOWS HOSPICE	9/24/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	1555 N VERDUGO RD	STE 202	GLENDALE	CA	91208	3208	19	06037	34.16965778	-118.2276168	Los Angeles County
142470	Fee-for-Service	1972709079	1972709079	1	1	GARCIA-VARGAS, LILIANA P MD	7/8/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	158391	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
142485	Fee-for-Service	1528234424	1528234424	1	1	GRABOWSKI & ASSOCIATES	9/15/2008	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	INC	5340 ELVAS AVE	STE 700	SACRAMENTO	CA	95819	2380	34	06067	38.574819	-121.434867	Sacramento County
142495	Fee-for-Service	1669409512	1669409512	1	1	GUNDOGAN, FUSUN MD	8/13/2021	207ZP0101X	NA	Other	026	PHYSICIANS	172771	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
142513	Fee-for-Service	1265560056	1265560056	1	1	GARLAND, ELYSIA LCSW	4/17/2022	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
142567	Fee-for-Service	1346249968	1346249968	1	1	GUADALUPE COUNTY HOSPITAL	4/14/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	117 CAMINO DE VIDA	None	SANTA ROSA	NM	88435	2267	00	None	34.92945139	-104.6937613	Guadalupe County
142569	Fee-for-Service	1558317933	1558317933	1	1	GUADIZ, JESSE L MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53509	08	Family Practice	0	In state provider	None	1851 N RIVERSIDE AVE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
142604	Fee-for-Service	1649498759	1649498759	1	1	GARRIDO, KIMBERLY A DPM	2/1/1998	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9400 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
142631	Fee-for-Service	1619982097	1619982097	1	1	GEORGE, CHRISTIANE DO	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8208	01	General Practice	0	In state provider	None	2071 E HERNDON	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
142648	Fee-for-Service	1184170888	1184170888	1	1	GENTLE HEALING/CARE INC	5/11/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	217 EAST ALAMEDA AVE	STE 302	BURBANK	CA	91502	1500	19	06037	34.17516147	-118.2991383	Los Angeles County
142679	Fee-for-Service	1154373280	1154373280	1	1	GASTROENTEROLOGY CONSUL	1/26/1987	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MED GRP	23 UPPER RAGSDALE DR	STE 200	MONTEREY	CA	93940	5771	27	06053	36.57529358	-121.8101334	Monterey County
142688	Fee-for-Service	1417192295	1417192295	1	1	GALLAGHER, GABRIEL L MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120671	05	Anesthesiology	0	In state provider	None	PUEBLO AT BATH STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.430526	-119.72196	Santa Barbara County
142701	Fee-for-Service	1710935127	1710935127	1	1	GUTOWSKI, TOMASZ D MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68028	02	General Surgery	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
142705	Fee-for-Service	1821033721	1821033721	1	1	GARFIELD BEACH CVS LLC	8/10/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19121 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2307	30	06059	33.685155	-117.988868	Orange County
142710	Fee-for-Service	1548568421	1548568421	1	7	GOLDEN VALLEY HEALTH CENTERS	1/19/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	645 7TH STREET	None	LOS BANOS	CA	93635	3740	24	06047	37.06223492	-120.8451098	Merced County
142712	Fee-for-Service	1881986412	1881986412	1	1	GERGIS-AQUINO, AMAL A DO	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11700	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
142713	Fee-for-Service	1619953403	1619953403	1	1	GREGORY, JUAN C MD	8/22/2005	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
142720	Fee-for-Service	1477612125	1477612125	1	1	GOCHMAN, GARY A MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59627	22	Pathology (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
142757	Fee-for-Service	1417292715	1417292715	1	1	GALVAN, JOAQUIN CRNA	11/28/2016	No Taxonomy Provided	NA	None	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
142808	Fee-for-Service	1487651519	1487651519	1	1	GARY D VOLENTINE	12/12/2017	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
142831	Fee-for-Service	1245262716	1245262716	1	1	GUDAPATI, SURENDRA B MD	6/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	76026	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
142850	Fee-for-Service	1649479809	1649479809	1	1	GUTIERREZ, ELIZABETH N MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	101212	26	Psychiatry (child)	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
142872	Fee-for-Service	1164765244	1164765244	1	1	GOLDBERG, BRADLEY S MD	7/1/2019	207PP0204X	NA	Other	026	PHYSICIANS	147964	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
142920	Fee-for-Service	1790152692	1790152692	1	1	GARCIA, LETICIA T LCSW	7/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
142987	Fee-for-Service	1881172344	1881172344	1	1	GOLDFEIN, LISA LPCC	1/30/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	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
143020	Fee-for-Service	1831135995	1831135995	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1676 W KATELLA AVE	None	ANAHEIM	CA	92802	3015	30	06059	33.80306838	-117.9406048	Orange County
143092	Fee-for-Service	1477691459	1477691459	1	1	GARZ, JULIE D CNM	3/5/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
143135	Fee-for-Service	1811170046	1811170046	1	1	GLADYS E PALOMENO MD INC	2/5/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	None	None	0	In state provider	None	28633 S WESTERN AVE	202	RANCHO PALOS VERD	CA	90275	0827	19	06037	33.75972936	-118.3126952	Los Angeles County
143139	Fee-for-Service	1649479809	1649479809	1	1	GUTIERREZ, ELIZABETH N MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	101212	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
143140	Fee-for-Service	1144759556	1144759556	1	1	GONICMAN, YAEL	10/7/2024	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
143157	Fee-for-Service	1225613995	1225613995	1	1	GILL, MANDEEP CRNA	4/21/2021	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
143169	Fee-for-Service	1285753566	1285753566	1	1	GOSS, SARAH H	5/14/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5199 E PACIFIC COAST HW	STE 511	LONG BEACH	CA	90804	3375	19	06037	33.78293818	-118.1329326	Los Angeles County
143186	Fee-for-Service	1700807393	1700807393	1	2	GREWAL, KULJINDER S MD	2/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	34108	18	Ophthalmology	0	In state provider	None	534 S 8TH ST	None	EL CENTRO	CA	92243	3214	13	06025	32.78811312	-115.5613947	Imperial County
143212	Fee-for-Service	1366932063	1366932063	1	1	GOMEZ, AMANDA LMFT	2/24/2023	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
143292	Fee-for-Service	1568665842	1568665842	1	1	GHODSI, SUSAN OD	9/17/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4255 CAMPUS DR.	SUITE A110	IRVINE	CA	92612	8627	30	06059	33.64910596	-117.8394276	Orange County
143307	Fee-for-Service	1114959798	1114959798	1	1	GHAHREMANI, GARY G MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50431	30	Radiology	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
143323	Fee-for-Service	1154855229	1154855229	1	1	GILL, HARMANJOT K MD	4/13/2021	208M00000X	NA	Other	026	PHYSICIANS	170728	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
143373	Fee-for-Service	1962633966	1962633966	1	1	GOVARTHANAN RAJENDIRAN	3/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
143377	Fee-for-Service	1992972715	1992972715	1	1	GO, WILLIAM A MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	62008	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
143382	Fee-for-Service	1487711875	1487711875	1	1	GENOVESE, MARK C MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	52149	83	Rheumatology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
143391	Fee-for-Service	1023024932	1023024932	1	1	GONZALEZ, SALVADOR A MD	4/30/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60322	08	Family Practice	0	In state provider	None	1350 S ORANGE AVE	None	FRESNO	CA	93702	3463	10	06019	36.728883	-119.763677	Fresno County
143398	Fee-for-Service	1003888132	1003888132	1	1	GRADY, STAFFORD R JR MD	9/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	47262	40	Pediatrics	0	In state provider	None	1688 WILLOW ST	STE C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
143449	Fee-for-Service	1669972386	1669972386	1	1	GIBBONS, NIKI L LMFT	9/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	369 PERKINS ST	None	SONOMA	CA	95476	6826	49	06097	38.28899026	-122.4655418	Sonoma County
143493	Fee-for-Service	1902037047	1902037047	1	1	GUPTA, MRINALI P MD	3/20/2020	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	167497	18	Ophthalmology	0	In state provider	None	2010 E FIRST STREET	SUITE 140	SANTA ANA	CA	92705	4086	30	06059	33.74554507	-117.8387522	Orange County
143520	Fee-for-Service	1386698181	1386698181	1	1	GAGE, MICHAEL L MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86864	40	Pediatrics	0	In state provider	None	1524 W LACEY BLVD	SUITE 104	HANFORD	CA	93230	5965	16	06031	36.32816338	-119.6690189	Kings County
143543	Fee-for-Service	1144512336	1144512336	1	1	GHOLKAR, NEIL A MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125764	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
143556	Fee-for-Service	1558662445	1558662445	1	1	GALLICCHIO, COLLEEN L PSYD	11/4/2022	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	27281 LAS RAMBLAS	STE 200	MISSION VIEJO	CA	92691	8303	30	06059	33.56652088	-117.668662	Orange County
143596	Fee-for-Service	1649486994	1649486994	1	1	GUMIDYALA, KRISHNA V MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108709	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
143614	Fee-for-Service	1750443818	1750443818	1	1	GOLD, JETH D 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
143626	Fee-for-Service	1972193498	1972193498	1	1	GEMELGA, GERARD CRNA	2/8/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
143648	Fee-for-Service	1871603878	1871603878	1	1	GOGIA, JASPAUL MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97055	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
143684	Fee-for-Service	1003888132	1003888132	1	1	GRADY, STAFFORD R JR MD	9/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	47262	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	1688 WILLOW ST	STE C	SAN JOSE	CA	95125	5109	43	06085	37.30345662	-121.9161453	Santa Clara County
143753	Fee-for-Service	1184821761	1184821761	1	1	GEOFFREY M HIRSCHBERG	3/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	98-1079 MOANALUA RD	None	AIEA	HI	96701	4713	00	None	21.38373524	-157.937629	Honolulu County
143765	Fee-for-Service	1821555087	1821555087	1	1	GROAT, STACIE B PT	5/18/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	19066 MAGNOLIA ST	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
143827	Fee-for-Service	1306454988	1306454988	1	1	GERKEN, HAYLEY LPCC	1/21/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
143830	Fee-for-Service	1740784495	1740784495	1	1	GAETA, XAVIER MD	8/22/2024	2080P0210X	NA	Nephrology	026	PHYSICIANS	164505	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
143864	Fee-for-Service	1588735559	1588735559	1	1	GLOWALLA, MICHAEL B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32342	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
143881	Fee-for-Service	1255430815	1255430815	1	1	GAEDE, JAMES E MD	8/19/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	86232	08	Family Practice	0	In state provider	None	150 N ROBERTSON DR	STE 300	BEVERLY HILLS	CA	90211	2145	19	06037	34.06812722	-118.3837146	Los Angeles County
143882	Fee-for-Service	1952353435	1952353435	1	1	GENERAL SURGICAL CONSUL	10/30/1995	208600000X	NA	General Surgery	026	PHYSICIANS	-	None	None	1	Border provider	CHONG,DENNIS MD	10001 SO EASTERN AVE	STE 206	LAS VEGAS	NV	89052	3908	00	None	36.006207	-115.1133392	Clark County
143906	Fee-for-Service	1629051008	1629051008	1	1	GRIFFIS, MICHAEL D MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73215	08	Family Practice	0	In state provider	None	68860 PEREZ RD	STE J	CATHEDRAL CITY	CA	92234	7248	33	06065	33.78351921	-116.4604447	Riverside County
143922	Fee-for-Service	1538190046	1538190046	1	1	GONZALEZ, ABIGAIL LMFT	3/10/2020	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
143934	Fee-for-Service	1609941806	1609941806	1	1	GARGAS, JESSIE L MD	6/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85447	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
143938	Fee-for-Service	1265840755	1265840755	1	1	GOODING, AMANDA L PHD	4/18/2017	103T00000X	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
143940	Fee-for-Service	1881600781	1881600781	1	1	GARCIA, MARTHA G MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61293	08	Family Practice	0	In state provider	None	2502 JENSEN AVE	None	SANGER	CA	93657	2250	10	06019	36.70680549	-119.572011	Fresno County
143972	Fee-for-Service	1801376389	1801376389	1	1	GOODRICH, LEIGH MD	2/9/2021	390200000X	NA	Other	026	PHYSICIANS	164709	None	None	0	In state provider	None	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
143979	Fee-for-Service	1891942355	1891942355	1	1	GOPAVARAM, DEEPA MD	4/22/2020	207R00000X	NA	Other	026	PHYSICIANS	165112	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
144009	Fee-for-Service	1134573108	1134573108	1	1	GALE, DARLA L LMFT	7/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6135 KING RD	SUITE D	LOOMIS	CA	95650	8877	31	06061	38.8251327	-121.1892156	Placer County
144147	Fee-for-Service	1396122073	1396122073	1	1	GOVAN, RIKESH S MD	7/20/2019	207L00000X	NA	Other	026	PHYSICIANS	159561	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
144163	Fee-for-Service	1528219110	1528219110	1	1	GAMAN-BEAN, SHAYNA K MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101793	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
144194	Fee-for-Service	1629051008	1629051008	1	1	GRIFFIS, MICHAEL D MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73215	38	Geriatrics	0	In state provider	None	68860 PEREZ RD	STE J	CATHEDRAL CITY	CA	92234	7248	33	06065	33.78351921	-116.4604447	Riverside County
144218	Fee-for-Service	1669779179	1669779179	1	1	GONZALES, PATRICK C MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120040	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3021	07	06013	37.9141514	-122.0422089	Contra Costa County
144230	Fee-for-Service	1790895639	1790895639	1	1	GABIKIAN, PATRIK MD	11/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126166	14	Neurological Surgery	0	In state provider	None	4760 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
144282	Fee-for-Service	1033264148	1033264148	1	1	GALE, MARVIN L MD	4/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24816	40	Pediatrics	0	In state provider	None	340 4TH AVE	STE 12	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
144288	Fee-for-Service	1144243601	1144243601	1	1	GAW, FELIX R MD INC	5/1/1999	208600000X	NA	General Surgery	026	PHYSICIANS	52839	02	General Surgery	0	In state provider	FELIX R. GAW MD INC	1211 W LA PALMA AVE	STE 209	ANAHEIM	CA	92801	2881	30	06059	33.84718298	-117.933758	Orange County
144304	Fee-for-Service	1346262136	1346262136	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14920 RAYMER ST	None	VAN NUYS	CA	91405	1146	19	06037	34.21322203	-118.4592163	Los Angeles County
144360	Fee-for-Service	1427058114	1427058114	1	1	GODAMBE, SANDIP A MD	9/1/2021	2080P0204X	NA	Other	026	PHYSICIANS	174599	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
144373	Fee-for-Service	1366656217	1366656217	1	1	GORMAN, SHARON L	5/19/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	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
144407	Fee-for-Service	1174565451	1174565451	1	1	GOLDMAN, MINDY ELLEN MD	6/30/1991	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	70292	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	# M1490	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
144413	Fee-for-Service	1063778272	1063778272	1	1	GASHO, CHRISTOPHER J MD	4/20/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	136882	None	None	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
144476	Fee-for-Service	1821199860	1821199860	1	1	GURURAJ, SANDHYA W MD	1/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
144480	Fee-for-Service	1902340144	1902340144	1	1	GRAF, ALEXANDER S	7/31/2017	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
144493	Fee-for-Service	1497036255	1497036255	1	1	GHORBANPOUR-SARAVI, MAJID MD	6/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152879	41	Internal Medicine	0	In state provider	None	2261 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3831	31	06061	38.74434897	-121.2413247	Placer County
144537	Fee-for-Service	1063771798	1063771798	1	1	GORDIAN MEDICAL II INC	12/27/2016	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	5834 LOUETTA ROAD	STE D	SPRING	TX	77379	7884	00	None	30.03132109	-95.50513228	Harris County
144539	Fee-for-Service	1982782678	1982782678	1	1	GERAGHTY, JOHN J MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42775	13	Neurology (M.D. only)	0	In state provider	None	3272 FORTUNE CT	None	AUBURN	CA	95602	7847	31	06061	38.94353165	-121.1017627	Placer County
144570	Fee-for-Service	1720042336	1720042336	1	1	GURSAHANI, MANMOHAN MD	1/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	51339	34	Urology and Urological Surgery	0	In state provider	None	1211 W LA PALMA AVE	STE 502	ANAHEIM	CA	92801	2812	30	06059	33.84718298	-117.933758	Orange County
144586	Fee-for-Service	1861126427	1861126427	1	1	GONZALEZ, ALEJANDRA LCSW	7/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
144588	Fee-for-Service	1912452368	1912452368	1	1	GOMEZ, CHLOE R CRNA	10/24/2016	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
144597	Fee-for-Service	1790217594	1790217594	1	1	GUERRERO MCCORMICK, KIANA C	1/26/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158485	None	None	0	In state provider	MD	19270 SONOMA HIGHWAY 12	None	SONOMA	CA	95476	5414	49	06097	38.29871411	-122.4751509	Sonoma County
144622	Fee-for-Service	1245682178	1245682178	1	1	GUAJARDO, LAUREN R OD	12/21/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 211	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
144672	Fee-for-Service	1225123821	1225123821	1	1	GOLDMAN, DONALD G MD	10/31/1983	208800000X	NA	Other	026	PHYSICIANS	39633	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 PACIFIC ST	None	MONTEREY	CA	93940	2819	27	06053	36.59463401	-121.8978403	Monterey County
144691	Fee-for-Service	1659648384	1659648384	1	1	GRACE WONG MD INC	4/3/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3808 W RIVERSIDE DR	SUITE 201	BURBANK	CA	91505	4339	19	06037	34.15252315	-118.3412174	Los Angeles County
144786	Fee-for-Service	1538387329	1538387329	1	1	GIES, MARJORIE S MD	2/22/2019	2084P0015X	NA	Psychiatry	086	MEDICAL DIRECTORS	69796	-	NOT APPLICABLE	0	In state provider	None	205 W MISSION ST	None	SANTA BARBARA	CA	93101	2820	42	06083	34.42839976	-119.7170978	Santa Barbara County
144793	Fee-for-Service	1467488528	1467488528	1	1	GIZA, CHRISTOPHER C MD	3/1/2001	2080P0008X	NA	Neurology	026	PHYSICIANS	74189	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
144816	Fee-for-Service	1962974956	1962974956	1	1	GOLDING, IAN F MD	2/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	157929	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
144859	Fee-for-Service	1750572020	1750572020	1	1	GORDON, L STEPHEN MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	12458	40	Pediatrics	0	In state provider	CHILDRENS CARDIAC MED CL	301 W HUNTINGTON DR	STE 415	ARCADIA	CA	91007	1506	19	06037	34.13481053	-118.0425638	Los Angeles County
144907	Fee-for-Service	1518115146	1518115146	1	1	GUEVARA, ANNA LIZZA L MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106138	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
144917	Fee-for-Service	1285038828	1285038828	1	1	GORMLEY, ERICA N LMFT	1/24/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1160 SUNSET BLVD	None	ROCKLIN	CA	95677	3772	31	06061	38.8125	-121.2848698	Placer County
144935	Fee-for-Service	1831264845	1831264845	1	1	GARVIN, CINZIA I LCSW	3/10/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47813376	-122.7279674	Sonoma County
144958	Fee-for-Service	1225123821	1225123821	1	1	GOLDMAN, DONALD G MD	10/31/1983	208800000X	NA	Other	026	PHYSICIANS	39633	34	Urology and Urological Surgery	0	In state provider	None	757 PACIFIC ST	None	MONTEREY	CA	93940	2819	27	06053	36.59463401	-121.8978403	Monterey County
144984	Fee-for-Service	1912103318	1912103318	1	1	GUMMADAPU, RAGINI MD	9/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97735	01	General Practice	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
145005	Fee-for-Service	1386849776	1386849776	1	1	GONZALEZ, PATRICIA C CRNA	7/29/2020	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
145080	Fee-for-Service	1467488528	1467488528	1	1	GIZA, CHRISTOPHER C MD	3/1/2001	2080P0008X	NA	Neurology	026	PHYSICIANS	74189	79	Neurology-Child	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
145128	Fee-for-Service	1295795805	1295795805	1	1	GENCARELLI, PETER MD	7/3/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	38133	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
145146	Fee-for-Service	1750572020	1750572020	1	1	GORDON, L STEPHEN MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	12458	35	Pediatric Cardiology (M.D. only)	0	In state provider	CHILDRENS CARDIAC MED CL	301 W HUNTINGTON DR	STE 415	ARCADIA	CA	91007	1506	19	06037	34.13481053	-118.0425638	Los Angeles County
145196	Fee-for-Service	1285083766	1285083766	1	1	GUY, MEGAN OT	1/29/2020	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W ARROW HWY	130	SAN DIMAS	CA	91773	2330	19	06037	34.10677054	-117.8331379	Los Angeles County
145293	Fee-for-Service	1629297338	1629297338	1	1	GURNEY, THERESA A MD	12/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91520	04	Otology, Laryngology, Rhinology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
145297	Fee-for-Service	1316190572	1316190572	1	1	GERSHMAN, LISA N MD	5/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112107	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
145329	Fee-for-Service	1316095227	1316095227	1	1	GANGULY, ARNAB MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75714	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
145366	Fee-for-Service	1588044028	1588044028	1	2	GOLDEN WAY CARE INC	2/27/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	15453 ELM LANE	None	CHINO HILLS	CA	91709	2029	36	06071	33.97262216	-117.7155882	San Bernardino County
145367	Fee-for-Service	1851553705	1851553705	1	1	GHISLETTA, LESLIE MD	3/31/2020	2086S0102X	NA	General Surgery	026	PHYSICIANS	146374	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
145369	Fee-for-Service	1629081252	1629081252	1	1	GIARDINI, ALYSON M LMFT	11/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9214 MARYSVILLE RD	None	OREGON HOUSE	CA	95962	9705	58	06115	39.3639952	-121.2510529	Yuba County
145370	Fee-for-Service	1235123373	1235123373	1	1	GROSSER, JEREMY I MD	9/27/2022	207R00000X	NA	Other	026	PHYSICIANS	67128	None	None	0	In state provider	None	7836 RESEDA BLVD	None	RESEDA	CA	91335	1902	19	06037	34.21305947	-118.536035	Los Angeles County
145382	Fee-for-Service	1467759043	1467759043	1	1	GONZALEZ, JOSEPH D MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115813	40	Pediatrics	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
145397	Fee-for-Service	1497759856	1497759856	1	1	GHC OF NATIONAL CITY II	2/2/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CASTLE MANOR CONV CTR	541 S V AVE	None	NATIONAL CITY	CA	91950	2828	37	06073	32.68429314	-117.0852037	San Diego County
145410	Fee-for-Service	1417953035	1417953035	1	1	GEIS, LINDA C MD	2/3/2023	207L00000X	NA	Other	026	PHYSICIANS	54992	None	None	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
145431	Fee-for-Service	1174704324	1174704324	1	1	GABOT, MARK H CRNA	5/25/2011	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
145445	Fee-for-Service	1720060593	1720060593	1	1	G.T.S. HOME HEALTH SERVICES	7/1/2024	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	13363 SATICOY ST	SUITE 101	NORTH HOLLYWOOD	CA	91605	3400	19	06037	34.2086537	-118.424562	Los Angeles County
145478	Fee-for-Service	1568244648	1568244648	1	1	GIVE FOR A SMILE	10/21/2024	172V00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	10861 ACACIA PKWY	None	GARDEN GROVE	CA	92840	5103	30	06059	33.7760549	-117.9426733	Orange County
145485	Fee-for-Service	1669418810	1669418810	1	1	GROSSNICKLE, DOUGLAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	19300 SW 65TH AVE	None	TUALATIN	OR	97062	7706	00	None	45.378774	-122.740551	Clackamas County
145506	Fee-for-Service	1508185851	1508185851	1	1	GARG, AMIT, K MD	3/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111127	78	Neoplastic Diseases/Oncology	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
145536	Fee-for-Service	1497858906	1497858906	1	1	GHARGHOURY, AYAD M MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50604	None	None	0	In state provider	None	58383 29 PALMS HWY	# 100	YUCCA VALLEY	CA	92284	5805	36	06071	34.13159539	-116.3901072	San Bernardino County
145579	Fee-for-Service	1336427798	1336427798	1	1	GARBER, BEVERLY B NP	5/17/2018	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
145605	Fee-for-Service	1689717472	1689717472	1	1	GUSTAFSON, CHARLES L LMFT	9/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	599 S BARRANCA AVE	STE 224	COVINA	CA	91723	2785	19	06037	34.079373	-117.881338	Los Angeles County
145614	Fee-for-Service	1275723629	1275723629	1	1	GREATER LONG BEACH	9/1/1996	174400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	ORTHOPAEDIC SURG/MED GRP	3801 KATELLA AVE	STE 130	LOS ALAMITOS	CA	90720	3362	30	06059	33.80318951	-118.066068	Orange County
145619	Fee-for-Service	1316095227	1316095227	1	1	GANGULY, ARNAB MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75714	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
145640	Fee-for-Service	1477598365	1477598365	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5900 TELEGRAPH RD	None	VENTURA	CA	93003	4300	56	06111	34.27802718	-119.2142839	Ventura County
145654	Fee-for-Service	1851553705	1851553705	1	1	GHISLETTA, LESLIE MD	3/31/2020	2086S0102X	NA	General Surgery	026	PHYSICIANS	146374	89	Surgery-Traumatic	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
145669	Fee-for-Service	1356466692	1356466692	1	1	GISIS, VERA M MSW LCSW	1/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16260 VENTURA BLVD	LL30	ENCINO	CA	91436	4590	19	06037	34.15687678	-118.4876342	Los Angeles County
145711	Fee-for-Service	1851774236	1851774236	1	1	GOLDEN STATE HEALTH CARE INC	6/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	10600	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3150 G STREET	SUITE C	MERCED	CA	95340	1346	24	06047	37.32054811	-120.4691942	Merced County
145740	Fee-for-Service	1649284670	1649284670	1	2	GIRGIS, GEORGE I MD	9/28/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	43715	-	NOT APPLICABLE	0	In state provider	None	1018 21ST STREET	None	BAKERSFIELD	CA	93301	4709	15	06029	35.37813217	-119.0132767	Kern County
145780	Fee-for-Service	1164898078	1164898078	1	2	GARDLEY, NIMRA LMFT	1/9/2020	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
145783	Fee-for-Service	1194851642	1194851642	1	1	GUILLEN, LETICIA	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
145906	Fee-for-Service	1003477191	1003477191	1	1	GHANNADI, SHEILA MD	8/30/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179076	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
145913	Fee-for-Service	1720148612	1720148612	1	1	GOSWAMI, SANJEEV K MD	3/7/2008	207R00000X	NA	Other	026	PHYSICIANS	88835	41	Internal Medicine	0	In state provider	None	1801 E. MARCH LANE	STE C300	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
145916	Fee-for-Service	1184602872	1184602872	1	1	GERST, SCOTT R MD	4/27/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185143	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
145966	Fee-for-Service	1063905347	1063905347	1	1	GLASKER, DREXZELL L NP	12/18/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1313 W 8TH ST	STE 100	LOS ANGELES	CA	90017	4420	19	06037	34.05048998	-118.269586	Los Angeles County
145991	Fee-for-Service	1356403984	1356403984	1	1	GIMIAN, JIANNE F PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
145992	Fee-for-Service	1235842683	1235842683	1	1	GONZALEZ, VANESSA OD	8/13/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11245 E WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
146040	Fee-for-Service	1104865153	1104865153	1	1	GHAZVINI, ALI MD	1/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	80873	41	Internal Medicine	0	In state provider	None	2742 DOW AVENUE	None	TUSTIN	CA	92780	7242	30	06059	33.71200542	-117.8088951	Orange County
146073	Fee-for-Service	1306170469	1306170469	1	1	GIESEMANN, LESLIE A MD APC	7/20/2009	2086S0127X	NA	General Surgery	026	PHYSICIANS	62713	02	General Surgery	0	In state provider	None	7090 MIRAMAR RD	# A-102	SAN DIEGO	CA	92121	2349	37	06073	32.87907456	-117.1630573	San Diego County
146076	Fee-for-Service	1053499731	1053499731	1	1	GAJENDRAN, VISWANATHAN	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69056	34	Urology and Urological Surgery	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
146131	Fee-for-Service	1417077983	1417077983	1	1	GHAJARNIA, M MEDHI MD	9/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103681	18	Ophthalmology	0	In state provider	None	1360 E HERNDON	STE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
146141	Fee-for-Service	1053462606	1053462606	1	1	GROSSMAN, ROBERT A MD	3/5/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	39997	None	None	0	In state provider	None	215 JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
146176	Fee-for-Service	1902246713	1902246713	1	1	GARRIDO, MICHELLE M MD	5/5/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	134221	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
146199	Fee-for-Service	1720148612	1720148612	1	1	GOSWAMI, SANJEEV K MD	3/7/2008	207R00000X	NA	Other	026	PHYSICIANS	88835	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 E. MARCH LANE	STE C300	STOCKTON	CA	95210	6676	39	06077	38.00315652	-121.2868715	San Joaquin County
146235	Fee-for-Service	1821048240	1821048240	1	1	GRANDISON, LYNETTE R MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	77970	40	Pediatrics	0	In state provider	None	2615 E WHITMORE AVE	None	CERES	CA	95307	2741	50	06099	37.5948033	-120.9466227	Stanislaus County
146251	Fee-for-Service	1487623906	1487623906	1	1	GEN, MICHAEL W MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87239	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1207 E HERNDON AVE	None	FRESNO	CA	93720	3235	10	06019	36.836829	-119.767298	Fresno County
146258	Fee-for-Service	1285124172	1285124172	1	1	GILFORD, MATTHEW D LMFT	4/1/2019	1041C0700X	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
146292	Fee-for-Service	1215077367	1215077367	1	1	GORE, PAUL PHD	8/21/2008	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8405 BEVERLY BLVD	None	LOS ANGELES	CA	90048	3476	19	06037	34.07607952	-118.373418	Los Angeles County
146306	Fee-for-Service	1144630617	1144630617	1	1	GLIVAR, PHILLIP J MD	8/22/2020	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	139186	20	Orthopedic Surgery	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 200	RIVERSIDE	CA	92505	8510	33	06065	33.90290859	-117.4941562	Riverside County
146327	Fee-for-Service	1003123670	1003123670	1	1	GASPARYAN, SRPOUHI MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113750	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
146328	Fee-for-Service	1871642736	1871642736	1	1	GENTRY, ELECTRA U LCSW	3/5/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
146359	Fee-for-Service	1306170469	1306170469	1	1	GIESEMANN, LESLIE A MD APC	7/20/2009	2086S0127X	NA	General Surgery	026	PHYSICIANS	62713	89	Surgery-Traumatic	0	In state provider	None	7090 MIRAMAR RD	# A-102	SAN DIEGO	CA	92121	2349	37	06073	32.87907456	-117.1630573	San Diego County
146382	Fee-for-Service	1760638662	1760638662	1	1	GOLDBERG, OLGA F MD	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105530	13	Neurology (M.D. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
146388	Fee-for-Service	1730343344	1730343344	1	1	GUPTA, CARMEN V MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124838	08	Family Practice	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
146391	Fee-for-Service	1194570911	1194570911	1	1	GUINTO, MERISSA MAREI B NP	7/23/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
146403	Fee-for-Service	1194820423	1194820423	2	1	GOLDMAN, I SCOTT MD	9/29/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42592	20	Orthopedic Surgery	0	In state provider	None	400 N MOUNTAIN AVE	STE 310	UPLAND	CA	91786	5182	36	06071	34.098489	-117.670074	San Bernardino County
146417	Fee-for-Service	1912281015	1912281015	1	1	GARCIA, CINDY MD	10/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130165	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
146452	Fee-for-Service	1972618247	1972618247	1	1	GALINKIN, JEFFREY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	1056 E 19TH AVE	None	DENVER	CO	80218	1007	00	None	39.74608265	-104.9738482	Denver County
146486	Fee-for-Service	1891121109	1891121109	1	1	GIRE-DUMAS, ARIELLE J MD	10/12/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147551	None	None	0	In state provider	None	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
146495	Fee-for-Service	1467639047	1467639047	1	1	GOOD EYE INC	4/19/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11718 BARRINGTON CT	None	LOS ANGELES	CA	90049	2930	19	06037	34.06429033	-118.4695409	Los Angeles County
146583	Fee-for-Service	1992761118	1992761118	1	1	GUBBALA, SUNITHA MD	2/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	79120	41	Internal Medicine	0	In state provider	None	2410 SAMARITAN DR	STE 201	SAN JOSE	CA	95124	3909	43	06085	37.25107654	-121.9451342	Santa Clara County
146595	Fee-for-Service	1831154673	1831154673	1	1	GURSAHANI, PUSHPA MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51340	None	None	0	In state provider	None	2021 DIVISADERO ST	None	FRESNO	CA	93701	2013	10	06019	36.74332969	-119.7864594	Fresno County
146621	Fee-for-Service	1508916859	1508916859	2	1	GARFIELD BEACH CVS LLC	6/21/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4200 E 4TH ST	None	ONTARIO	CA	91764	5250	36	06071	34.075701	-117.5618295	San Bernardino County
146631	Fee-for-Service	1871580480	1871580480	2	1	GREENFIELD CARE CTR FULLERTN	6/1/2003	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	330 W BASTANCHURY RD	None	FULLERTON	CA	92835	3403	30	06059	33.89354453	-117.9326311	Orange County
146645	Fee-for-Service	1467985762	1467985762	1	1	GUILLAUME, ALEXANDER W	8/24/2020	207P00000X	NA	Other	026	PHYSICIANS	157177	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
146675	Fee-for-Service	1871591099	1871591099	1	1	GREEN, WILLIAM MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27289	08	Family Practice	0	In state provider	None	3860 SADDLE RD	None	SOUTH LAKE TAHOE	CA	96150	8673	09	06017	38.934261	-119.9399445	El Dorado County
146713	Fee-for-Service	1710962865	1710962865	1	2	GLENDALE EYE MEDICAL GROUP	1/26/2004	No Taxonomy Provided	NA	None	023	GROUP 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
146723	Fee-for-Service	1982011953	1982011953	1	1	GARFIELD BEACH CVS LLC	5/4/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1795 E LUGONIA AVE	None	REDLANDS	CA	92374	2723	36	06071	34.07013548	-117.139338	San Bernardino County
146735	Fee-for-Service	1528041811	1528041811	1	3	GROSSMONT HOSPITAL CORPORATI	2/15/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	8851 CENTER DRIVE	SUITE 600	LA MESA	CA	91942	3061	37	06073	32.78189749	-117.0075062	San Diego County
146743	Fee-for-Service	1851385124	1851385124	1	1	GOLDSTEIN, DAWN R MD	8/27/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61718	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2190 LYNN RD	STE 300	THOUSAND OAKS	CA	91360	8024	56	06111	34.20728091	-118.8855456	Ventura County
146759	Fee-for-Service	1235709411	1235709411	1	1	GANT, STEPHEN M PT	12/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8545 SIERRA AVE	None	FONTANA	CA	92335	3868	36	06071	34.09849683	-117.4356608	San Bernardino County
146795	Fee-for-Service	1881915627	1881915627	1	1	GHANEVATI, MAHIN DO	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12583	01	General Practice	0	In state provider	None	191 S BUENA VISTA ST	STE 200	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
146796	Fee-for-Service	1700554102	1700554102	1	1	GARCIA, JAYNELLE MAY AU	1/10/2025	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
146825	Fee-for-Service	1740449727	1740449727	1	1	GHASEMI VARNAMKHASTI, MANIJE	11/15/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	135712	08	Family Practice	0	In state provider	H MD	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
146833	Fee-for-Service	1497716765	1497716765	1	1	GOMEZ, ARTURO MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74594	20	Orthopedic Surgery	0	In state provider	None	1830 FLOWER ST	STE 144	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
146851	Fee-for-Service	1184634800	1184634800	1	1	GRENIER, ELISE M MD	9/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90674	08	Family Practice	0	In state provider	None	2001 UNION ST	STE 300	SAN FRANCISCO	CA	94123	4108	38	06075	37.7974427	-122.432532	San Francisco County
146922	Fee-for-Service	1114998911	1114998911	1	1	GRANBURY HOSPITAL CORPORATIO	1/9/2024	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1310 PALUXY RD	None	GRANBURY	TX	76048	5655	00	None	32.43163598	-97.80298081	Hood County
146938	Fee-for-Service	1154994846	1154994846	1	1	GROW HEALTHCARE GROUP PC	10/6/2023	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	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
146943	Fee-for-Service	1760459978	1760459978	1	1	GEORGE M KHURI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14519 DETROIT AVE	None	LAKEWOOD	OH	44107	4316	00	None	41.48527894	-81.79643923	Cuyahoga County
146963	Fee-for-Service	1871591099	1871591099	1	1	GREEN, WILLIAM MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27289	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3860 SADDLE RD	None	SOUTH LAKE TAHOE	CA	96150	8673	09	06017	38.934261	-119.9399445	El Dorado County
146984	Fee-for-Service	1700868437	1700868437	1	1	GREEN, RALPH MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38466	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
146989	Fee-for-Service	1205449832	1205449832	1	1	GARCIA, AUTUMN NP	7/14/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
147001	Fee-for-Service	1952987729	1952987729	1	1	GOMEZ CASAREZ, AXEL MD	7/12/2024	208600000X	NA	General Surgery	026	PHYSICIANS	183885	02	General Surgery	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
147003	Fee-for-Service	1710962865	1710962865	1	2	GLENDALE EYE MEDICAL GROUP	2/27/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	14124 FOOTHILL BLVD	None	SYLMAR	CA	91342	8049	19	06037	34.31598785	-118.4413895	Los Angeles County
147049	Fee-for-Service	1992767040	1992767040	1	1	GLENVIEW PATHOLOGY MED	1/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP INC	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
147077	Fee-for-Service	1164191417	1164191417	1	3	GLEN L XIONG, MD INC	2/7/2025	207R00000X	NA	Other	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	5255 HEMLOCK ST	None	SACRAMENTO	CA	95841	3017	34	06067	38.662884	-121.341969	Sacramento County
147096	Fee-for-Service	1275927386	1275927386	1	1	GIRGIS, MAUREEN MD	9/6/2018	390200000X	NA	Other	026	PHYSICIANS	151677	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
147113	Fee-for-Service	1740449727	1740449727	1	1	GHASEMI VARNAMKHASTI, MANIJE	11/15/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	135712	66	Emergency Medicine (Urgent Care)	0	In state provider	H MD	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
147196	Fee-for-Service	1639356553	1639356553	1	1	GERLACH, MELISSA J MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109053	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
147209	Fee-for-Service	1114998911	1114998911	1	1	GRANBURY HOSPITAL CORPORATIO	1/9/2024	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1310 PALUXY RD	None	GRANBURY	TX	76048	5655	00	None	32.43163598	-97.80298081	Hood County
147227	Fee-for-Service	1154994846	1154994846	1	1	GROW HEALTHCARE GROUP PC	8/2/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	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
147287	Fee-for-Service	1700363231	1700363231	1	1	GOOBLAR, JONATHAN S PHD	12/11/2018	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
147328	Fee-for-Service	1659315901	1659315901	1	1	GARFIELD BEACH CVS, LLC	9/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1299 BROADWAY	None	EL CAJON	CA	92021	4902	37	06073	32.80768255	-116.9366175	San Diego County
147352	Fee-for-Service	1568094258	1568094258	2	1	GIBBINS, CHANTELL M LCSW	3/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5000 BECHELLI LN	STE 103	REDDING	CA	96002	3553	45	06089	40.53859067	-122.354796	Shasta County
147367	Fee-for-Service	1003310947	1003310947	1	1	GOSLINGA, THOMAS MD	9/9/2024	208M00000X	NA	Other	026	PHYSICIANS	166672	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
147387	Fee-for-Service	1134410491	1134410491	1	1	GEMS HOMEHEALTH CARE	8/9/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	535 N BRAND BLVD	SUITE 290	GLENDALE	CA	91203	3908	19	06037	34.154298	-118.2551395	Los Angeles County
147388	Fee-for-Service	1336694660	1336694660	1	1	GODINEZ, MICHELLE A LCSW	1/5/2024	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
147396	Fee-for-Service	1942220926	1942220926	1	1	GROSSMAN, STEPHEN M	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64749	41	Internal Medicine	0	In state provider	None	87 E OLIVE AVE	STE 100	FRESNO	CA	93728	3059	10	06019	36.75763476	-119.8110295	Fresno County
147404	Fee-for-Service	1841359452	1841359452	1	1	GOLDIN, JACK MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27283	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
147418	Fee-for-Service	1407529290	1407529290	1	1	GHAHGHAHI, SIMIN PHD	5/19/2025	No Taxonomy Provided	NA	None	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
147482	Fee-for-Service	1053393835	1053393835	1	1	GRIFFEN, STEVEN C MD	7/22/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	77150	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
147486	Fee-for-Service	1740224005	1740224005	1	1	GARFIELD BEACH CVS LLC	1/3/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 LINCOLN BLVD	None	SANTA MONICA	CA	90401	2732	19	06037	34.01916332	-118.4909028	Los Angeles County
147493	Fee-for-Service	1669410239	1669410239	1	1	GLATZ, THEODORE H MD	9/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	30983	40	Pediatrics	0	In state provider	None	UCI MEDICAL CTR BLDG 42	None	ORANGE	CA	92668	0000	30	06059	0	0	None
147515	Fee-for-Service	1154994846	1154994846	1	1	GROW HEALTHCARE GROUP PC	10/13/2023	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	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
147567	Fee-for-Service	1568523835	1568523835	1	1	GONZALES, MICHELE A NP	9/24/2012	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
147573	Fee-for-Service	1093929077	1093929077	1	1	GHAFFARI, HOMEYRA LMFT	9/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2740 FULTON AVE	STE 100D	SACRAMENTO	CA	95821	5190	34	06067	38.615157	-121.4009055	Sacramento County
147587	Fee-for-Service	1437186160	1437186160	1	1	GRAY, SUNSHYNE M LCSW	7/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	12 NEVADA ST	SUITE B	REDLANDS	CA	92373	4222	36	06071	34.04940822	-117.2174557	San Bernardino County
147588	Fee-for-Service	1821657644	1821657644	1	1	GARG, PRIYANKA MD	8/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
147593	Fee-for-Service	1285602698	1285602698	1	1	GHARAVI, MOHAMMAD A MD	10/1/1998	208G00000X	NA	General Surgery	026	PHYSICIANS	30200	33	Thoracic Surgery	0	In state provider	None	2100 LYNN RD	STE 100	THOUSAND OAKS	CA	91360	8030	56	06111	34.2074907	-118.8854443	Ventura County
147599	Fee-for-Service	1972541688	1972541688	1	1	GILILLAND, WILLARD C	12/27/2005	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3505 LONG BEACH BLVD	STE 1C	LONG BEACH	CA	90807	3946	19	06037	33.82054429	-118.1893881	Los Angeles County
147604	Fee-for-Service	1528003324	1528003324	1	1	GARFIELD BEACH CVS, LLC	8/29/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	228 NORTH HARBOR BLVD.	None	SANTA ANA	CA	92703	3337	30	06059	33.74674056	-117.9202229	Orange County
147612	Fee-for-Service	1811248347	1811248347	1	1	GILBERT, TARI L NP	1/12/2015	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	9001	37	06073	32.7537975	-117.1658298	San Diego County
147621	Fee-for-Service	1649444167	1649444167	1	1	GEBHARD, THOMAS A MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
147655	Fee-for-Service	1578842563	1578842563	1	1	GALICIA, CIARA R	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
147683	Fee-for-Service	1912915380	1912915380	1	1	GAINES, PETER M MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64747	None	None	0	In state provider	None	700 17TH ST	None	MODESTO	CA	95354	1209	50	06099	37.64283069	-120.9903982	Stanislaus County
147732	Fee-for-Service	1396789640	1396789640	1	1	GARFIELD BEACH CVS, LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1820 W. VERDUGO AVE	None	BURBANK	CA	91506	2150	19	06037	34.16724439	-118.3249624	Los Angeles County
147741	Fee-for-Service	1194731208	1194731208	1	1	GERALD PHILIP ROSELLIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4060 E STEVENS CIR UNIV	None	SEATTLE	WA	98195	0001	00	None	47.65585491	-122.3044819	King County
147745	Fee-for-Service	1508035288	1508035288	1	1	GABOT, NAOMI M CRNA	2/8/2012	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
147788	Fee-for-Service	1639181530	1639181530	1	1	GELLERMAN, DOUGLAS R MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42777	18	Ophthalmology	0	In state provider	INC	7012 RESEDA BLVD	STE B	RESEDA	CA	91335	4274	19	06037	34.197975	-118.5360215	Los Angeles County
147804	Fee-for-Service	1154994846	1154994846	1	1	GROW HEALTHCARE GROUP PC	4/19/2023	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	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
147885	Fee-for-Service	1790756054	1790756054	1	1	GOINES, SANDRA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8212	08	Family Practice	0	In state provider	None	1703 TERMINO AVE	STE 209	LONG BEACH	CA	90804	2128	19	06037	33.7883073	-118.1459488	Los Angeles County
147897	Fee-for-Service	1376010702	1376010702	1	1	GRADASCEVIC, NERMIN PT	10/21/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	957 FAULKNERROAD	105	SANTA PAULA	CA	93060	9129	56	06111	34.33481551	-119.0867489	Ventura County
147906	Fee-for-Service	1598187221	1598187221	1	1	GARLAND, ISRAEL J CRNA	4/14/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
147912	Fee-for-Service	1871886457	1871886457	1	1	GARFIELD BEACH CVS, LLC	4/19/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	377 32ND AVE	None	SAN FRANCISCO	CA	94121	1738	38	06075	37.78210804	-122.492403	San Francisco County
147944	Fee-for-Service	1265405724	1265405724	1	1	GRAHAM, ROBERT H MD	5/23/2017	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
147957	Fee-for-Service	1093800112	1093800112	1	1	GENE S HAN, MD INC	3/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 220	LOS ANGELES	CA	90006	6507	19	06037	34.05260995	-118.3015825	Los Angeles County
147963	Fee-for-Service	1205993029	1205993029	1	1	GREEN, MARGOT PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
147987	Fee-for-Service	1912929514	1912929514	2	1	GARFIELD BEACH CVS LLC	9/28/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6835 KATELLA AVE	None	CYPRESS	CA	90630	5107	30	06059	33.80299023	-118.0131695	Orange County
147997	Fee-for-Service	1023299831	1023299831	1	1	GARON, BONNIE L MD	11/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86046	30	Radiology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
148001	Fee-for-Service	1740881861	1740881861	1	1	GRISELDA TUCHAN PINEDA MARRI	12/16/2020	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	AGE AND FAMILY THERAPIST	2820 SOUTH VERMONT AVENU	16	LOS ANGELES	CA	90007	2291	19	06037	34.028991	-118.291524	Los Angeles County
148069	Fee-for-Service	1588677751	1588677751	1	1	GILSON, GEORGE J MD	5/19/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88159	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
148089	Fee-for-Service	1184193476	1184193476	1	1	GARFIELD BEACH CVS , L.L.C.	2/15/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1023 4TH AVE	None	SAN DIEGO	CA	92101	4815	37	06073	32.71593432	-117.1610368	San Diego County
148092	Fee-for-Service	1154994846	1154994846	1	1	GROW HEALTHCARE GROUP PC	10/7/2023	101YM0800X	NA	Other	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
148190	Fee-for-Service	1184646887	1184646887	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13831 BROOKHURST STREET	None	GARDEN GROVE	CA	92843	3120	30	06059	33.76157612	-117.9550842	Orange County
148195	Fee-for-Service	1164654828	1164654828	1	1	GIOIOSO-DATTA, CRISTINA MD	2/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116630	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
148238	Fee-for-Service	1780732602	1780732602	1	1	GHANSHANI, SUSHMA R MD	3/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76765	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
148239	Fee-for-Service	1679511810	1679511810	1	1	GILES, JON T MD	1/24/2024	207RR0500X	NA	Other	026	PHYSICIANS	72386	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
148253	Fee-for-Service	1851341895	1851341895	1	1	GOLD, SIMONE M MD	11/30/1991	207P00000X	NA	Other	026	PHYSICIANS	70224	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
148335	Fee-for-Service	1316031099	1316031099	1	1	GLASSMAN, JERROLD MD AMC	3/16/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4060 FOURTH AVE	STE 650	SAN DIEGO	CA	92103	2121	37	06073	32.75053673	-117.1616539	San Diego County
148365	Fee-for-Service	1033341763	1033341763	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 2ND ST	None	DAVIS	CA	95618	9446	57	06113	38.55272862	-121.6993047	Yolo County
148380	Fee-for-Service	1154994846	1154994846	1	1	GROW HEALTHCARE GROUP PC	4/19/2023	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	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
148383	Fee-for-Service	1124231865	1124231865	1	1	GOLDEN VALLEY HEALTH	4/8/1996	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	1121 HAMMOND ST	None	MODESTO	CA	95351	3509	50	06099	37.614366	-121.0186465	Stanislaus County
148397	Fee-for-Service	1376760900	1376760900	1	1	GUPTA, MAMATHA M MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	99377	45	Nephrology (Renal-Kidney)	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
148403	Fee-for-Service	1891318945	1891318945	1	1	GOLDEN SKY HOSPICE, INC	3/17/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVE	STE 204A	CANOGA PARK	CA	91303	0700	19	06037	34.1994564	-118.5884133	Los Angeles County
148414	Fee-for-Service	1770018913	1770018913	1	1	GASTEL-WARDELL, EDWARD MD	8/12/2019	171000000X	NA	Other	026	PHYSICIANS	157380	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	30	06059	33.61676129	-117.869325	Orange County
148449	Fee-for-Service	1730237678	1730237678	1	1	GONZALEZ, DENNIS A MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80474	08	Family Practice	0	In state provider	None	145 THUNDER DR	None	VISTA	CA	92083	6010	37	06073	33.18535652	-117.288201	San Diego County
148454	Fee-for-Service	1528068541	1528068541	1	1	GOMEZ, TRACEY A NP	1/8/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	40075 BOB HOPE DRIVE	SUITE A	RANCHO MIRAGE	CA	92270	3945	33	06065	33.75715732	-116.4082724	Riverside County
148504	Fee-for-Service	1669892147	1669892147	1	1	GONZALEZ, ANDRES MD	1/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160421	None	None	0	In state provider	None	9655 MONTE VISTA AVE	STE 402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
148523	Fee-for-Service	1184975922	1184975922	1	1	GIMBEL, ANNE LMFT	4/16/2025	No Taxonomy Provided	NA	None	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
148538	Fee-for-Service	1366859449	1366859449	1	13	GOLDEN STATE PROVIDERS, A ME	1/14/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	2190 LYNN ROAD	SUITE 300	THOUSAND OAKS	CA	91360	8024	56	06111	34.20728091	-118.8855456	Ventura County
148560	Fee-for-Service	1679184006	1679184006	1	1	GLORIA HOSPICE, INC	12/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4311 WILSHIRE BLVD	STE 302	LOS ANGELES	CA	90010	3713	19	06037	34.0617922	-118.3218639	Los Angeles County
148572	Fee-for-Service	1083809537	1083809537	1	1	GUIJON, OLGA L MD	2/7/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55616	40	Pediatrics	0	In state provider	None	406 S MAIN ST	None	SANTA ANA	CA	92701	5712	30	06059	33.742008	-117.8677165	Orange County
148587	Fee-for-Service	1215257548	1215257548	1	1	GUYUMDZHYAN, KARAPET CRNA	5/3/2011	No Taxonomy Provided	NA	None	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
148623	Fee-for-Service	1780119776	1780119776	1	1	GARFIELD BEACH CVS LLC	11/20/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	233 WINSTON DR	None	SAN FRANCISCO	CA	94132	1901	38	06075	37.72695059	-122.4766035	San Francisco County
148663	Fee-for-Service	1871027912	1871027912	1	1	G & A HOME HEALTH CARE INC	7/4/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	UNIT 230	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
148673	Fee-for-Service	1124231865	1124231865	1	1	GOLDEN VALLEY HEALTH	4/8/1996	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	1121 HAMMOND ST	None	MODESTO	CA	95351	3509	50	06099	37.614366	-121.0186465	Stanislaus County
148686	Fee-for-Service	1376760900	1376760900	1	1	GUPTA, MAMATHA M MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	99377	41	Internal Medicine	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
148688	Fee-for-Service	1750328803	1750328803	1	1	GAVINI, JOHN R MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77882	41	Internal Medicine	0	In state provider	None	1524 W LACEY BLVD	None	HANFORD	CA	93230	5965	16	06031	36.32816338	-119.6690189	Kings County
148690	Fee-for-Service	1891318945	1891318945	1	1	GOLDEN SKY HOSPICE, INC	3/17/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVE	STE 204A	CANOGA PARK	CA	91303	0700	19	06037	34.1994564	-118.5884133	Los Angeles County
148749	Fee-for-Service	1629017728	1629017728	1	1	GOO, HELEN A MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86126	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
148767	Fee-for-Service	1639437916	1639437916	1	1	GARG, SHALLY MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130056	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
148808	Fee-for-Service	1043644586	1043644586	1	1	GUARINO, NATALIA M	6/1/2014	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
148840	Fee-for-Service	1922461557	1922461557	1	1	GOLDBLATT, ARIELLA S MD	7/21/2022	207R00000X	NA	Other	026	PHYSICIANS	168334	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
148844	Fee-for-Service	1447889274	1447889274	1	3	GO GENTLY MEDICAL GROUP. INC	1/25/2023	207RH0002X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	.	4010 WATSON PLAZA DRIVE,	STE. 140	LAKEWOOD	CA	90712	4047	19	06037	33.83123565	-118.1550195	Los Angeles County
148847	Fee-for-Service	1679184006	1679184006	1	1	GLORIA HOSPICE, INC	12/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4311 WILSHIRE BLVD	STE 302	LOS ANGELES	CA	90010	3713	19	06037	34.0617922	-118.3218639	Los Angeles County
148904	Fee-for-Service	1760426019	1760426019	1	1	GARFIELD BEACH CVS, LLC	10/26/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1322 W 6TH ST	None	CORONA	CA	92882	3167	33	06065	33.87780605	-117.5892666	Riverside County
148949	Fee-for-Service	1609921816	1609921816	1	1	GASPARD, DONALD J MD	1/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	7031	02	General Surgery	0	In state provider	None	123 CONGRESS ST	None	PASADENA	CA	91105	0000	19	06037	34.13403545	-118.1535777	Los Angeles County
148950	Fee-for-Service	1457104259	1457104259	1	1	GONZALES, NADJA DOULA	4/12/2024	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	31	06061	0	0	None
148975	Fee-for-Service	1457713646	1457713646	1	1	GINA WILSON	11/25/2018	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
148981	Fee-for-Service	1700014362	1700014362	1	1	GREENE, MEREDITH L MD	9/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107361	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
149015	Fee-for-Service	1144230053	1144230053	1	1	GREWAL, SAJOT S MD	6/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85167	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
149018	Fee-for-Service	1215479027	1215479027	1	1	GARDENA PHARMACY CORPORATION	4/20/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15418 CRENSHAW BLVD	None	GARDENA	CA	90249	4524	19	06037	33.890391	-118.3265105	Los Angeles County
149024	Fee-for-Service	1891721106	1891721106	1	1	GAFFAR, MUBINA MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53662	41	Internal Medicine	0	In state provider	None	9655 MONTE VISTA AVE	STE 402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
149059	Fee-for-Service	1932233665	1932233665	1	1	GRIER, BARNETT J W JR MD	1/15/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	23617	-	NOT APPLICABLE	0	In state provider	None	2303 SOUTH FIGUEROA WAY	None	LOS ANGELES	CA	90007	2504	19	06037	34.03084145	-118.2749778	Los Angeles County
149087	Fee-for-Service	1316508823	1316508823	1	1	GUESNON, MIMI	5/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5871 PINE AVE	SUITE 230	CHINO HILLS	CA	91709	6545	36	06071	33.94767013	-117.6754339	San Bernardino County
149178	Fee-for-Service	1396795720	1396795720	1	1	GONZALEZ, ANDRES A MD	8/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90026	36	Psychiatry	0	In state provider	None	1520 SAN PABLO ST	STE 3000	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
149181	Fee-for-Service	1558344473	1558344473	1	1	GARCIA, JOHN R INC	9/29/2005	208600000X	NA	General Surgery	026	PHYSICIANS	86774	02	General Surgery	0	In state provider	None	5959 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93309	0436	15	06029	35.36306164	-119.0711264	Kern County
149187	Fee-for-Service	1588684393	1588684393	1	1	GETZELMAN, JULIA K MD	5/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70987	40	Pediatrics	0	In state provider	None	1580 VALENCIA ST	STE 506	SAN FRANCISCO	CA	94110	4418	38	06075	37.74746923	-122.4202583	San Francisco County
149207	Fee-for-Service	1740224096	1740224096	1	1	GARFIELD BEACH CVS, LLC	10/7/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1122 E BROADWAY	None	GLENDALE	CA	91205	1316	19	06037	34.14620773	-118.240819	Los Angeles County
149216	Fee-for-Service	1194901587	1194901587	1	1	GOODWIN, LAWRENCE T JR	12/31/1989	207W00000X	NA	Ophthalmology	026	PHYSICIANS	40581	18	Ophthalmology	0	In state provider	MD INC	8717 LA TIJERA BLVD	None	LOS ANGELES	CA	90045	3906	19	06037	33.95788109	-118.3936725	Los Angeles County
149218	Fee-for-Service	1356493225	1356493225	1	1	GOLDEN, NEVILLE H MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52649	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
149266	Fee-for-Service	1073541041	1073541041	1	1	GREGORY L SITKA MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
149270	Fee-for-Service	1255377495	1255377495	1	1	GLUCKSTEIN, LAWRENCE D	9/30/1988	207L00000X	NA	Other	026	PHYSICIANS	60407	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
149299	Fee-for-Service	1740737493	1740737493	1	1	GENTRY, DESHA D	4/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
149313	Fee-for-Service	1104871011	1104871011	1	1	GOYLE, SIMMI MD	3/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53745	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
149356	Fee-for-Service	1003025743	1003025743	1	1	GANDHI, NAINESH K MD	5/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131442	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
149373	Fee-for-Service	1205424942	1205424942	1	1	GURJEET KAILA	6/13/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	511 E KERN AVE	None	TULARE	CA	93274	4210	54	06107	36.20732981	-119.341515	Tulare County
149388	Fee-for-Service	1619905007	1619905007	1	1	GORADIA, TUSHAR M MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	86829	14	Neurological Surgery	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
149401	Fee-for-Service	1053948539	1053948539	1	1	GUTIERREZ, CRISTINA MD	11/26/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185663	40	Pediatrics	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6919	38	06075	37.78610439	-122.421569	San Francisco County
149405	Fee-for-Service	1033788898	1033788898	1	1	GENDRON SONG, JI YEONG CNP	3/31/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1900 19TH AVE	None	SAN FRANCISCO	CA	94116	1250	38	06075	37.75211157	-122.4762664	San Francisco County
149418	Fee-for-Service	1609189893	1609189893	1	1	GUTMARK, RON MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129409	18	Ophthalmology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
149450	Fee-for-Service	1790979938	1790979938	1	1	GUPTA, NAVEEN MD	2/11/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	86996	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
149459	Fee-for-Service	1629334032	1629334032	1	1	GIMA, KRISTIAN S DO	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13550	02	General Surgery	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6002	19	06037	34.28200485	-118.4030797	Los Angeles County
149466	Fee-for-Service	1396795720	1396795720	1	1	GONZALEZ, ANDRES A MD	8/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90026	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 3000	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
149501	Fee-for-Service	1245416668	1245416668	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2370 S AZUSA AVE	None	WEST COVINA	CA	91792	1511	19	06037	34.0336568	-117.913389	Los Angeles County
149579	Fee-for-Service	1346389343	1346389343	1	1	GILLIAN BATY MD	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
149609	Fee-for-Service	1760569396	1760569396	1	1	GLASEROFF, ALAN M MD	7/1/1983	261QP2300X	NA	Other	026	PHYSICIANS	40866	08	Family Practice	0	In state provider	None	1318 H ST	None	ARCATA	CA	95521	5837	12	06023	40.87239326	-124.085509	Humboldt County
149616	Fee-for-Service	1134683634	1134683634	1	1	GALANG, GIRLIE B	1/28/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4516 THIRA WAY	None	ELK GROVE	CA	95758	5156	34	06067	38.42775	-121.4514495	Sacramento County
149629	Fee-for-Service	1861835852	1861835852	1	1	GOLAN, RON MD	11/18/2020	208800000X	NA	Other	026	PHYSICIANS	168628	None	None	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
149646	Fee-for-Service	1730250465	1730250465	1	1	GREEN, ARLEN D DO	9/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9441	25	Physical Medicine and Rehabilitation	0	In state provider	None	13132 STUDEBAKER RD	#6	NORWALK	CA	90650	2561	19	06037	33.911874	-118.099151	Los Angeles County
149668	Fee-for-Service	1518964642	1518964642	1	1	GILBERT, ROGER M MD	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	48646	30	Radiology	0	In state provider	None	1800 I ST	None	SACRAMENTO	CA	95814	3004	34	06067	38.578113	-121.4819685	Sacramento County
149680	Fee-for-Service	1023034501	1023034501	1	1	GINEJKO, JOSEPH J DO	7/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9989	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
149715	Fee-for-Service	1851550123	1851550123	1	1	GRACE SOUSA, 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
149761	Fee-for-Service	1447528385	1447528385	1	1	GAIKWAD, SHUBHANGI N MD	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128376	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	SUITE B100	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
149787	Fee-for-Service	1073556304	1073556304	1	1	GROVER, IAN R MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55341	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
149818	Fee-for-Service	1932257995	1932257995	1	1	GARCIA, NELSON A MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	34864	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
149837	Fee-for-Service	1356416382	1356416382	1	1	GARCIA, REBEKAH C LCSW	2/6/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 W FIRST ST	STE 346	CLAREMONT	CA	91711	4742	19	06037	34.09450024	-117.7183344	Los Angeles County
149843	Fee-for-Service	1417344631	1417344631	1	3	GALVIS, ALVARO E MD	8/4/2022	207L00000X	NA	Other	026	PHYSICIANS	19254	01	General Practice	0	In state provider	None	505 SOUTH MAIN STREET	1200	ORANGE	CA	92866	4511	30	06059	33.78004808	-117.8672472	Orange County
149846	Fee-for-Service	1811901580	1811901580	1	2	GUPTA, LEENA K MD	9/16/2021	207R00000X	NA	Other	026	PHYSICIANS	98907	None	None	0	In state provider	None	5189 HOSPITAL RD	None	MARIPOSA	CA	95338	9524	22	06043	37.50033166	-119.9769163	Mariposa County
149900	Fee-for-Service	1326443649	1326443649	1	1	GRIGORIAN, TEODIK DO	7/11/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	15169	06	Cardiovascular Disease (M.D. only)	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
149904	Fee-for-Service	1134683634	1134683634	1	1	GALANG, GIRLIE B	1/28/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4516 THIRA WAY	None	ELK GROVE	CA	95758	5156	34	06067	38.42775	-121.4514495	Sacramento County
149923	Fee-for-Service	1295122133	1295122133	1	1	GRAVES, RECECCA C DO	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14307	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
149986	Fee-for-Service	1215965348	1215965348	1	1	GAUT, PAULA L MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	57766	77	Infectious Disease	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
150000	Fee-for-Service	1649779919	1649779919	1	2	GREEN PHYSICAL THERAPY, INC.	1/6/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2091 W FLORIDA AVE	STE 210	HEMET	CA	92545	4800	33	06065	33.7473485	-116.9931105	Riverside County
150057	Fee-for-Service	1568502912	1568502912	1	1	GARA, JENNIFER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 E RIDGE RD	None	MCALLEN	TX	78503	5490	00	None	26.18417639	-98.21180006	Hidalgo County
150092	Fee-for-Service	1730710104	1730710104	1	1	GIANG, STEVEN OD	7/22/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4029 43RD STREET	SUITE 300	SAN DIEGO	CA	92105	8537	37	06073	32.75012697	-117.1019424	San Diego County
150099	Fee-for-Service	1003975855	1003975855	1	1	GUZMAN PARK, SHANDRA LMFT	8/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	151 WARWICK AVE	None	SAN LEANDRO	CA	94577	1935	01	06001	37.73796757	-122.1566232	Alameda County
150102	Fee-for-Service	1184079261	1184079261	1	1	GARCIA-RUIZ, NURIA S MD	7/3/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156569	None	None	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 330	PLEASANTON	CA	94588	5802	01	06001	37.69214859	-121.8796532	Alameda County
150129	Fee-for-Service	1134313026	1134313026	2	1	GARFIELD BEACH CVS LLC	3/17/2017	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11133 BALBOA BLVD	None	GRANADA HILLS	CA	91344	4204	19	06037	34.272981	-118.5022195	Los Angeles County
150135	Fee-for-Service	1912971334	1912971334	1	1	GROVE, JAY R MD	1/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60426	02	General Surgery	0	In state provider	None	2385 S MELROSE DR	None	VISTA	CA	92081	8788	37	06073	33.14409946	-117.2417711	San Diego County
150149	Fee-for-Service	1891458055	1891458055	1	1	GUTIERREZ, ELIZABETH	10/22/2021	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
150157	Fee-for-Service	1548749500	1548749500	1	1	GRAVANO, JASON PHD	10/16/2019	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
150164	Fee-for-Service	1215020136	1215020136	1	1	GARINGO, ARLENE D MD	8/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71245	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
150174	Fee-for-Service	1518982339	1518982339	1	1	GASPARIANS, MELINEH OD	7/21/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17909 SOLEDAD CYN RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
150181	Fee-for-Service	1649445677	1649445677	1	1	GOEL, GATI A MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115420	41	Internal Medicine	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
150185	Fee-for-Service	1518298306	1518298306	1	2	GOLDEN VALLEY HEALTH CENTERS	7/13/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1500 FLORIDA AVE	None	MODESTO	CA	95350	4408	50	06099	37.665738	-120.9962205	Stanislaus County
150200	Fee-for-Service	1811182173	1811182173	1	1	GARCIA, MARIELA I MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97280	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
150207	Fee-for-Service	1093737884	1093737884	2	1	GARFIELD BEACH CVS LLC	3/2/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16400 BEACH BLVD	None	WESTMINSTER	CA	92683	7858	30	06059	33.725799	-117.985779	Orange County
150233	Fee-for-Service	1316409634	1316409634	1	1	GUPTA, BALI MD	10/21/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
150234	Fee-for-Service	1811048671	1811048671	1	1	GREGG, KENNETH D LCSW	12/11/2015	No Taxonomy Provided	NA	None	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
150273	Fee-for-Service	1710035670	1710035670	1	1	GABE, DIANE MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	59760	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
150283	Fee-for-Service	1225141971	1225141971	1	1	GOLDBERG, JAY W MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66617	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
150324	Fee-for-Service	1417074238	1417074238	1	1	GOHIL, DIPALI S	11/9/2022	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
150357	Fee-for-Service	1942409669	1942409669	1	2	GALLANT, NATALIE M MD	3/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	108703	40	Pediatrics	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
150385	Fee-for-Service	1194223040	1194223040	1	1	GUILL, CHERYL LMFT	3/21/2025	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
150387	Fee-for-Service	1306024849	1306024849	1	1	GILL, HIMMAT S MD INC	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97685	83	Rheumatology	0	In state provider	None	7135 N CHESTNUT AVE	STE 104	FRESNO	CA	93720	0362	10	06019	36.84004644	-119.7371857	Fresno County
150402	Fee-for-Service	1609882331	1609882331	1	1	GREENBAUM, MARK R MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	48834	01	General Practice	0	In state provider	None	500 UNIVERSITY AVE	STE 210	SACRAMENTO	CA	95825	6524	34	06067	38.568402	-121.418019	Sacramento County
150452	Fee-for-Service	1467474072	1467474072	2	1	GARFIELD BEACH CVS LLC	7/10/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6705 CAMINO ARROYO	None	GILROY	CA	95020	7075	43	06085	36.999783	-121.55463	Santa Clara County
150473	Fee-for-Service	1518298306	1518298306	1	2	GOLDEN VALLEY HEALTH CENTERS	7/13/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1500 FLORIDA AVE	None	MODESTO	CA	95350	4408	50	06099	37.665738	-120.9962205	Stanislaus County
150480	Fee-for-Service	1548394133	1548394133	1	1	GIBSON, PAUL M LCSW	3/28/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	478 EUREKA STREET	None	SAN FRANCISCO	CA	94114	2715	38	06075	37.75458258	-122.4376876	San Francisco County
150503	Fee-for-Service	1518033984	1518033984	1	1	GILL, SUKHMANI K MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69630	36	Psychiatry	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
150509	Fee-for-Service	1063404515	1063404515	1	1	GUIANG, ORLANDO GONZALEZ	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8230 MIRA MESA BLVD	STE B	SAN DIEGO	CA	92126	2625	37	06073	32.91275067	-117.1464546	San Diego County
150515	Fee-for-Service	1609852284	1609852284	1	1	GILGOFF, RACHEL LEE MD	8/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81451	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
150520	Fee-for-Service	1316189053	1316189053	1	1	GOVIL, ASHUL MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126257	41	Internal Medicine	0	In state provider	None	4053 LONE TREE WAY	SUITE 200	ANTIOCH	CA	94531	6200	07	06013	37.97569499	-121.800733	Contra Costa County
150529	Fee-for-Service	1528041811	1528041811	1	2	GROSSMONT HOSPITAL CORPORATI	5/29/1991	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
150535	Fee-for-Service	1902192719	1902192719	1	1	GRANGER, SHANNON L MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12532	05	Anesthesiology	0	In state provider	None	6235 N FRESNO STREET	SUITE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
150555	Fee-for-Service	1316047384	1316047384	1	1	GAYNON, PAUL S MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	30173	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
150642	Fee-for-Service	1275649113	1275649113	1	1	GRUJIC, SAVA MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79404	22	Pathology (M.D. only)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
150644	Fee-for-Service	1922163336	1922163336	1	1	GOELMAN, LIZABETH D	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
150664	Fee-for-Service	1336124825	1336124825	1	1	GREENSPAN, L STACY	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E BOULDER ST	None	COLORADO SPGS	CO	80909	5533	00	None	38.8388119	-104.7995065	El Paso County
150677	Fee-for-Service	1306024849	1306024849	1	1	GILL, HIMMAT S MD INC	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97685	41	Internal Medicine	0	In state provider	None	7135 N CHESTNUT AVE	STE 104	FRESNO	CA	93720	0362	10	06019	36.84004644	-119.7371857	Fresno County
150712	Fee-for-Service	1396164422	1396164422	1	1	GUNER, JOIE MD	12/8/2023	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171711	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
150738	Fee-for-Service	1316409584	1316409584	1	1	GHIASI, YASAMIN N MD	7/15/2024	207K00000X	NA	Other	026	PHYSICIANS	177332	03	Allergy	0	In state provider	None	8641 WILSHIRE BLVD	210	BEVERLY HILLS	CA	90211	2900	19	06037	34.06614972	-118.3798912	Los Angeles County
150749	Fee-for-Service	1700997251	1700997251	1	1	GREEN, LAWRENCE H MD AMC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26942	18	Ophthalmology	0	In state provider	None	2601 W ALAMEDA AVE	STE 204	BURBANK	CA	91505	4810	19	06037	34.15783817	-118.3293969	Los Angeles County
150763	Fee-for-Service	1518298306	1518298306	1	2	GOLDEN VALLEY HEALTH CENTERS	5/2/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 FLORIDA AVE	None	MODESTO	CA	95350	4408	50	06099	37.665738	-120.9962205	Stanislaus County
150808	Fee-for-Service	1881837813	1881837813	1	1	GILL, SUKHDEEP K MD	2/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	123259	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
150836	Fee-for-Service	1053414086	1053414086	1	1	GARCIA, RAFAEL A MD	5/31/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50715	40	Pediatrics	0	In state provider	None	995 GATEWAY CENTER WAY	STE 201	SAN DIEGO	CA	92102	4545	37	06073	32.71405516	-117.1158459	San Diego County
150838	Fee-for-Service	1538581517	1538581517	1	1	GROST, EMILY R CRNA	12/21/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
150843	Fee-for-Service	1316047384	1316047384	1	1	GAYNON, PAUL S MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	30173	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
150845	Fee-for-Service	1124294665	1124294665	1	1	GHEYSAR, OMID MD	9/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102295	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
150858	Fee-for-Service	1407246408	1407246408	1	1	GUEST, RICHARD MD	4/7/2016	193400000X	NA	Other	026	PHYSICIANS	33685	02	General Surgery	0	In state provider	APMC	18250 ROSCOE BLVD	STE 335	NORTHRIDGE	CA	91325	4282	19	06037	34.22076142	-118.5313223	Los Angeles County
150909	Fee-for-Service	1285020032	1285020032	1	1	GLEN SAXBY	4/29/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 E WHEELER RD	None	MOSES LAKE	WA	98837	1820	00	None	47.128302	-119.2653765	Grant County
150985	Fee-for-Service	1215592514	1215592514	1	1	GORMAN, JESSICA M LMFT	8/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
150989	Fee-for-Service	1205951530	1205951530	1	1	GRATTAN, ROBIN Y MD	6/25/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99132	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
151051	Fee-for-Service	1518298306	1518298306	1	2	GOLDEN VALLEY HEALTH CENTERS	7/27/2023	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1500 FLORIDA AVE	None	MODESTO	CA	95350	4408	50	06099	37.665738	-120.9962205	Stanislaus County
151065	Fee-for-Service	1295239465	1295239465	1	1	GOLDMAN, MAX L MD	8/13/2021	208M00000X	NA	Other	026	PHYSICIANS	165358	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
151071	Fee-for-Service	1174582688	1174582688	1	1	GOLSHAN, HEDYEH M	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75923	41	Internal Medicine	0	In state provider	None	8110 MANGO AVE	None	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
151092	Fee-for-Service	1164892493	1164892493	1	1	GARCIA, ROBERT M LMFT	9/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5000 BECHELLI LN	103	REDDING	CA	96002	3553	45	06089	40.53859067	-122.354796	Shasta County
151113	Fee-for-Service	1477585776	1477585776	1	1	GONZALEZ, JAMES N	4/8/2011	2086S0129X	NA	General Surgery	026	PHYSICIANS	66820	None	None	0	In state provider	None	1555 EAST ST	STE 220	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
151128	Fee-for-Service	1235699927	1235699927	1	1	GUNEY, EKIN MD	7/2/2024	207ZN0500X	NA	Other	026	PHYSICIANS	178216	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
151131	Fee-for-Service	1316047384	1316047384	1	1	GAYNON, PAUL S MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	30173	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
151146	Fee-for-Service	1194911628	1194911628	1	1	GJOLAJ, MARK P MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96652	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
151230	Fee-for-Service	1396368411	1396368411	1	1	GALINDO, KIMBERLY G S	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	1043 W 52ND ST.	None	LOS ANGELES	CA	90037	3511	19	06037	33.99506921	-118.2930715	Los Angeles County
151299	Fee-for-Service	1851759666	1851759666	1	1	GOMEZ, ROBYN LCSW	1/4/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5800 S EASTERN AVE	260	COMMERCE	CA	90040	4019	19	06037	33.98534547	-118.1620372	Los Angeles County
151326	Fee-for-Service	1487717997	1487717997	1	1	GRIEVE, SUSAN	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
151333	Fee-for-Service	1679750327	1679750327	1	1	GRANTHOM, MARIA S MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	33532	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	208 GREEN VALLEY ROAD	None	FREEDOM	CA	95019	3135	44	06087	36.93777813	-121.7711905	Santa Cruz County
151334	Fee-for-Service	1760850010	1760850010	1	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17170 CAMINO DEL SUR	None	SAN DIEGO	CA	92127	2538	37	06073	33.01884895	-117.1257352	San Diego County
151362	Fee-for-Service	1851322614	1851322614	1	1	GOLDSTEIN, RUTH B.	1/31/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50710	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
151402	Fee-for-Service	1285830372	1285830372	1	1	GREGG, JAMES M PHD	9/2/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
151413	Fee-for-Service	1649535675	1649535675	1	1	GREEN, ROLAND M PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
151433	Fee-for-Service	1194911628	1194911628	1	1	GJOLAJ, MARK P MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96652	01	General Practice	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
151479	Fee-for-Service	1487787214	1487787214	1	1	GOMEZ-MORA, RAQUEL MD	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71246	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
151498	Fee-for-Service	1851609176	1851609176	1	1	GREEN CROSS MED NET INC	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5832 S VERMONT AVE	None	LOS ANGELES	CA	90044	3712	19	06037	33.98805	-118.2914425	Los Angeles County
151504	Fee-for-Service	1043531676	1043531676	1	1	GREEN, MACK C IV MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125909	01	General Practice	0	In state provider	None	16008 KAMANA ROAD	SUITE 100	APPLE VALLEY	CA	92307	1308	36	06071	34.54191149	-117.2725046	San Bernardino County
151517	Fee-for-Service	1396368411	1396368411	1	1	GALINDO, KIMBERLY G S	6/4/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1043 W 52ND ST.	None	LOS ANGELES	CA	90037	3511	19	06037	33.99506921	-118.2930715	Los Angeles County
151521	Fee-for-Service	1649471533	1649471533	1	1	GONZALES, JULIA S NP	12/9/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	46900 MONROE ST	SUITE E	INDIO	CA	92203	4827	33	06065	33.707718	-116.233843	Riverside County
151538	Fee-for-Service	1902072549	1902072549	1	1	GAINES, TULAY C NP	8/22/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
151549	Fee-for-Service	1952842395	1952842395	1	1	GARCIA, JONATHAN MD	5/14/2020	207R00000X	NA	Other	026	PHYSICIANS	159930	41	Internal Medicine	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
151580	Fee-for-Service	1699302950	1699302950	1	1	GORVITOVSKAIA, ANASTASSIA M	8/12/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	D	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
151591	Fee-for-Service	1538270434	1538270434	1	1	GARVIN, W JOSEPH OD	1/31/1987	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	147 E GRAND AVE	None	ESCONDIDO	CA	92025	2701	37	06073	33.12208968	-117.0804888	San Diego County
151611	Fee-for-Service	1528080132	1528080132	2	1	GARFIELD BEACH CVS LLC	12/26/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1640 N MAIN ST	None	SALINAS	CA	93906	5102	27	06053	36.714528	-121.652397	Monterey County
151692	Fee-for-Service	1770595274	1770595274	1	1	GOLDMAN, STEVEN R MD	12/18/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	26277	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
151703	Fee-for-Service	1740202506	1740202506	1	1	GONZALEZ, SUSANA G MD	8/31/1994	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75475	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1510 SAN PABLO ST	STE 104	LOS ANGELES	CA	90033	5392	19	06037	34.06287152	-118.2029433	Los Angeles County
151720	Fee-for-Service	1801016605	1801016605	1	1	GOLDEN VALLEY HEALTH CTR	3/1/1997	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	PLANADA	9235 E BROADWAY	None	PLANADA	CA	95365	9573	24	06047	37.29049953	-120.3207705	Merced County
151722	Fee-for-Service	1558650572	1558650572	1	1	GONCALVES, LISA LMFT	4/16/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
151740	Fee-for-Service	1801825203	1801825203	1	1	GIROLAMI, MICHAEL H MD	1/1/1979	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	23272	41	Internal Medicine	0	In state provider	None	1828 EL CAMINO REAL	RM 4	BURLINGAME	CA	94010	3103	41	06081	37.59552262	-122.3838771	San Mateo County
151783	Fee-for-Service	1851609176	1851609176	1	1	GREEN CROSS MED NET INC	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	5832 S VERMONT AVE	None	LOS ANGELES	CA	90044	3712	19	06037	33.98805	-118.2914425	Los Angeles County
151825	Fee-for-Service	1235171067	1235171067	1	1	GLAZER, DEVON N DPM	8/29/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 420	MISSION VIEJO	CA	92691	8038	30	06059	33.56286021	-117.6673449	Orange County
151850	Fee-for-Service	1952746802	1952746802	1	1	GUPTA, SAURABH MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155051	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
151860	Fee-for-Service	1285996264	1285996264	1	1	GOLDMAN, ADRIAN D DO	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13852	40	Pediatrics	0	In state provider	None	7520 ARROYO CIRCLE	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
151863	Fee-for-Service	1063467835	1063467835	1	1	GAME, JAMES 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
151871	Fee-for-Service	1932148178	1932148178	1	1	GADDINI, MICHAEL S MD	1/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52746	08	Family Practice	0	In state provider	None	1600 CREEKSIDE DR	STE 3300	FOLSOM	CA	95630	3486	34	06067	38.669994	-121.147488	Sacramento County
151872	Fee-for-Service	1679658348	1679658348	1	1	GILL, KANWALJIT S MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	44486	20	Orthopedic Surgery	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
151884	Fee-for-Service	1083700728	1083700728	1	1	GOODSON, SHARON M	4/12/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
151919	Fee-for-Service	1053670273	1053670273	1	1	GANGU, SHANTAVEER MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120455	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
151949	Fee-for-Service	1144917626	1144917626	1	1	GOCKING, ODECIR E CNP	5/23/2023	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16955 VANOWEN ST	None	VAN NUYS	CA	91406	4542	19	06037	34.19389751	-118.503342	Los Angeles County
151953	Fee-for-Service	1720602469	1720602469	1	1	GREBE, MICHELLE D LMFT	10/26/2023	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
151970	Fee-for-Service	1205097631	1205097631	1	1	GLICKMAN, KATHRYN A LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27951 SMYTH DRIVE	105	VALENCIA	CA	91355	4049	19	06037	34.44222202	-118.5700452	Los Angeles County
151973	Fee-for-Service	1235544933	1235544933	1	1	GIESE, ISAIAH W	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153384	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
151996	Fee-for-Service	1366490120	1366490120	1	1	GHEI, KAMAL S MD	12/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86169	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
152011	Fee-for-Service	1174128508	1174128508	1	1	GURDIAN, ELIZABETH A PT	6/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
152064	Fee-for-Service	1306374848	1306374848	1	1	GULARTE, NICHOLAS P DO	9/14/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	17177	None	None	0	In state provider	None	3421 VILLA LANE	SUITE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
152071	Fee-for-Service	1851609176	1851609176	1	1	GREEN CROSS MED NET INC	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5832 S VERMONT AVE	None	LOS ANGELES	CA	90044	3712	19	06037	33.98805	-118.2914425	Los Angeles County
152118	Fee-for-Service	1316264021	1316264021	1	1	GORT, ADAM E 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
152140	Fee-for-Service	1598086316	1598086316	1	1	GORTER, SUZANNE G LMFT	8/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1439 MARSH ST	None	SAN LUIS OBISPO	CA	93401	2921	40	06079	35.28438803	-120.6537878	San Luis Obispo County
152188	Fee-for-Service	1699782516	1699782516	1	2	GARCIA, JEFFREY	2/1/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 N 11TH AVE	None	HANFORD	CA	93230	2084	16	06031	36.34290408	-119.6550902	Kings County
152201	Fee-for-Service	1235146077	1235146077	1	1	GIRGIS, EMAD N MD	6/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98998	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
152206	Fee-for-Service	1548321391	1548321391	1	1	GODINO, MARIA T LCSW	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
152217	Fee-for-Service	1982026050	1982026050	2	1	GARFIELD BEACH CVS LLC	11/17/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5104 COMMONS DR	None	ROCKLIN	CA	95677	3911	31	06061	38.804508	-121.207297	Placer County
152221	Fee-for-Service	1821158312	1821158312	1	1	GASIOR, ANNE E MD	7/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	64898	01	General Practice	0	In state provider	None	152 PIONEER LN	STE D	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
152225	Fee-for-Service	1740456516	1740456516	1	1	GINSBERG, HAROLD N MD	2/8/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	7753	None	None	0	In state provider	None	136 N 3RD ST	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
152252	Fee-for-Service	1699772210	1699772210	1	1	GOLLARD, RUSSELL P MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	68	Hematology	1	Border provider	None	58 N PECOS RD	None	HENDERSON	NV	89074	7319	00	None	36.03160397	-115.1002424	Clark County
152266	Fee-for-Service	1699349977	1699349977	1	1	GOODFELLOW, MARGARET E OT	5/26/2023	390200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
152284	Fee-for-Service	1134205628	1134205628	1	1	GOOD, WILLIAM Z MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	16126	08	Family Practice	0	In state provider	None	1840 N HACIENDA BLVD	None	LA PUENTE	CA	91744	1143	19	06037	34.05164127	-117.9426446	Los Angeles County
152298	Fee-for-Service	1558023911	1558023911	1	1	GALEN INPATIENT PHYSICIANS,	12/1/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
152414	Fee-for-Service	1871753392	1871753392	1	1	GARDNER, STEPHEN MD	10/30/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	124837	20	Orthopedic Surgery	0	In state provider	None	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
152426	Fee-for-Service	1598279572	1598279572	1	1	GOMEZ, KEYLLA N CCC-SLP	3/26/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
152462	Fee-for-Service	1720270499	1720270499	1	1	GARRELS, SCOTT R PHD	9/20/2010	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
152467	Fee-for-Service	1487214698	1487214698	1	1	G2 ANESTHESIA PC	6/18/2020	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
152478	Fee-for-Service	1750524328	1750524328	1	1	GAVANKAR, SHEETAL S MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	102890	83	Rheumatology	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
152507	Fee-for-Service	1902067325	1902067325	1	1	GLASSBERG, JOCYLEN E MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55943	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
152538	Fee-for-Service	1699772210	1699772210	1	1	GOLLARD, RUSSELL P MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	58 N PECOS RD	None	HENDERSON	NV	89074	7319	00	None	36.03160397	-115.1002424	Clark County
152548	Fee-for-Service	1992093272	1992093272	1	1	GARDNER, RACHAEL NP	10/25/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
152574	Fee-for-Service	1134205628	1134205628	1	1	GOOD, WILLIAM Z MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	16126	01	General Practice	0	In state provider	None	1840 N HACIENDA BLVD	None	LA PUENTE	CA	91744	1143	19	06037	34.05164127	-117.9426446	Los Angeles County
152576	Fee-for-Service	1700805124	1700805124	1	1	GOODMAN, PAUL M MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24856	04	Otology, Laryngology, Rhinology	0	In state provider	None	4033 3RD AVE	STE 104	SAN DIEGO	CA	92103	2136	37	06073	32.75053781	-117.1627168	San Diego County
152579	Fee-for-Service	1114211612	1114211612	2	1	GARFIELD BEACH CVS LLC	3/2/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11990 LOS OSOS VALLEY RD	None	SAN LUIS OBISPO	CA	93405	6861	40	06079	35.252388	-120.684537	San Luis Obispo County
152580	Fee-for-Service	1942312467	1942312467	1	1	GELBART, MORRIS PHD	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
152581	Fee-for-Service	1427880335	1427880335	1	1	GRUMBOS, JAMIE LMFT	10/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
152587	Fee-for-Service	1558023911	1558023911	1	1	GALEN INPATIENT PHYSICIANS,	12/1/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
152602	Fee-for-Service	1437221736	1437221736	1	1	GERBINO II, PETER G	12/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	63968	None	None	0	In state provider	None	900 CASS ST	None	MONTEREY	CA	93940	4544	27	06053	36.59318924	-121.8959747	Monterey County
152605	Fee-for-Service	1508841271	1508841271	1	1	GUBSER, M SASHA	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
152625	Fee-for-Service	1417928276	1417928276	1	1	GEORGE W LEON, MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9201 W THOMAS RD	None	PHOENIX	AZ	85037	3332	00	None	33.47892	-112.2579	Maricopa County
152634	Fee-for-Service	1346269719	1346269719	1	1	GARLIN, AMY B MD	5/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79325	41	Internal Medicine	0	In state provider	None	2850 TELEGRAPH AVE	STE 110	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
152675	Fee-for-Service	1194097048	1194097048	1	1	GIORGIO, JOSEPH A PSYD	2/27/2012	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
152690	Fee-for-Service	1184852360	1184852360	1	1	GOLDENBERG, EMILY B MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128428	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
152753	Fee-for-Service	1740317254	1740317254	1	1	GANGULY, ANINDITA PHD	11/27/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	162 N SANTA FE ST	None	HEMET	CA	92543	4451	33	06065	33.74923371	-116.9629676	Riverside County
152772	Fee-for-Service	1750524328	1750524328	1	1	GAVANKAR, SHEETAL S MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	102890	41	Internal Medicine	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
152792	Fee-for-Service	1295050771	1295050771	1	2	GOLDEN GATE ENT CORPORATION	10/30/2017	261QH0100X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1711 TARAVAL ST	None	SAN FRANCISCO	CA	94116	2308	38	06075	37.74263686	-122.4845313	San Francisco County
152809	Fee-for-Service	1376838680	1376838680	1	1	GROTTING, JOHN A MD	10/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144169	20	Orthopedic Surgery	0	In state provider	None	4910 DIRECTORS PLACE	STE 350	SAN DIEGO	CA	92121	3834	37	06073	32.89428695	-117.2115258	San Diego County
152826	Fee-for-Service	1265631741	1265631741	1	1	GRAY, KATHERINE V MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	82331	20	Orthopedic Surgery	0	In state provider	None	260 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
152860	Fee-for-Service	1962404756	1962404756	1	1	GREY, CURTIS 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	2000 S PALESTINE ST	None	ATHENS	TX	75751	5610	00	None	32.16969	-95.846049	Henderson County
152886	Fee-for-Service	1548778723	1548778723	1	1	GOOD SAMARITAN PHARMACY INC	4/20/2018	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8137 MALACHITE AVE	STE A	RANCHO CUCAMONGA	CA	91730	3571	36	06071	34.105869	-117.597371	San Bernardino County
152944	Fee-for-Service	1902984693	1902984693	1	1	GARONE, SHELLY R MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69056	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
152949	Fee-for-Service	1235737545	1235737545	1	1	GONG, JANINE L PT	10/22/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
152957	Fee-for-Service	1326129479	1326129479	1	1	GRAY, GREGORY E MD	7/31/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	None	300 E SANTA CLARA ST	STE 106	VENTURA	CA	93001	2768	56	06111	34.27950554	-119.2959405	Ventura County
152989	Fee-for-Service	1447596143	1447596143	1	1	GARFIELD BEACH CVS LLC	10/24/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1059 HYDE ST	None	SAN FRANCISCO	CA	94109	4916	38	06075	37.79070235	-122.4173626	San Francisco County
153003	Fee-for-Service	1699012302	1699012302	1	1	GARRETT, STEPHANIE S MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
153014	Fee-for-Service	1134385156	1134385156	1	1	GLASER, KATHERINE B MD	7/1/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169008	09	Gynecology (D.O. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
153015	Fee-for-Service	1033379276	1033379276	1	1	GOMEZ, NADIA A MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	3175 ST ROSE PARKWAY	SUITE 200	HENDERSON	NV	89052	3507	00	None	35.99940075	-115.12488	Clark County
153019	Fee-for-Service	1588044028	1588044028	1	1	GOLDEN WAY CARE INC	2/10/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2825 EAST DUTCH AVE	None	ANAHEIM	CA	92806	2930	30	06059	33.84242549	-117.8702955	Orange County
153022	Fee-for-Service	1689027252	1689027252	1	1	GRACE, JACKLINE MD	2/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159411	08	Family Practice	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
153036	Fee-for-Service	1861524415	1861524415	1	1	GRIGSBY, EMILY W MD	3/17/2008	207P00000X	NA	Other	026	PHYSICIANS	95839	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
153064	Fee-for-Service	1356883714	1356883714	1	1	GREGG-ARMAZ, NICOLE K CCC-SL	4/15/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P	190 ORCHARD AVE	C200	VACAVILLE	CA	95688	3647	48	06095	38.358945	-122.004786	Solano County
153069	Fee-for-Service	1710180468	1710180468	1	1	GRUBE, MATTHEW A MD	8/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108508	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE 1700	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
153080	Fee-for-Service	1295050771	1295050771	1	2	GOLDEN GATE ENT CORPORATION	10/30/2017	261QH0100X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	1711 TARAVAL ST	None	SAN FRANCISCO	CA	94116	2308	38	06075	37.74263686	-122.4845313	San Francisco County
153116	Fee-for-Service	1144872052	1144872052	1	3	GOLDEN STATE IMAGING ASSOCIA	3/13/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TES INC	6601 WHITE FEATHER	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
153123	Fee-for-Service	1750329298	1750329298	1	1	GUEVARA-REBUENO, BRIGIDA	10/27/2008	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	40347	08	Family Practice	0	In state provider	MD	475 W BADILLO STREET	None	COVINA	CA	91723	1834	19	06037	34.08634352	-117.8986545	Los Angeles County
153142	Fee-for-Service	1134151251	1134151251	1	1	GUPTA,USHA MD INC	8/13/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	33035	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
153155	Fee-for-Service	1043695604	1043695604	1	1	GREEN, YASMINA L LCSW	9/9/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
153165	Fee-for-Service	1518084177	1518084177	1	1	GALVAN, EVA LMFT	9/4/2018	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
153166	Fee-for-Service	1083230213	1083230213	1	1	GOOD HEART'S HOSPICE INC	4/21/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7200 VINELAND AVE	UNIT 202	SUN VALLEY	CA	91352	5089	19	06037	34.2016328	-118.3703012	Los Angeles County
153183	Fee-for-Service	1992837991	1992837991	1	1	GALARZA, STEVEN F DO INC	10/1/2018	193200000X	NA	Other	026	PHYSICIANS	8374	36	Psychiatry	0	In state provider	None	28078 BAXTER ROAD	SUITE 230	MURRIETA	CA	92563	1403	33	06065	33.615	-117.1670265	Riverside County
153209	Fee-for-Service	1780816561	1780816561	1	1	GOPLANI, SANDEEP M MD	7/27/2023	207RS0012X	NA	Other	026	PHYSICIANS	186356	None	None	0	In state provider	None	6555 COYLE AVENUE	SUITE 380	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
153224	Fee-for-Service	1730575473	1730575473	1	1	GOWDA, CHANDAN DO	9/9/2019	207R00000X	NA	Other	026	PHYSICIANS	16255	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
153233	Fee-for-Service	1790707487	1790707487	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12051 IMPERIAL HWY	None	NORWALK	CA	90650	3084	19	06037	33.91721762	-118.0754212	Los Angeles County
153236	Fee-for-Service	1750542445	1750542445	1	1	GOLDMAN, BABAK M	10/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120541	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
153257	Fee-for-Service	1932281334	1932281334	1	1	GUERRERO, THOMAS M MD	8/9/2022	2085R0001X	NA	Other	026	PHYSICIANS	66756	None	None	0	In state provider	None	1410 S LA BRUCHERIE RD	STE B	EL CENTRO	CA	92243	9676	13	06025	32.78048827	-115.578488	Imperial County
153267	Fee-for-Service	1871515668	1871515668	2	1	GARFIELD BEACH CVS LLC	3/23/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5711 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	2918	19	06037	34.174926	-118.4661865	Los Angeles County
153301	Fee-for-Service	1053371690	1053371690	1	1	GARZA, EDUARDO G MD	4/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71612	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
153302	Fee-for-Service	1134385156	1134385156	1	1	GLASER, KATHERINE B MD	7/1/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	169008	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
153335	Fee-for-Service	1619993771	1619993771	1	1	GREENBERG, DANIEL	6/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	44959	None	None	0	In state provider	None	703 N A ST	None	OXNARD	CA	93030	4309	56	06111	34.209063	-119.1784975	Ventura County
153358	Fee-for-Service	1033505169	1033505169	1	1	GARCIA, ROMAN MD	3/13/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167250	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
153408	Fee-for-Service	1184933871	1184933871	1	1	GUERTIN, LISA C NP	10/23/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
153422	Fee-for-Service	1407910250	1407910250	1	1	GARVEY ELEM SD	1/21/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2730 DEL MAR AVE	None	ROSEMEAD	CA	91770	3026	19	06037	34.06127739	-118.0994023	Los Angeles County
153441	Fee-for-Service	1548410509	1548410509	1	1	GARCIA, JEWEL PT	2/7/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
153453	Fee-for-Service	1083230213	1083230213	1	1	GOOD HEART'S HOSPICE INC	4/21/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7200 VINELAND AVE	UNIT 202	SUN VALLEY	CA	91352	5089	19	06037	34.2016328	-118.3703012	Los Angeles County
153454	Fee-for-Service	1578149076	1578149076	1	1	GILL MEDICAL ASSOCIATES, INC	2/16/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1503 E MARCH LN	A	STOCKTON	CA	95210	5622	39	06077	38.00228434	-121.2903651	San Joaquin County
153471	Fee-for-Service	1053355081	1053355081	1	1	GOULD, SUSAN MD	2/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	59562	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
153500	Fee-for-Service	1609080399	1609080399	1	1	GILILLAND, SUSAN	2/20/2008	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	13922 B SEAL BEACH BLVD	None	SEAL BEACH	CA	97040	5377	30	06059	33.76132389	-118.0777961	Orange County
153612	Fee-for-Service	1033245766	1033245766	1	1	GORDON-MARTINEZ, MARTA L LMF	5/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	13601 WHITTIER BLVD	STE 208	WHITTIER	CA	90605	1955	19	06037	33.96101144	-118.0289736	Los Angeles County
153625	Fee-for-Service	1376930321	1376930321	1	1	GREENBERG, SOLOMON MD	7/15/2019	207R00000X	NA	Other	026	PHYSICIANS	147219	41	Internal Medicine	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
153660	Fee-for-Service	1265454052	1265454052	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	560 CONTRA COSTA BLVD	None	PLEASANT HILL	CA	94523	1216	07	06013	37.97767657	-122.0659043	Contra Costa County
153672	Fee-for-Service	1457858581	1457858581	1	1	GARCIA, APRIL DO	6/21/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	17531	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
153684	Fee-for-Service	1962977371	1962977371	1	1	GUMBO, ELISHA	11/13/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	37657 BRUTUS WAY	None	BEAUMONT	CA	92223	8056	33	06065	33.94565949	-117.0137644	Riverside County
153694	Fee-for-Service	1477713048	1477713048	1	6	GOBER, BRIANNE C MD	8/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145392	None	None	0	In state provider	None	8351 BROADWAY	None	LEMON GROVE	CA	91945	2009	37	06073	32.74628447	-117.017576	San Diego County
153772	Fee-for-Service	1568272367	1568272367	1	1	GRUNDY, LEOMA DOULA	2/12/2025	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	01	06001	0	0	None
153818	Fee-for-Service	1003994724	1003994724	1	1	GIUSTINA, THOMAS A MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	56924	07	Dermatology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
153819	Fee-for-Service	1992913214	1992913214	1	1	GOLSHANI, KIARASH MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113684	14	Neurological Surgery	0	In state provider	None	25455 BARTON ROAD	SUITE A108	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
153831	Fee-for-Service	1467125757	1467125757	1	1	GARDEN GROVE GUEST HOME	12/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	12882 SHACKELFORD LANE	None	GARDEN GROVE	CA	92841	5109	30	06059	33.77512936	-117.972012	Orange County
153844	Fee-for-Service	1366530412	1366530412	1	1	GOLGERT, WILLIAM A MD	1/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101903	45	Nephrology (Renal-Kidney)	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
153893	Fee-for-Service	1619364866	1619364866	1	1	GORDON, ALEXANDRA J MD	11/23/2020	207P00000X	NA	Other	026	PHYSICIANS	144600	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
153918	Fee-for-Service	1659807154	1659807154	1	1	GESMUNDO, CRISTINA DO	9/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17198	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
153922	Fee-for-Service	1093472607	1093472607	1	1	GREGORY, DEBORAH L CNP	3/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4235 PACIFIC COAST HWY	None	TORRANCE	CA	90505	5525	19	06037	33.80817211	-118.3588219	Los Angeles County
153944	Fee-for-Service	1821006263	1821006263	1	1	GEOULA, JACK MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94898	41	Internal Medicine	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
153952	Fee-for-Service	1699780072	1699780072	1	1	GHAZAR GUS ZOKIAN	4/1/1992	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	MEDIC CARE SUPPLIES	2930 HONOLULU AVE	STE 101	LA CRESCENTA	CA	91214	3979	19	06037	34.21321777	-118.2428641	Los Angeles County
153971	Fee-for-Service	1962977371	1962977371	1	1	GUMBO, ELISHA	11/13/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	37657 BRUTUS WAY	None	BEAUMONT	CA	92223	8056	33	06065	33.94565949	-117.0137644	Riverside County
153974	Fee-for-Service	1114577160	1114577160	1	2	GO GREEN AMBULANCE CORP	3/31/2022	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7111 WINNETKA AVENUE	SUITE 6	WINNETKA	CA	91302	1000	19	06037	34.199739	-118.5710185	Los Angeles County
154054	Fee-for-Service	1194145771	1194145771	1	1	GARY M. FEINBERG ENT, INC.	8/21/2018	207YX0007X	NA	ENT/Otolaryngology	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	None	4646 BROCKTON AVE	SUITE 201	RIVERSIDE	CA	92506	0104	33	06065	33.9760171	-117.3860626	Riverside County
154065	Fee-for-Service	1023146206	1023146206	1	1	GEULA, FOEAD MD	6/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95741	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
154087	Fee-for-Service	1013134576	1013134576	1	1	GOFFSTEIN, DEREK MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2931 N TENAYA WAY	STE 102	LAS VEGAS	NV	89128	0000	00	None	36.21475528	-115.2504424	Clark County
154094	Fee-for-Service	1083875330	1083875330	2	1	GARFIELD BEACH CVS LLC	10/4/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5837 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	6866	34	06067	38.672874	-121.274775	Sacramento County
154112	Fee-for-Service	1407863038	1407863038	1	1	GRAY, JOHN M DO	12/13/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6185	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
154132	Fee-for-Service	1972950426	1972950426	1	1	GODIWALLA, ROXANA Y DO	3/19/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	15794	None	None	0	In state provider	None	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
154137	Fee-for-Service	1972907574	1972907574	1	1	GOSHTASEB, RAY R MD	3/18/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	144426	45	Nephrology (Renal-Kidney)	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
154154	Fee-for-Service	1851554372	1851554372	1	2	GILL, MUHAMMAD A MD	10/31/2022	207R00000X	NA	Other	086	MEDICAL DIRECTORS	103683	-	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
154193	Fee-for-Service	1417198847	1417198847	1	1	GIEDD, JAY N MD	9/13/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	134480	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
154219	Fee-for-Service	1386775476	1386775476	1	1	GILLEY HENSLEY, LAURA B MD	4/1/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	175956	36	Psychiatry	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
154223	Fee-for-Service	1972791259	1972791259	1	1	GARETT RHULE	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
154231	Fee-for-Service	1346328499	1346328499	1	1	GUHA, AMAL K MD FACOG	3/24/1980	174400000X	NA	Other	026	PHYSICIANS	35044	None	None	0	In state provider	None	16124 KASOTA RD	None	APPLE VALLEY	CA	92307	2216	36	06071	34.54426738	-117.2667469	San Bernardino County
154249	Fee-for-Service	1356873541	1356873541	1	1	GRICHKEVITCH, HELEN V MD	2/13/2023	207L00000X	NA	Other	026	PHYSICIANS	172831	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
154261	Fee-for-Service	1477990125	1477990125	1	1	GRAFF, JOHN P DO	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13264	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
154339	Fee-for-Service	1871501320	1871501320	1	1	GARFIELD BEACH CVS LLC	3/23/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15718 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	2640	19	06037	33.88806	-118.3523515	Los Angeles County
154346	Fee-for-Service	1336340215	1336340215	1	1	GERBER, A MARCUS MD	12/31/1987	2085B0100X	NA	MRI Provider	026	PHYSICIANS	37582	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
154356	Fee-for-Service	1164059028	1164059028	1	1	GONZALEZ, ALEJANDRA R MD	8/1/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	183148	None	None	0	In state provider	None	2970 HILLTOP MALL ROAD	305	RICHMOND	CA	94806	1947	07	06013	37.97819764	-122.329244	Contra Costa County
154365	Fee-for-Service	1184811648	1184811648	1	1	GR LOZANO SERVICES INC	4/3/2007	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SOUTHBAY MEDICAL TRANSPO	693 VISTA SAN RAFAEL	None	SAN DIEGO	CA	92154	5503	37	06073	32.58178772	-117.0132647	San Diego County
154383	Fee-for-Service	1881761773	1881761773	1	1	GROVE, JAMES A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37939	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
154399	Fee-for-Service	1083275986	1083275986	1	1	GOTTLIEB, JILLIAN G MD	8/8/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179731	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
154410	Fee-for-Service	1992966253	1992966253	2	1	GARFIELD BEACH CVS LLC	5/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16858 GOLDEN VALLEY PKWY	None	LATHROP	CA	95330	8535	39	06077	37.80809035	-121.3000753	San Joaquin County
154421	Fee-for-Service	1306509260	1306509260	1	1	GAN, KAYLA E OT	4/12/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
154424	Fee-for-Service	1972907574	1972907574	1	1	GOSHTASEB, RAY R MD	3/18/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	144426	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
154503	Fee-for-Service	1558619395	1558619395	1	1	GARFIELD BEACH CVS LLC	3/28/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	303 S LA BREA AVE	None	LOS ANGELES	CA	90036	3526	19	06037	34.068501	-118.3440585	Los Angeles County
154594	Fee-for-Service	1568741924	1568741924	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2120 W MAIN ST	None	ALHAMBRA	CA	91801	1856	19	06037	34.09195404	-118.1466969	Los Angeles County
154607	Fee-for-Service	1033314687	1033314687	1	1	GUPTA, KINSHUK PT	6/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
154620	Fee-for-Service	1396987624	1396987624	1	1	GONZALEZ, ROSA A LMFT	3/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
154652	Fee-for-Service	1174541353	1174541353	1	1	GUTIEZREZ, ORLANDO 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 GARTH RD	None	BAYTOWN	TX	77521	2122	00	None	29.76910842	-94.97759843	Harris County
154690	Fee-for-Service	1518015494	1518015494	1	1	GURBANI, MEENA S MD	4/8/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55112	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
154790	Fee-for-Service	1275761314	1275761314	1	1	GHAFFARI, NEDA S T MD	7/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111540	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 EAST HAMILTON AVENUE	SUITE 220	CAMPBELL	CA	95008	0665	43	06085	37.29428651	-121.934403	Santa Clara County
154795	Fee-for-Service	1952586232	1952586232	1	1	GANGOPADHYAY, THIEN CNP	5/26/2022	363LF0000X	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
154921	Fee-for-Service	1366464158	1366464158	2	1	GARFIELD BEACH CVS LLC	4/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1919 FULTON AVE	None	SACRAMENTO	CA	95825	1905	34	06067	38.600838	-121.403232	Sacramento County
154958	Fee-for-Service	1306174602	1306174602	1	1	GARCIA-SWAIN, SUSAN E MD	7/5/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	39681	-	NOT APPLICABLE	0	In state provider	None	1133 COLOMA WAY	SUITE C	ROSEVILLE	CA	95661	4480	31	06061	38.73639952	-121.2734295	Placer County
154993	Fee-for-Service	1982851200	1982851200	1	1	GOODSON, MARIE R CCC-SLP	12/5/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
154999	Fee-for-Service	1164711990	1164711990	1	1	GADGIL, MEGHANA A MD	1/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122055	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
155011	Fee-for-Service	1013322882	1013322882	1	1	GARDNER, ELAINE MD	11/5/2014	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
155043	Fee-for-Service	1336437201	1336437201	1	1	GANGAR, JAMES A MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144023	08	Family Practice	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
155045	Fee-for-Service	1528681798	1528681798	1	1	GOLDEN 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	SUITE 225B	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
155074	Fee-for-Service	1295111821	1295111821	1	1	GRANTZ, CAROLINE J PHD	1/27/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	STE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
155080	Fee-for-Service	1326125279	1326125279	1	1	GARCIA, RAMON F MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42503	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
155089	Fee-for-Service	1801850144	1801850144	1	1	GONZALEZ, MARITZA MD	4/30/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	64360	22	Pathology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
155092	Fee-for-Service	1891409231	1891409231	1	1	GWEBU, BLESSED	5/23/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3045 N WINSLOW ST	None	VISALIA	CA	93291	8686	54	06107	36.357345	-119.334654	Tulare County
155141	Fee-for-Service	1619044500	1619044500	1	1	GOULBOURNE, KARITA E MD	12/1/1997	207P00000X	NA	Other	026	PHYSICIANS	75630	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
155189	Fee-for-Service	1477538627	1477538627	1	1	GARCIA-FERRER, FRANCISCO	5/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83005	18	Ophthalmology	0	In state provider	None	1611 ALHAMBRA BLVD	None	SACRAMENTO	CA	95816	7051	34	06067	38.56554661	-121.4682967	Sacramento County
155206	Fee-for-Service	1528055183	1528055183	1	1	GOMEZ, 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	346 GRAND AVE	None	JOHNSON CITY	NY	13790	2580	00	None	42.109812	-75.9635235	Broome County
155225	Fee-for-Service	1811142169	1811142169	1	1	GO, ORSON D MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138454	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2 MEDICAL PLAZA DR	STE 175	ROSEVILLE	CA	95661	3049	31	06061	38.76507948	-121.2477476	Placer County
155257	Fee-for-Service	1801071303	1801071303	1	1	GAKHAR, HARLEEN K MD	6/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102121	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
155275	Fee-for-Service	1891798658	1891798658	1	1	GORWIT, JEFFREY I MD	7/1/1976	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25365	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
155279	Fee-for-Service	1811008063	1811008063	1	1	GRIFFITS, WILLIAM R MD	6/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7885	41	Internal Medicine	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
155323	Fee-for-Service	1972782043	1972782043	1	1	GITLIN, SUSAN LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
155325	Fee-for-Service	1134803604	1134803604	1	1	GWADA, BERYL AWUOR	10/17/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13061 MILLER AVENUE	None	NORWALK	CA	90650	3342	19	06037	33.91081782	-118.0536383	Los Angeles County
155334	Fee-for-Service	1528681798	1528681798	1	1	GOLDEN HOSPICE, INC	2/1/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	SUITE 225B	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
155379	Fee-for-Service	1891409231	1891409231	1	1	GWEBU, BLESSED	5/23/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3045 N WINSLOW ST	None	VISALIA	CA	93291	8686	54	06107	36.357345	-119.334654	Tulare County
155385	Fee-for-Service	1013572478	1013572478	1	1	GRIESHEIMER, STACY M CCC-SLP	4/3/2025	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
155433	Fee-for-Service	1174681324	1174681324	1	1	GTL INC	6/3/2020	No Taxonomy Provided	NA	None	068	HCBC BENEFIT PROVIDER	-	-	NOT APPLICABLE	2	Out of state provider	None	27475 MEADOWBROOK RD	None	NOVI	MI	48377	3532	00	None	42.492393	-83.457882	Oakland County
155449	Fee-for-Service	1659479848	1659479848	1	1	GREENFIELD, PAULA R MD	3/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	73696	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
155460	Fee-for-Service	1275686818	1275686818	1	1	GASTROENTEROLOGY ASSOC	2/28/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF SO CALIF MED GRP	201 S ALVARADO ST	STE 707	LOS ANGELES	CA	90057	2390	19	06037	34.06417777	-118.2719543	Los Angeles County
155482	Fee-for-Service	1184128548	1184128548	1	1	GE, MARSHALL X MD	9/12/2023	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	164225	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
155485	Fee-for-Service	1245237346	1245237346	1	1	GARETTO, THOMAS P MD	9/5/2017	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
155495	Fee-for-Service	1295856805	1295856805	1	1	GIAMBUZZI, EUGENA M LMFT	8/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27715 JEFFERSON AVE.	112	TEMECULA	CA	92590	6600	33	06065	33.51272967	-117.1590194	Riverside County
155497	Fee-for-Service	1033593769	1033593769	1	1	GUPTA, SURENDRA MD	9/21/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	152468	None	None	0	In state provider	None	805 FRESNO ST	None	FRESNO	CA	93706	3118	10	06019	36.72759914	-119.8041481	Fresno County
155524	Fee-for-Service	1447889274	1447889274	1	2	GO GENTLY MEDICAL GROUP. INC	1/25/2023	207RH0002X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	.	7365 CARNELIAN ST	240	RANCHO CUCAMONGA	CA	91730	1158	36	06071	34.12038413	-117.6160525	San Bernardino County
155554	Fee-for-Service	1992972186	1992972186	1	1	GASKA, BARTHOLOMEW NP	10/10/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
155592	Fee-for-Service	1508866393	1508866393	1	1	GUNZ, EDWARD F MD	4/1/1983	207L00000X	NA	Other	026	PHYSICIANS	44361	05	Anesthesiology	0	In state provider	None	1820 TRIBUTE RD	STE J	SACRAMENTO	CA	95815	4307	34	06067	38.599578	-121.444326	Sacramento County
155608	Fee-for-Service	1013297639	1013297639	1	1	GENERAL MEDICAL CARE	6/12/2018	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6470 FOOTHILL BLVD	STE D	TUJUNGA	CA	91402	2729	19	06037	34.24452205	-118.2728144	Los Angeles County
155613	Fee-for-Service	1134803604	1134803604	1	1	GWADA, BERYL AWUOR	10/17/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13061 MILLER AVENUE	None	NORWALK	CA	90650	3342	19	06037	33.91081782	-118.0536383	Los Angeles County
155618	Fee-for-Service	1942521877	1942521877	1	1	GARRETT, VIRGINIA INC	1/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	45812	25	Physical Medicine and Rehabilitation	0	In state provider	None	3737 MCCRAY ST	None	RIVERSIDE	CA	92506	2928	33	06065	33.94855347	-117.397764	Riverside County
155621	Fee-for-Service	1801474382	1801474382	1	1	GALSTYAN, ARPINE MD	4/10/2025	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
155639	Fee-for-Service	1871232454	1871232454	1	1	GONZALEZ, TERESA M NP	2/25/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
155673	Fee-for-Service	1982995825	1982995825	1	1	GOGIA, NAMRITA MD	1/10/2017	207R00000X	NA	Other	026	PHYSICIANS	125158	41	Internal Medicine	0	In state provider	None	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
155720	Fee-for-Service	1861807679	1861807679	1	1	GOLDSTEIN, ITAMAR L MD	10/24/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
155745	Fee-for-Service	1164691424	1164691424	1	1	GUILLEN-IBARRA, MIRIAM LMFT	9/17/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	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
155775	Fee-for-Service	1366420416	1366420416	1	1	GUPTA, NAVEEN MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34794	41	Internal Medicine	0	In state provider	None	360 E 7TH ST	STE B	UPLAND	CA	91786	6701	36	06071	34.08880374	-117.6465151	San Bernardino County
155799	Fee-for-Service	1235187758	1235187758	1	1	GERO, BERNARD MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	47869	None	None	0	In state provider	None	415 ROLLING OAKS DR	STE 160	THOUSAND OAKS	CA	91361	1029	56	06111	34.17439717	-118.8691161	Ventura County
155801	Fee-for-Service	1730197823	1730197823	1	1	GAMBLING, DAVID R MD	11/30/1994	207L00000X	NA	Other	026	PHYSICIANS	43238	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
155816	Fee-for-Service	1134622640	1134622640	1	1	GASPAR, JOHN LMFT	2/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4401 SEPULVEDA BLVD	UNIT 210	SHERMAN OAKS	CA	91403	3934	19	06037	34.150356	-118.467397	Los Angeles County
155822	Fee-for-Service	1871047282	1871047282	1	1	GSR HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	837 N LA CADENA DRIVE	STE B	COLTON	CA	92324	2747	36	06071	34.07377398	-117.322951	San Bernardino County
155897	Fee-for-Service	1790799864	1790799864	1	1	GINN, PATRICK D	11/18/1993	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	50537	10	Gastroenterology (M.D. only)	0	In state provider	None	110 N VALERIA ST	STE 505	FRESNO	CA	93701	2168	10	06019	36.74388938	-119.7847725	Fresno County
155908	Fee-for-Service	1508982828	1508982828	1	1	GODLEY, JOANNE	4/28/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	88711	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
155923	Fee-for-Service	1154691855	1154691855	1	1	GUINDI, MAHA MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55048	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
155938	Fee-for-Service	1093443301	1093443301	1	1	GATBONTON, RODOLFO	9/8/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	857 SOUTH PAGOSSA WAY	None	ANAHEIM HILLS	CA	92808	2362	30	06059	33.85862451	-117.7293432	Orange County
155952	Fee-for-Service	1053502096	1053502096	1	1	GUSTAFSON, WILLIAM C MD	4/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103464	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
155969	Fee-for-Service	1043326366	1043326366	1	1	GIBBS, ROBERT L MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73898	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
155980	Fee-for-Service	1336137934	1336137934	1	2	GRAF, GEORGE MD	1/24/2024	207L00000X	NA	Other	086	MEDICAL DIRECTORS	64260	-	NOT APPLICABLE	0	In state provider	None	8929 WILSHIRE BLVD STE 2	None	BEVERLY HILLS	CA	90211	1951	19	06037	34.06709669	-118.386182	Los Angeles County
155987	Fee-for-Service	1972721801	1972721801	1	1	GURJEET S GROVER M.D.	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4403 HARRISON BLVD	STE 3815	OGDEN	UT	84403	3330	00	None	41.18328	-111.9536955	Weber County
156005	Fee-for-Service	1578903878	1578903878	1	1	GAYTAN-MEJIA, ROSALVA LCSW	5/23/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1555 DOOLITTLE DRIVE	None	SAN LEANDRO	CA	94577	2239	01	06001	37.71160019	-122.184628	Alameda County
156026	Fee-for-Service	1114707601	1114707601	1	1	GENESIS AMBULATORY SURGERY C	12/5/2024	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1401 TUSTIN AVE	105	SANTA ANA	CA	92705	8644	30	06059	33.757254	-117.8341425	Orange County
156067	Fee-for-Service	1679899736	1679899736	1	1	GAMSON, KATELYN L MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120331	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
156106	Fee-for-Service	1689005571	1689005571	1	1	GONZALEZ, THANIA L LPCC	12/2/2020	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ELEAU	855 N LARK ELLEN AVE	SUITE V	WEST COVINA	CA	91741	6210	19	06037	34.087707	-117.9166385	Los Angeles County
156108	Fee-for-Service	1720525926	1720525926	1	1	GUTIERREZ, ELYSE MD	10/11/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153450	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
156109	Fee-for-Service	1871047282	1871047282	1	1	GSR HOSPICE INC	7/28/2017	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	837 N LA CADENA DRIVE	STE B	COLTON	CA	92324	2747	36	06071	34.07377398	-117.322951	San Bernardino County
156156	Fee-for-Service	1457088858	1457088858	1	1	GATE MEDICAL SUPPLY LLC	1/18/2023	332BP3500X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1685 E MAIN ST.	STE. 202-A	EL CAJON	CA	92021	5225	37	06073	32.81132509	-116.9192044	San Diego County
156163	Fee-for-Service	1679773253	1679773253	1	1	GUPTA, DEEPASHREE MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154338	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
156227	Fee-for-Service	1093443301	1093443301	1	1	GATBONTON, RODOLFO	9/8/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	857 SOUTH PAGOSSA WAY	None	ANAHEIM HILLS	CA	92808	2362	30	06059	33.85862451	-117.7293432	Orange County
156241	Fee-for-Service	1053502096	1053502096	1	1	GUSTAFSON, WILLIAM C MD	4/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103464	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
156264	Fee-for-Service	1912955576	1912955576	1	1	GREENBLATT, DAVID Y MD	6/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120249	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
156294	Fee-for-Service	1174656896	1174656896	1	1	GREENE, RITCHIE W LCSW	10/30/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91376	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
156321	Fee-for-Service	1295775328	1295775328	1	1	GOODMAN, STEVEN B MD	12/31/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53215	01	General Practice	0	In state provider	None	1250 PEACH ST	STE A	SAN LUIS OBISPO	CA	93401	2871	40	06079	35.28647825	-120.6599674	San Luis Obispo County
156365	Fee-for-Service	1538155759	1538155759	1	1	GOMEZ, RICHARD L MD	9/2/2016	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
156401	Fee-for-Service	1518406636	1518406636	1	2	GENTECH LABORATORIES LLC	3/1/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	4403 N BELTWOOD PKWY	SUITE 300	DALLAS	TX	75244	3216	00	None	32.95028048	-96.8331645	Dallas County
156425	Fee-for-Service	1952668105	1952668105	1	1	GRAHAM, WILLIAM B III MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129182	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
156438	Fee-for-Service	1639548811	1639548811	1	1	GROFSKY, KATE S	12/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2275 S. MAIN ST.	SUITE 201	CORONA	CA	92882	5303	33	06065	33.85511663	-117.5694892	Riverside County
156447	Fee-for-Service	1679773253	1679773253	1	1	GUPTA, DEEPASHREE MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154338	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
156472	Fee-for-Service	1508363003	1508363003	1	1	GISI, BRANDON L MD	1/24/2022	390200000X	NA	Other	026	PHYSICIANS	164183	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
156493	Fee-for-Service	1801298369	1801298369	1	1	GREATER SOLUTIONS, LLC	4/3/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6236 LANCE PLACE	None	SAN DIEGO	CA	92120	4708	37	06073	32.79116781	-117.0678599	San Diego County
156519	Fee-for-Service	1225250087	1225250087	1	1	G & J ROTH PROFESSIONAL	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CORPORATION	255 W BULLARD AVE	STE 102	CLOVIS	CA	93612	0861	10	06019	36.82308345	-119.714949	Fresno County
156529	Fee-for-Service	1053502096	1053502096	1	1	GUSTAFSON, WILLIAM C MD	4/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103464	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
156532	Fee-for-Service	1821135310	1821135310	1	1	GARGA, NINA I MD	4/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84681	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
156548	Fee-for-Service	1093726945	1093726945	1	1	GOSPE JR., SIDNEY 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	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
156553	Fee-for-Service	1912955576	1912955576	1	1	GREENBLATT, DAVID Y MD	6/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120249	67	Endocrinology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
156557	Fee-for-Service	1871077222	1871077222	1	1	GOCE, PAUL RRT	2/1/2021	2279E0002X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
156568	Fee-for-Service	1326145673	1326145673	1	1	GOONEWARDENA, VISAKHA K	6/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80630	41	Internal Medicine	0	In state provider	MD	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
156576	Fee-for-Service	1144431800	1144431800	1	1	GREEN, PATRICK 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	1250 E 3900 S	STE 260	SALT LAKE CTY	UT	84124	1371	00	None	40.68704883	-111.8558593	Salt Lake County
156593	Fee-for-Service	1841279171	1841279171	1	1	GLENN M BOLTON, 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
156611	Fee-for-Service	1952340499	1952340499	1	1	GUPTA, ATUL DO	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7636	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
156612	Fee-for-Service	1295775328	1295775328	1	1	GOODMAN, STEVEN B MD	12/31/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53215	08	Family Practice	0	In state provider	None	1250 PEACH ST	STE A	SAN LUIS OBISPO	CA	93401	2871	40	06079	35.28647825	-120.6599674	San Luis Obispo County
156627	Fee-for-Service	1437106457	1437106457	1	1	GODINEZ, ANDRES	6/23/2008	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	885 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4733	19	06037	34.05028343	-118.138517	Los Angeles County
156639	Fee-for-Service	1750306940	1750306940	1	1	GOLDHABER, JOSHUA MD	12/31/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	57887	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
156658	Fee-for-Service	1487169561	1487169561	1	1	GLADYSZ, KIMBERLY	9/29/2023	171M00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
156664	Fee-for-Service	1588619290	1588619290	1	1	GARVEY, MICHAEL C LCSW	11/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
156679	Fee-for-Service	1073046975	1073046975	1	1	GORHAM, ARTHUR N DO	12/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18506	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
156707	Fee-for-Service	1588074959	1588074959	1	1	GRETHER, DUSTIN DPM	5/25/2020	213ES0103X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
156729	Fee-for-Service	1235442500	1235442500	1	1	GARCIA, LUIS LCSW	12/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	930 TRUXTUN AVE STE 206	None	BAKERSFIELD	CA	93301	4700	15	06029	35.37343547	-119.012751	Kern County
156758	Fee-for-Service	1063191385	1063191385	1	1	GOLDEN VALLEY MEDICAL TRANSP	7/13/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ORT INC	4604 CIMARRON RIDGE DR	None	BAKERSFIELD	CA	93313	5549	15	06029	35.27484636	-119.0534768	Kern County
156759	Fee-for-Service	1669733119	1669733119	1	1	GOUGH, AMELIA C LMFT	10/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	417 NEAL STREET	None	GRASS VALLEY	CA	95945	6411	29	06057	39.21827879	-121.0658607	Nevada County
156762	Fee-for-Service	1063562312	1063562312	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2005 TOWN CENTER PLZ	None	WEST SACRAMENTO	CA	95691	4957	57	06113	38.54994304	-121.5353821	Yolo County
156775	Fee-for-Service	1699435636	1699435636	1	1	GOLDEN PALMS HOME HEALTH	12/18/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	333 N PALM CANYON DR	SUITE 210	PALM SPRINGS	CA	92262	5664	33	06065	33.827652	-116.5468485	Riverside County
156802	Fee-for-Service	1770607053	1770607053	1	1	GRUNBERG, GREGORY E MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53591	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
156815	Fee-for-Service	1326423922	1326423922	1	1	GOZALI, TRISNA NP	2/14/2018	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
156860	Fee-for-Service	1184967044	1184967044	1	1	GIBSON, JOY MD	7/12/2023	208M00000X	NA	Other	026	PHYSICIANS	174733	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
156862	Fee-for-Service	1952428567	1952428567	1	1	GOKHALE, JANAKI A MD	1/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145207	35	Pediatric Cardiology (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
156874	Fee-for-Service	1770513798	1770513798	1	1	GORDON, JOSH L MD	4/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83917	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
156878	Fee-for-Service	1144648999	1144648999	1	1	GRIFFIN, KATHRYN LEE MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147235	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
156919	Fee-for-Service	1235514191	1235514191	1	1	GUNDE, SHRAVAN MD	9/4/2018	390200000X	NA	Other	026	PHYSICIANS	155564	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
156979	Fee-for-Service	1225017627	1225017627	1	1	GULUR,PADMA MD	6/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130566	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
156988	Fee-for-Service	1730409186	1730409186	1	1	GLASBERG, TALIA V MD	10/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129769	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 WEST CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
156998	Fee-for-Service	1740462464	1740462464	1	1	GHOLAMI, PARVIZ MD	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101582	10	Gastroenterology (M.D. only)	0	In state provider	None	1227 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2871	56	06111	34.27181352	-118.7762625	Ventura County
157015	Fee-for-Service	1710111505	1710111505	1	1	GALEWYRICK, SARAH E MD	7/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131432	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
157016	Fee-for-Service	1821048257	1821048257	1	1	GU, MAI MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68810	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
157041	Fee-for-Service	1437132438	1437132438	1	1	GRUHLKE, THOMAS A MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90027	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
157058	Fee-for-Service	1104371681	1104371681	1	1	GARCIA, MARIALUISA NP	2/6/2024	363A00000X	NA	Physician Assistant	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
157092	Fee-for-Service	1710059720	1710059720	1	1	GRAVES, DANIEL 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
157106	Fee-for-Service	1720151137	1720151137	1	2	GATEWAYS HOSPITAL/MNTL HLT	7/1/2016	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1891 EFFIE STREET	None	LOS ANGELES	CA	90026	1711	19	06037	34.08461594	-118.2570874	Los Angeles County
157115	Fee-for-Service	1750772141	1750772141	1	1	GOLDEN STATE MANAGEMENT GROU	6/10/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON	1101 HORIZON DR	STE 103	FAIRFIELD	CA	94533	1688	48	06095	38.27385284	-122.0119698	Solano County
157128	Fee-for-Service	1063057917	1063057917	1	1	GREGORIO, MARION PT	11/30/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	126 AVOCADO AVE	STE 107	PERRIS	CA	92571	2605	33	06065	33.8102395	-117.2244465	Riverside County
157150	Fee-for-Service	1952428567	1952428567	1	1	GOKHALE, JANAKI A MD	1/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145207	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157151	Fee-for-Service	1013348903	1013348903	1	1	GREEN, LYN CRNA	3/25/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	455 PLUMAS	None	YUBA CITY	CA	95991	5074	51	06101	39.13180779	-121.6136017	Sutter County
157197	Fee-for-Service	1235771882	1235771882	1	1	GOLETA, HAILLEY PT	10/17/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
157216	Fee-for-Service	1265866487	1265866487	1	1	GROVA, MONICA M MD	9/22/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	136035	68	Hematology	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
157219	Fee-for-Service	1831459015	1831459015	1	1	GONZALEZ, HENRY J M D INC	9/9/2013	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	56342	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
157273	Fee-for-Service	1487732012	1487732012	1	1	GREENSPAN, LOUISE MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62776	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
157330	Fee-for-Service	1215582689	1215582689	1	1	GRABER, CARLY A LCSW	11/8/2023	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
157347	Fee-for-Service	1073665444	1073665444	1	1	GAVRILIS, BESSIE MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66907	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
157357	Fee-for-Service	1770921587	1770921587	1	1	GARCIA, DAFNE	4/17/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
157372	Fee-for-Service	1659667574	1659667574	1	1	GARCHA, GURKARAN S MD	6/10/2020	207R00000X	NA	Other	026	PHYSICIANS	161815	41	Internal Medicine	0	In state provider	None	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
157399	Fee-for-Service	1285672782	1285672782	1	1	GLASTONBURY,	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84737	30	Radiology	0	In state provider	CHRISTINE M MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
157425	Fee-for-Service	1598360794	1598360794	1	1	GONZALEZ-CORREA, JOSE MD	3/15/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188139	None	None	0	In state provider	None	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	19	06037	34.2214515	-118.4573205	Los Angeles County
157445	Fee-for-Service	1760610414	1760610414	1	1	GESSIN, JACOB S MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116321	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
157452	Fee-for-Service	1457693756	1457693756	1	1	GOODYER, WILLIAM R MD	5/31/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	136214	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
157461	Fee-for-Service	1437171220	1437171220	2	1	GARFIELD BEACH CVS LLC	3/23/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3535 S LA CIENEGA BLVD	None	LOS ANGELES	CA	90016	4407	19	06037	34.02306175	-118.3723136	Los Angeles County
157466	Fee-for-Service	1083739577	1083739577	1	1	GALVAN, RICHARD S LCSW	3/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	BLDG 4	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
157476	Fee-for-Service	1538445739	1538445739	1	1	GOLDEN OAKS HOSPICE INC	2/23/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21021 DEVONSHIRE ST	SUITE 108	CHATSWORTH	CA	91311	8238	19	06037	34.2572805	-118.591686	Los Angeles County
157502	Fee-for-Service	1265866487	1265866487	1	1	GROVA, MONICA M MD	9/22/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	136035	02	General Surgery	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
157570	Fee-for-Service	1174651871	1174651871	1	1	GARBARINO, JENNIFER J PHD	10/22/2024	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	28676 ROBINSON CANYON RD	None	CARMEL	CA	93923	8022	27	06053	36.50974697	-121.8099413	Monterey County
157577	Fee-for-Service	1922373448	1922373448	1	1	GLORIA, ORALIA CCC-SLP	8/30/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3518 JEFFERSON AVE	None	REDWOOD CITY	CA	94062	3136	41	06081	37.46715891	-122.2492205	San Mateo County
157592	Fee-for-Service	1912149790	1912149790	1	1	GLICKMAN, SAMUEL R MD	11/20/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	158303	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
157621	Fee-for-Service	1992364939	1992364939	1	1	GOODLIN, GRANT D CNP	6/16/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
157623	Fee-for-Service	1912942913	1912942913	1	1	GARFIELD BEACH CVS LLC	12/17/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	426 E CHASE AVE	None	EL CAJON	CA	92020	6409	37	06073	32.78042953	-116.9567955	San Diego County
157630	Fee-for-Service	1518389659	1518389659	1	1	GONZALEZ, VERONICA Y LMFT	1/20/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14393 PARK AVE	#200	VICTORVILLE	CA	92392	3302	36	06071	34.5123	-117.3248825	San Bernardino County
157681	Fee-for-Service	1548587306	1548587306	1	1	GUPTA, RAVI K MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120602	30	Radiology	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
157709	Fee-for-Service	1336617315	1336617315	1	1	GUZMAN, GERARDO CPO	12/26/2018	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	6190 FAIRMOUNT AVENUE	SUITE A	SAN DIEGO	CA	92120	3428	37	06073	32.78728736	-117.1014929	San Diego County
157744	Fee-for-Service	1407298789	1407298789	1	1	GLASSER, MARGA R MD	8/27/2018	207L00000X	NA	Other	026	PHYSICIANS	134166	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
157761	Fee-for-Service	1538445739	1538445739	1	1	GOLDEN OAKS HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21021 DEVONSHIRE ST	SUITE 108	CHATSWORTH	CA	91311	8238	19	06037	34.2572805	-118.591686	Los Angeles County
157786	Fee-for-Service	1487173845	1487173845	1	1	GUDAVALLI, ROHINI PT	3/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
157839	Fee-for-Service	1306867809	1306867809	1	1	GLENSKI, WILLIAM MD	12/4/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185669	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
157873	Fee-for-Service	1457445553	1457445553	1	1	GUSS, ROBERT B MD	9/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	35444	18	Ophthalmology	0	In state provider	None	1180 N INDIAN CANYON DR	STE 130	PALM SPRINGS	CA	92262	4857	33	06065	33.839505	-116.5455735	Riverside County
157880	Fee-for-Service	1912158312	1912158312	1	1	GROSZ, DANIEL E MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	49772	36	Psychiatry	0	In state provider	A PROFESSIONAL CORPORATI	16661 VENTURA BLVD	SUITE 603	ENCINO	CA	91436	4829	19	06037	34.15820737	-118.496492	Los Angeles County
157889	Fee-for-Service	1598706400	1598706400	1	1	GARFIELD BEACH CVS, LLC	10/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7740 RANCHO SANTA FE RD.	None	CARLSBAD	CA	92009	8685	37	06073	33.08100093	-117.2372485	San Diego County
157893	Fee-for-Service	1245318138	1245318138	1	1	GANGUPANTULA, GOPIKA MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81025	None	None	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
157920	Fee-for-Service	1417900317	1417900317	1	1	GARY M PLANT MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	76 NE 12TH ST	None	MADRAS	OR	97741	1827	00	None	44.63720858	-121.1220787	Jefferson County
157925	Fee-for-Service	1386795474	1386795474	1	1	GONZALES, RICHARD D MD	12/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76122	None	None	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
157937	Fee-for-Service	1164506408	1164506408	1	1	GORDON, KAREN	12/31/1988	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	41988	10	Gastroenterology (M.D. only)	0	In state provider	None	230 PROSPECT PL	STE 220	CORONADO	CA	92118	1978	37	06073	32.69468235	-117.1677128	San Diego County
157948	Fee-for-Service	1457778490	1457778490	1	1	GOMEZ-SANCHEZ, CLARA M MD	8/24/2022	2086S0129X	NA	General Surgery	026	PHYSICIANS	140410	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
157955	Fee-for-Service	1891734687	1891734687	1	1	GIL, ENRIQUE G MD	3/31/1987	207RP1001X	NA	Pulmonology	026	PHYSICIANS	40220	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
157956	Fee-for-Service	1699480079	1699480079	1	1	GARFIELD BEACH CVS, L.L.C	5/30/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17506 YORBA LINDA BLVD	None	YORBA LINDA	CA	92886	3825	30	06059	33.8882997	-117.8275838	Orange County
158009	Fee-for-Service	1962698712	1962698712	1	1	GHOSH, SOMNATH B 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
158017	Fee-for-Service	1194760090	1194760090	1	1	GARFIELD BEACH CVS LLC	5/22/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	883 S SANTA FE AVE	None	VISTA	CA	92083	5237	37	06073	33.19403652	-117.2347369	San Diego County
158060	Fee-for-Service	1154579159	1154579159	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 N GAFFEY ST	None	SAN PEDRO	CA	90731	1274	19	06037	33.76064043	-118.2928749	Los Angeles County
158072	Fee-for-Service	1821282898	1821282898	2	1	GARFIELD BEACH CVS LLC	1/17/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4400 TOWN CENTER BLVD	None	EL DORADO HILLS	CA	95762	7131	09	06017	38.649951	-121.062105	El Dorado County
158086	Fee-for-Service	1194721167	1194721167	1	1	GONZALEZ, MELVIN A MD	12/4/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	46612	01	General Practice	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
158110	Fee-for-Service	1164670519	1164670519	2	1	GARFIELD BEACH CVS LLC	5/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 W 120TH ST	None	HAWTHORNE	CA	90250	3388	19	06037	33.921918	-118.32138	Los Angeles County
158167	Fee-for-Service	1881616571	1881616571	2	1	GARFIELD BEACH CVS LLC	10/18/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7505 LAGUNA BLVD	None	ELK GROVE	CA	95758	5061	34	06067	38.426301	-121.415463	Sacramento County
158183	Fee-for-Service	1740317254	1740317254	1	2	GANGULY, ANINDITA PHD	11/9/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4344 LATHAM	110	RIVERSIDE	CA	92501	0400	33	06065	34.00198519	-117.3739252	Riverside County
158210	Fee-for-Service	1568540342	1568540342	1	1	GORDON, PETER W MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	42113	78	Neoplastic Diseases/Oncology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
158218	Fee-for-Service	1609830009	1609830009	1	1	GRIMSLEY, BRADLEY 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	621 N HALL ST	STE 100	DALLAS	TX	75226	1305	00	None	32.787963	-96.7821075	Dallas County
158246	Fee-for-Service	1801966197	1801966197	1	1	GALBRAITH, DAVID MD	2/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83549	01	General Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
158251	Fee-for-Service	1548243827	1548243827	1	1	GILL, GURSHARAN K MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88412	67	Endocrinology	0	In state provider	None	2025 SOQUEL AVENUE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
158297	Fee-for-Service	1962698712	1962698712	1	1	GHOSH, SOMNATH B 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
158302	Fee-for-Service	1326493115	1326493115	1	1	GOLDEN VALLEY HEALTH CENTERS	4/7/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	198 NORTH G STREET	None	EMPIRE	CA	95319	1066	50	06099	37.64084134	-120.9011164	Stanislaus County
158321	Fee-for-Service	1770701419	1770701419	1	1	GEOFFREY ALLEN TALMON, 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	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
158347	Fee-for-Service	1831200708	1831200708	1	1	GUTIERREZ, SHEILA G LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	150 E MEDA AVE	STE 110	GLENDORA	CA	91741	2607	19	06037	34.13845555	-117.8643588	Los Angeles County
158352	Fee-for-Service	1639519622	1639519622	1	1	GARZA, LAREINA CNM	1/5/2022	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	18031 US HWY 18	F	APPLE VALLEY	CA	92307	2152	36	06071	34.54008717	-117.2706344	San Bernardino County
158372	Fee-for-Service	1194721167	1194721167	1	1	GONZALEZ, MELVIN A MD	12/4/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	46612	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
158407	Fee-for-Service	1629301452	1629301452	1	1	GREEN, LASHAWN R NP	4/8/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3737 MARTIN L KING JR BL	#605B	LYNWOOD	CA	90262	3543	19	06037	33.92872742	-118.2006921	Los Angeles County
158427	Fee-for-Service	1295997815	1295997815	1	1	GONZALEZ, GUSTAVO V MD	11/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96103	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
158431	Fee-for-Service	1164953030	1164953030	1	1	GOLDRATH, KATHRYN E MD	3/9/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159775	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
158451	Fee-for-Service	1720159759	1720159759	1	1	GOETZ, LORRIE D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42482	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
158475	Fee-for-Service	1114310687	1114310687	1	1	GAETO, HOLLIE DO	7/6/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16494	08	Family Practice	0	In state provider	None	3612 DALE RD	None	MODESTO	CA	95356	0500	50	06099	37.69097901	-121.0498748	Stanislaus County
158486	Fee-for-Service	1801824297	1801824297	1	1	GLORI ALLEN M.D.	3/19/2014	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
158495	Fee-for-Service	1568540342	1568540342	1	1	GORDON, PETER W MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	42113	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
158526	Fee-for-Service	1174556286	1174556286	1	1	GOCKE, KARNA SUE MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69631	01	General Practice	0	In state provider	None	251 TURNPIKE DR	None	FOLSOM	CA	95630	0000	34	06067	38.654946	-121.170537	Sacramento County
158531	Fee-for-Service	1801966197	1801966197	1	1	GALBRAITH, DAVID MD	2/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83549	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
158532	Fee-for-Service	1053982629	1053982629	1	1	GIVRAD, MATTHEW M PSYD	11/17/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SERVICES	450 NORTH BRAND BOULEVA	STE 600	GLENDALE	CA	91203	2349	19	06037	34.152633	-118.254971	Los Angeles County
158564	Fee-for-Service	1821301714	1821301714	1	2	GASTROENTEROLOGY ASSOCIATES	7/10/2024	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF BEVERLY HILLS	8631 W 3RD STREET	815E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
158574	Fee-for-Service	1588742670	1588742670	1	1	GEE, DAVID S MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	50578	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
158577	Fee-for-Service	1477501278	1477501278	1	1	GADDIS, ALFRED T MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60616	08	Family Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
158583	Fee-for-Service	1851375828	1851375828	1	1	GUNER, YIGIT S MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89069	40	Pediatrics	0	In state provider	None	1120 W LA VETA	STE 100	ORANGE	CA	92868	4215	30	06059	33.78029455	-117.864369	Orange County
158590	Fee-for-Service	1326493115	1326493115	1	1	GOLDEN VALLEY HEALTH CENTERS	4/7/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	198 NORTH G STREET	None	EMPIRE	CA	95319	1066	50	06099	37.64084134	-120.9011164	Stanislaus County
158641	Fee-for-Service	1407242910	1407242910	1	1	GIUFFRE, ELLEN E	5/18/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	145 HODENCAMP ROAD	None	THOUSAND OAKS	CA	91360	5810	56	06111	34.1802034	-118.868502	Ventura County
158651	Fee-for-Service	1336256718	1336256718	1	1	GARCIA, JENNIFER	9/5/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3300 E SOUTH ST	STE 203	LAKEWOOD	CA	90805	4589	19	06037	33.86018093	-118.1537163	Los Angeles County
158696	Fee-for-Service	1558907055	1558907055	1	1	GRACE HOSPICE CARE INC	5/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1739 TERMINO AVE	SUITE A	LONG BEACH	CA	90804	2121	19	06037	33.78886597	-118.1459367	Los Angeles County
158699	Fee-for-Service	1952338881	1952338881	1	1	GALLERY, CHRISTIAN A MD	11/29/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CHILDREN & FAM MED CARE	1190 W OLIVE AVE	STE L	MERCED	CA	95348	1960	24	06047	37.31910454	-120.4885665	Merced County
158710	Fee-for-Service	1033322870	1033322870	1	1	GOLDEN VALLEY HEALTH CTR	4/1/2001	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1717 LAS VEGAS ST	None	MODESTO	CA	95358	5500	50	06099	37.6052798	-121.0027523	Stanislaus County
158726	Fee-for-Service	1427082320	1427082320	1	1	GOLDBERG, MARK MD	12/1/2003	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	69198	30	Radiology	0	In state provider	None	157 E COOLIDGE AVE	None	MODESTO	CA	95350	4504	50	06099	37.66550138	-120.991345	Stanislaus County
158728	Fee-for-Service	1700200599	1700200599	1	1	GLASSMAN, KYLE LMFT	8/22/2023	172V00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
158767	Fee-for-Service	1023655768	1023655768	1	1	GADZIALA, ELIZABETH CRNA	3/10/2022	163WC0200X	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
158778	Fee-for-Service	1346892874	1346892874	1	1	GOMEZ, KEVIN LMFT	8/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
158791	Fee-for-Service	1508494238	1508494238	1	1	GLASER, JOHANNA S MD	11/10/2023	208M00000X	NA	Other	026	PHYSICIANS	189222	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
158842	Fee-for-Service	1083926729	1083926729	1	1	GILMAN PODIATRY A PROF CORP	1/28/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	17777 VENTURA BLVD	STE 230	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
158859	Fee-for-Service	1821301714	1821301714	1	2	GASTROENTEROLOGY ASSOCIATES	7/10/2024	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OF BEVERLY HILLS	8631 W 3RD STREET	815E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
158865	Fee-for-Service	1568875805	1568875805	1	1	GRAHAM, KAMARA W MD	7/19/2017	207P00000X	NA	Other	026	PHYSICIANS	148740	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
158874	Fee-for-Service	1851375828	1851375828	1	1	GUNER, YIGIT S MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89069	02	General Surgery	0	In state provider	None	1120 W LA VETA	STE 100	ORANGE	CA	92868	4215	30	06059	33.78029455	-117.864369	Orange County
158877	Fee-for-Service	1326493115	1326493115	1	1	GOLDEN VALLEY HEALTH CENTERS	5/12/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	198 NORTH G STREET	None	EMPIRE	CA	95319	1066	50	06099	37.64084134	-120.9011164	Stanislaus County
158902	Fee-for-Service	1245348341	1245348341	1	1	GHOLAMI, SAEED MD	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74551	05	Anesthesiology	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
158910	Fee-for-Service	1518115906	1518115906	1	1	GOWRA, VEENA MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105276	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
158914	Fee-for-Service	1003459611	1003459611	1	1	GREEN, ELIZABETH LMFT	11/13/2023	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
158945	Fee-for-Service	1386280014	1386280014	1	1	GOLDEN HEARTH HOSPICE INC	9/8/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1480 COLORADO BLVD	SUITE 120-B	LOS ANGELES	CA	90041	2357	19	06037	34.13925431	-118.1972852	Los Angeles County
158954	Fee-for-Service	1922036789	1922036789	1	1	GOODMAN, ROBERT I MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81768	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
158984	Fee-for-Service	1558907055	1558907055	1	1	GRACE HOSPICE CARE INC	5/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1739 TERMINO AVE	SUITE A	LONG BEACH	CA	90804	2121	19	06037	33.78886597	-118.1459367	Los Angeles County
158997	Fee-for-Service	1033322870	1033322870	1	1	GOLDEN VALLEY HEALTH CTR	4/1/2001	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1717 LAS VEGAS ST	None	MODESTO	CA	95358	5500	50	06099	37.6052798	-121.0027523	Stanislaus County
159017	Fee-for-Service	1154944635	1154944635	1	1	GHIASSI, TINA CNP	8/6/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
159030	Fee-for-Service	1982608568	1982608568	1	1	GHEEWALA, UMESH H MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	38329	None	None	0	In state provider	None	907 SAN RAMON VALLEY BL	STE 202	DANVILLE	CA	94526	4036	07	06013	37.80813695	-121.9922024	Contra Costa County
159041	Fee-for-Service	1942389580	1942389580	1	1	GREWAL, GURINDER S MD	4/28/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37609	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	530 W EATON AVE	None	TRACY	CA	95376	3400	39	06077	37.74328351	-121.433886	San Joaquin County
159061	Fee-for-Service	1457417685	1457417685	1	1	GREEN, DAVID M PHD	9/2/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5333 MISSION CENTER RD	STE 354	SAN DIEGO	CA	92108	1350	37	06073	32.77178608	-117.1547851	San Diego County
159075	Fee-for-Service	1801889050	1801889050	1	1	GUNDRY, STEVEN R MD AMC	2/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65020	02	General Surgery	0	In state provider	None	555 E TACHEVAH DR	STE 3W103	PALM SPRINGS	CA	92262	5747	33	06065	33.83753681	-116.5424435	Riverside County
159113	Fee-for-Service	1487604559	1487604559	1	1	GARFF, ANDREW 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	1003 WILLOW CREED RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
159131	Fee-for-Service	1588068787	1588068787	1	3	GROWING MINDS PSYCHOLOGICAL	6/17/2020	103TB0200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	16800 DEVONSHIRE ST	212	GRANADA HILLS	CA	91344	7403	19	06037	34.25745651	-118.4982159	Los Angeles County
159136	Fee-for-Service	1962769299	1962769299	1	1	GUANZON, FELICIANA A LMFT	11/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	180 NEWPORT CENTER DR	270D	NEWPORT BEACH	CA	92660	6972	30	06059	33.61250509	-117.8753746	Orange County
159137	Fee-for-Service	1316924582	1316924582	1	1	GREER, BETINA G MD	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80364	08	Family Practice	0	In state provider	None	5700 CANOGA AVE	STE 500	WOODLAND HILLS	CA	91367	6582	19	06037	34.17400487	-118.5973608	Los Angeles County
159138	Fee-for-Service	1760679484	1760679484	1	1	GHAZANFAR, KHATERA DO	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10133	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
159151	Fee-for-Service	1962743161	1962743161	1	1	GENTLE TOUCH HOSPICE CARE	7/31/2014	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	6338 COLDWATER CYN AVE	None	NORTH HOLLYWOOD	CA	91606	6338	19	06037	34.186149	-118.4137745	Los Angeles County
159162	Fee-for-Service	1467035303	1467035303	1	1	GENOA HEALTHCARE LLC	12/1/2021	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6950 65TH ST	ROOM: PHARMACY	SACRAMENTO	CA	95823	2316	34	06067	38.50065	-121.4357265	Sacramento County
159179	Fee-for-Service	1558481291	1558481291	1	1	GELB, ARTHUR F MD INC	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	18436	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3650 SOUTH ST	STE 308	LAKEWOOD	CA	90712	1518	19	06037	33.86019847	-118.149255	Los Angeles County
159203	Fee-for-Service	1770511867	1770511867	1	1	GOODARZI, MARK O MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66512	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
159213	Fee-for-Service	1992413157	1992413157	1	1	GAMMA NEURO NETWORK INC	7/8/2024	2084N0600X	NA	Neurology	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
159215	Fee-for-Service	1083651749	1083651749	1	1	GUNASEKARAN, THIRUMAZHISAI	8/9/2023	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	185273	None	None	0	In state provider	MD	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
159229	Fee-for-Service	1316792872	1316792872	1	1	GARCIA, JOSEPH N LCSW	5/2/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
159234	Fee-for-Service	1386280014	1386280014	1	1	GOLDEN HEARTH HOSPICE INC	9/8/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1480 COLORADO BLVD	SUITE 120-B	LOS ANGELES	CA	90041	2357	19	06037	34.13925431	-118.1972852	Los Angeles County
159237	Fee-for-Service	1225316250	1225316250	2	1	GILENO, RACHEL LMFT	10/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	77711 FLORA ROAD	309	PALM DESERT	CA	92211	4103	33	06065	33.76854997	-116.3077307	Riverside County
159257	Fee-for-Service	1881732915	1881732915	1	1	GOODFRIED, ALAN LMFT	2/17/2020	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1844 SAN MIGUEL DR	#306A	WALNUT CREEK	CA	94596	4962	07	06013	37.89504879	-122.0529911	Contra Costa County
159261	Fee-for-Service	1033287180	1033287180	1	1	GUIDE, SHIREEN V MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95744	None	None	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
159363	Fee-for-Service	1073555074	1073555074	1	1	GUTIERREZ, CARMEN MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73862	08	Family Practice	0	In state provider	None	1110 W LA PALMA AVE	STE 1	ANAHEIM	CA	92801	2822	30	06059	33.84712953	-117.9320355	Orange County
159377	Fee-for-Service	1174636229	1174636229	1	1	GONZALEZ, MARCO A MD	1/1/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76308	08	Family Practice	0	In state provider	None	2118 MARGUERITE ST	None	DOS PALOS	CA	93620	2339	24	06047	36.98679421	-120.6293768	Merced County
159395	Fee-for-Service	1891889101	1891889101	1	1	GURLAND, BROOKE H MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150190	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
159400	Fee-for-Service	1760725766	1760725766	1	1	GREAT EXPECTATIONS SERVICES	12/17/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	4825 GLENHAVEN DRIVE	None	OCEANSIDE	CA	92056	3045	37	06073	33.21967094	-117.268266	San Diego County
159419	Fee-for-Service	1588068787	1588068787	1	3	GROWING MINDS PSYCHOLOGICAL	8/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CORPORATION	16800 DEVONSHIRE ST	212	GRANADA HILLS	CA	91344	7403	19	06037	34.25745651	-118.4982159	Los Angeles County
159423	Fee-for-Service	1285144576	1285144576	1	3	GOHO, INC.	2/16/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18155 VENTURA BLVD	None	TARZANA	CA	91356	3616	19	06037	34.16606244	-118.5291524	Los Angeles County
159440	Fee-for-Service	1962743161	1962743161	1	1	GENTLE TOUCH HOSPICE CARE	7/31/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	6338 COLDWATER CYN AVE	None	NORTH HOLLYWOOD	CA	91606	6338	19	06037	34.186149	-118.4137745	Los Angeles County
159464	Fee-for-Service	1558481291	1558481291	1	1	GELB, ARTHUR F MD INC	4/28/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	18436	41	Internal Medicine	0	In state provider	None	3650 SOUTH ST	STE 308	LAKEWOOD	CA	90712	1518	19	06037	33.86019847	-118.149255	Los Angeles County
159467	Fee-for-Service	1700142858	1700142858	1	1	GUENTHART, BRANDON A MD	6/4/2021	208600000X	NA	General Surgery	026	PHYSICIANS	160343	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
159489	Fee-for-Service	1770511867	1770511867	1	1	GOODARZI, MARK O MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66512	67	Endocrinology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
159501	Fee-for-Service	1831395557	1831395557	1	1	GOLDSTEIN, RACHEL Y MD	6/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120711	20	Orthopedic 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
159548	Fee-for-Service	1639193709	1639193709	1	1	GREENE, ROBERT M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25204	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2510 WEBER ST	# 200	BERKELEY	CA	94705	0000	01	06001	0	0	None
159593	Fee-for-Service	1528840485	1528840485	1	1	GOLD PATH, INC.	1/14/2025	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	931 BUENA VISTA ST	200	DUARTE	CA	91010	1713	19	06037	34.141635	-117.9775755	Los Angeles County
159595	Fee-for-Service	1659576320	1659576320	1	1	GARCIA, NATALIE MD	6/14/2019	207R00000X	NA	Other	026	PHYSICIANS	107840	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
159600	Fee-for-Service	1356555312	1356555312	1	1	GIUDICE, MATTHEW F MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87405	05	Anesthesiology	0	In state provider	None	2420 CAMINO RAMON	SUITE 270	SAN RAMON	CA	94583	4319	07	06013	37.77229042	-121.9634581	Contra Costa County
159627	Fee-for-Service	1528041811	1528041811	1	1	GROSSMONT HOSPITAL CORPORATI	5/29/1991	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
159664	Fee-for-Service	1144321100	1144321100	1	1	GILANI, BEHZAD B MD	6/18/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	40127	40	Pediatrics	0	In state provider	None	15725 WHITTIER BLVD	STE 100	WHITTIER	CA	90603	2349	19	06037	33.94435533	-117.9931159	Los Angeles County
159669	Fee-for-Service	1073977435	1073977435	1	1	GIACOMAZZI, CHRISTINA DO	11/11/2021	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	15797	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
159670	Fee-for-Service	1568969996	1568969996	1	1	GUTIERREZ, ANDRES	11/3/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167060	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
159689	Fee-for-Service	1174297428	1174297428	1	1	GALLAGHER, TODD J PT	4/11/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
159706	Fee-for-Service	1841431921	1841431921	1	1	GOLUB, RICHARD M CRNA	4/23/2010	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
159707	Fee-for-Service	1588068787	1588068787	1	3	GROWING MINDS PSYCHOLOGICAL	3/1/2019	103TB0200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	16800 DEVONSHIRE ST	212	GRANADA HILLS	CA	91344	7403	19	06037	34.25745651	-118.4982159	Los Angeles County
159763	Fee-for-Service	1619364700	1619364700	1	1	GILL, RYAN M MD	6/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147941	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
159764	Fee-for-Service	1326684721	1326684721	1	1	GUARDIAN ANGEL HOME CARE AND	4/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE OF ONTARIO LLC	2910 E INLAND EMPIRE BLV	SUITE 100	ONTARIO	CA	91764	4896	36	06071	34.06986	-117.589617	San Bernardino County
159800	Fee-for-Service	1841547460	1841547460	1	1	GRASSLAND DIALYSIS LLC	10/1/2012	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3901 S WESTERN AVE	None	LOS ANGELES	CA	90062	1112	19	06037	34.01437872	-118.3089371	Los Angeles County
159805	Fee-for-Service	1053473090	1053473090	1	1	GONAVARAM, PARTHA S MD	10/12/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174846	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
159822	Fee-for-Service	1740730423	1740730423	1	1	GARCIA PENA, KARLA MARIA	10/6/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	37234 LIANA LN	None	PALMDALE	CA	93551	6238	19	06037	34.56066705	-118.1737748	Los Angeles County
159861	Fee-for-Service	1750458618	1750458618	1	1	GOLDENBERG, TODD M MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67899	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
159862	Fee-for-Service	1205113503	1205113503	1	1	GREEN, DANIEL D CP	11/21/2011	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1524 21ST ST	#B	BAKERSFIELD	CA	93301	4002	15	06029	35.3781555	-119.0195505	Kern County
159865	Fee-for-Service	1700010022	1700010022	1	1	GELMAN, SUSAN K MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121165	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
159879	Fee-for-Service	1689618936	1689618936	1	1	GARFIELD BEACH CVS LLC	4/9/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	222 W CARRILLO ST	None	SANTA BARBARA	CA	93101	6163	42	06083	34.41874557	-119.7048203	Santa Barbara County
159894	Fee-for-Service	1295813772	1295813772	1	1	GONZALEZ, DIANE	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83702	08	Family Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
159963	Fee-for-Service	1588604581	1588604581	1	1	GORDON, ROBERT T MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	28835	33	Thoracic Surgery	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
159968	Fee-for-Service	1649284670	1649284670	1	1	GIRGIS, GEORGE I MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	43715	None	None	0	In state provider	None	501 W COLUMBUS ST	None	BAKERSFIELD	CA	93301	1263	15	06029	35.39728876	-119.0068276	Kern County
160039	Fee-for-Service	1598029332	1598029332	1	1	GOYAL, NIDHI P MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111133	10	Gastroenterology (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
160040	Fee-for-Service	1609024603	1609024603	2	1	GARFIELD BEACH CVS LLC	5/31/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6750 CHERRY AVE	None	LONG BEACH	CA	90805	1717	19	06037	33.877053	-118.166148	Los Angeles County
160058	Fee-for-Service	1093751158	1093751158	1	1	GARFIELD BEACH CVS LLC	8/29/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15520 GOLDENWEST ST	None	HUNTINGTON BEACH	CA	92647	2752	30	06059	33.73677836	-118.0068698	Orange County
160084	Fee-for-Service	1700381365	1700381365	1	1	GALVIN, KATIE MD	9/24/2024	208600000X	NA	General Surgery	026	PHYSICIANS	164349	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
160085	Fee-for-Service	1932255403	1932255403	1	1	GANONG, RICHARD B MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	29712	41	Internal Medicine	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
160090	Fee-for-Service	1396709994	1396709994	1	1	GULASEKARAM, BALASUBRA-	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	35405	36	Psychiatry	0	In state provider	MANIAM MD	6800 LINCOLN AVE	STE 205	BUENA PARK	CA	90620	4164	30	06059	33.83178874	-118.0144022	Orange County
160110	Fee-for-Service	1548459340	1548459340	1	1	GAFFNEY, SHANNON M DO	4/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14319	30	Radiology	0	In state provider	None	3161 L STREET	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
160112	Fee-for-Service	1740730423	1740730423	1	1	GARCIA PENA, KARLA MARIA	10/6/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	37234 LIANA LN	None	PALMDALE	CA	93551	6238	19	06037	34.56066705	-118.1737748	Los Angeles County
160126	Fee-for-Service	1912352774	1912352774	1	1	GAYTRI MANEK MD INC	3/11/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	11180 WARNER AVE	STE 271	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71632048	-117.9334575	Orange County
160155	Fee-for-Service	1063562023	1063562023	1	1	GROSS, MERIK S MD	9/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88209	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
160157	Fee-for-Service	1427490077	1427490077	1	1	GHANBARI, NEDA OD	12/17/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	230 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
160191	Fee-for-Service	1700854387	1700854387	1	1	GNOYSKI, JOSEPH M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	25	Physical Medicine and Rehabilitation	1	Border provider	None	653 N TOWN CENTER DR	STE 410	LAS VEGAS	NV	89144	0518	00	None	36.17975641	-115.3155995	Clark County
160207	Fee-for-Service	1346464641	1346464641	1	1	GONGGUY, ELIZABETH PHD	1/3/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	6968	19	06037	34.07067	-118.4432445	Los Angeles County
160217	Fee-for-Service	1982797759	1982797759	1	1	GARETT, KENNETH PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2359 E SMOKEWOOD AVE	None	PALM SPRINGS	CA	92264	4967	33	06065	33.79045152	-116.515412	Riverside County
160246	Fee-for-Service	1750523353	1750523353	1	1	GAMET, JARED D MD	3/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	214 E 23RD STREET	None	CHEYENNE	WY	82001	3748	00	None	41.1402124	-104.8159812	Laramie County
160252	Fee-for-Service	1588604581	1588604581	1	1	GORDON, ROBERT T MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	28835	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
160274	Fee-for-Service	1902678618	1902678618	1	1	GONZALEZ, NATALIA LCSW	1/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
160309	Fee-for-Service	1033242656	1033242656	1	1	GILLIAM, SCOTT D LMFT	5/22/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11600 WASHINGTON PLACE	SUITE 102B	LOS ANGELES	CA	90066	5000	19	06037	34.00465708	-118.4208535	Los Angeles County
160325	Fee-for-Service	1598029332	1598029332	1	1	GOYAL, NIDHI P MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111133	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
160362	Fee-for-Service	1063411643	1063411643	1	1	GLASSON, JULIE R MD	1/5/2024	2086S0120X	NA	General Surgery	026	PHYSICIANS	77829	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
160372	Fee-for-Service	1295872166	1295872166	1	1	GOLMITZ, VICTORIA S	3/1/2007	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1081 MARSHALL WAY	STE C	PLACERVILLE	CA	95667	5722	09	06017	38.72587207	-120.7912486	El Dorado County
160379	Fee-for-Service	1942388582	1942388582	1	1	GHEORGEVICI, DORINA MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77027	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
160387	Fee-for-Service	1124440847	1124440847	1	1	GIRGENTI, NANCY A LMFT	2/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
160388	Fee-for-Service	1710140843	1710140843	1	1	GOPIKRISHNA PALADUGU MD	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
160401	Fee-for-Service	1881171163	1881171163	1	1	GORDON, HANNAH MD	10/4/2023	207P00000X	NA	Other	026	PHYSICIANS	185475	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
160414	Fee-for-Service	1912352774	1912352774	1	1	GAYTRI MANEK MD INC	3/11/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	11180 WARNER AVE	STE 271	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71632048	-117.9334575	Orange County
160434	Fee-for-Service	1295776102	1295776102	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	206 N AZUSA AVE	None	COVINA	CA	91722	3606	19	06037	34.087347	-117.9076905	Los Angeles County
160442	Fee-for-Service	1699880856	1699880856	2	1	GALLAGHER, RENATA MD	10/7/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	77290	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
160471	Fee-for-Service	1801944848	1801944848	1	1	GEREB, STACIE MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
160486	Fee-for-Service	1902223852	1902223852	1	1	GOWDA, INDIRA M MD	1/4/2019	207P00000X	NA	Other	026	PHYSICIANS	156360	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
160555	Fee-for-Service	1912925611	1912925611	1	3	GYNECOLOGIC ONCOLOGY	3/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	23600 TELO AVE	STE 250	TORRANCE	CA	90505	4037	19	06037	33.81215054	-118.3384029	Los Angeles County
160571	Fee-for-Service	1639180300	1639180300	1	1	GOWDA, VINAY C MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74884	41	Internal Medicine	0	In state provider	None	1100 PEAR TREE LN	None	NAPA	CA	94558	6446	28	06055	38.32087983	-122.2946228	Napa County
160590	Fee-for-Service	1437103926	1437103926	1	1	GURUSWAMI, BHANUMATHI MD	5/1/2000	207L00000X	NA	Other	026	PHYSICIANS	65567	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
160604	Fee-for-Service	1548282171	1548282171	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30602 SANTA MARGARITA PK	None	RANCHO SANTA MARG	CA	92688	2814	30	06059	33.6434626	-117.5978842	Orange County
160608	Fee-for-Service	1396321444	1396321444	1	1	GOLD STAR HOSPICE LLC	9/29/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	830 STEWART DRIVE	STE 185	SUNNYVALE	CA	94085	4513	43	06085	37.38395509	-122.0096036	Santa Clara County
160658	Fee-for-Service	1558903211	1558903211	1	1	GARAY, ERICA LCSW	12/5/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
160665	Fee-for-Service	1023495009	1023495009	1	1	GRAHAM, EMILY LCSW	11/11/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
160704	Fee-for-Service	1871753731	1871753731	1	1	GATSCHET, HSINJU R MD	8/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106886	02	General Surgery	0	In state provider	None	8715 CENTER PARKWAY	SUITE A	SACRAMENTO	CA	95823	7921	34	06067	38.439225	-121.4228745	Sacramento County
160725	Fee-for-Service	1174551568	1174551568	1	2	GADGIL, UDAY G MD	2/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40126	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	315 N 3RD AVE	STE 305	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
160736	Fee-for-Service	1750519070	1750519070	2	1	GUTIERREZ, JENNIFER S MD	9/24/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	139632	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
160766	Fee-for-Service	1235121955	1235121955	1	1	GORDON, RICAHRD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	323 JEFFORDS ST	None	CLEARWATER	FL	33756	3825	00	None	27.95360943	-82.80313838	Pinellas County
160800	Fee-for-Service	1760651335	1760651335	1	1	GARNICA, WILLIAM MD INC	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67752	01	General Practice	0	In state provider	None	1043 R STREET	None	FRESNO	CA	93721	1312	10	06019	36.74038639	-119.7827527	Fresno County
160803	Fee-for-Service	1649214867	1649214867	1	1	GREALLY, ROBERT D MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77954	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
160811	Fee-for-Service	1841786274	1841786274	1	1	GREKOV, KAROLINA MD	6/8/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160100	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
160828	Fee-for-Service	1942629217	1942629217	1	1	GROUSBECK, BRIE C MD	2/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137513	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
160842	Fee-for-Service	1912925611	1912925611	1	3	GYNECOLOGIC ONCOLOGY	3/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	None	23600 TELO AVE	STE 250	TORRANCE	CA	90505	4037	19	06037	33.81215054	-118.3384029	Los Angeles County
160849	Fee-for-Service	1962414219	1962414219	1	1	GERUNDO, HELENA M MD	12/1/1983	207R00000X	NA	Other	026	PHYSICIANS	36910	41	Internal Medicine	0	In state provider	#107	1530 E CHEVY CHASE DR	None	GLENDALE	CA	91206	4163	19	06037	34.150689	-118.2303855	Los Angeles County
160855	Fee-for-Service	1306149083	1306149083	1	1	GRAHAM, DRAYTON P A MEDICAL	3/14/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	27833	41	Internal Medicine	0	In state provider	CORPORATION	4477 W 118TH ST	STE 401	HAWTHORNE	CA	90250	2269	19	06037	33.92734752	-118.354221	Los Angeles County
160869	Fee-for-Service	1962715425	1962715425	1	1	GOLLAHALLI SHIVARAMAIAH,	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125865	41	Internal Medicine	0	In state provider	NAGESH MD	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
160876	Fee-for-Service	1750347639	1750347639	1	1	GREWAL, PUNEET K MD	4/9/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	53793	41	Internal Medicine	0	In state provider	None	530 W EATON AVE	STE K	TRACY	CA	95376	3455	39	06077	37.74328351	-121.433886	San Joaquin County
160881	Fee-for-Service	1407063092	1407063092	1	1	GUO, HONG PSYD	3/26/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
160897	Fee-for-Service	1396321444	1396321444	1	1	GOLD STAR HOSPICE LLC	9/29/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	830 STEWART DRIVE	STE 185	SUNNYVALE	CA	94085	4513	43	06085	37.38395509	-122.0096036	Santa Clara County
160904	Fee-for-Service	1023469384	1023469384	1	1	GUNDAPUNENI, SINDHU N MD	9/2/2020	208M00000X	NA	Other	026	PHYSICIANS	158713	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
160939	Fee-for-Service	1497721260	1497721260	1	1	GREEN, ALAN C MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	76287	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
160949	Fee-for-Service	1326448069	1326448069	1	1	GLOBAL DISCOVERY BIOSCIENCES	7/13/2015	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	13885 ALTON PARKWAY	STE B	IRVINE	CA	92618	1647	30	06059	33.66185067	-117.7091364	Orange County
160962	Fee-for-Service	1992912489	1992912489	1	1	GOLSORKHI, AMIR H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	101035	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
161042	Fee-for-Service	1265508105	1265508105	1	1	GOLDEN SHORES FIRE DEPARTMEN	3/29/2023	2278P4000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	T	12950 OATMAN HWY	None	TOPOCK	AZ	86436	0066	00	None	34.78023	-114.4805355	Mohave County
161046	Fee-for-Service	1639495575	1639495575	1	1	GAW, J MD APC	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38464	41	Internal Medicine	0	In state provider	None	931 BUENA VISTA STREET	SUITE 106	DUARTE	CA	91010	1780	19	06037	34.141635	-117.9775755	Los Angeles County
161089	Fee-for-Service	1760651335	1760651335	1	1	GARNICA, WILLIAM MD INC	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	67752	08	Family Practice	0	In state provider	None	1043 R STREET	None	FRESNO	CA	93721	1312	10	06019	36.74038639	-119.7827527	Fresno County
161093	Fee-for-Service	1194761791	1194761791	1	1	GEORGE TIMOTHY BURSON	5/6/2024	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
161142	Fee-for-Service	1306149083	1306149083	1	1	GRAHAM, DRAYTON P A MEDICAL	3/14/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	27833	29	Pulmonary Diseases (M.D. only)	0	In state provider	CORPORATION	4477 W 118TH ST	STE 401	HAWTHORNE	CA	90250	2269	19	06037	33.92734752	-118.354221	Los Angeles County
161226	Fee-for-Service	1023175429	1023175429	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10600 FIRESTONE BLVD	None	NORWALK	CA	90650	7410	19	06037	33.92626733	-118.1068201	Los Angeles County
161230	Fee-for-Service	1427062462	1427062462	1	1	GREEN, STEPHANIE S MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70614	08	Family Practice	0	In state provider	None	1045 ATLANTIC AVE	STE 508	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
161231	Fee-for-Service	1801838669	1801838669	1	1	GILLEN, MARTIN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98623	0000	00	None	46.1309207	-122.9408931	Cowlitz County
161265	Fee-for-Service	1124056684	1124056684	1	1	GARVEY, JAMES A MD	5/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86047	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
161292	Fee-for-Service	1073374666	1073374666	1	1	GREEN, DOMINNIQUE	3/7/2025	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
161337	Fee-for-Service	1821236704	1821236704	1	1	GRACIA, GERALD J MD	8/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108980	89	Surgery-Traumatic	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
161363	Fee-for-Service	1164402632	1164402632	1	1	GUBA, GERARDO MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65337	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
161374	Fee-for-Service	1548818123	1548818123	1	1	GOLDSTEIN, KAELEN LMFT	1/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1633 E 4TH ST	STE 256	SANTA ANA	CA	92701	5171	30	06059	33.7481375	-117.846441	Orange County
161428	Fee-for-Service	1023494549	1023494549	1	1	GARHAN, DANIELLE OT	10/14/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
161455	Fee-for-Service	1841342201	1841342201	1	1	GAUDIEL, LORNA G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26379	41	Internal Medicine	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
161558	Fee-for-Service	1124039953	1124039953	1	1	GEVER, DEBORAH L MD	7/19/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49737	40	Pediatrics	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
161589	Fee-for-Service	1629234380	1629234380	1	1	GLADSJO, JULIE A MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98641	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
161607	Fee-for-Service	1003997313	1003997313	1	1	GOLDSTEIN, BARRY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
161613	Fee-for-Service	1760479695	1760479695	1	1	GRAHAM, TIMOTHY P 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
161616	Fee-for-Service	1366859449	1366859449	1	15	GOLDEN STATE PROVIDERS, A ME	10/19/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
161626	Fee-for-Service	1821236704	1821236704	1	1	GRACIA, GERALD J MD	8/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108980	02	General Surgery	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
161635	Fee-for-Service	1336443100	1336443100	1	1	GHAYAL, PUNEET MD	1/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137435	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	SUITE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
161670	Fee-for-Service	1821343948	1821343948	1	1	GAITHER, AMBER MD	9/25/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186237	None	None	0	In state provider	None	4050 BARRANCA PKWY	STE 200	IRVINE	CA	92604	1723	30	06059	33.68293726	-117.8067799	Orange County
161672	Fee-for-Service	1679219109	1679219109	1	1	GILBERT, SAMANTHA J PT	5/5/2023	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
161691	Fee-for-Service	1801444666	1801444666	1	1	GRANT, PATRICK M 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
161716	Fee-for-Service	1386684132	1386684132	1	1	GARVIN, ALAN A MD	2/28/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	59373	06	Cardiovascular Disease (M.D. only)	0	In state provider	VALLEY HEART ASSOC MED	1540 FLORIDA AVE	STE 100	MODESTO	CA	95350	4430	50	06099	37.667115	-120.9962205	Stanislaus County
161728	Fee-for-Service	1144370743	1144370743	1	1	GASTILLO, GINNA MD	3/1/2001	207RX0202X	NA	Oncology	026	PHYSICIANS	51963	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
161745	Fee-for-Service	1588068787	1588068787	1	1	GROWING MINDS PSYCHOLOGICAL	8/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CORPORATION	771 DAILY DR	310	CAMARILLO	CA	93010	0780	56	06111	34.21844191	-119.0570006	Ventura County
161765	Fee-for-Service	1861424418	1861424418	1	1	GREENSTADT, MARK A	4/1/1983	174400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	18350 ROSCOE BLVD	STE 300	NORTHRIDGE	CA	91325	4156	19	06037	34.22071855	-118.5341175	Los Angeles County
161766	Fee-for-Service	1174706824	1174706824	1	1	GAITHER, JOSHUA 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	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
161770	Fee-for-Service	1821697434	1821697434	1	1	GLOB REGENCY SNR C SVCS LLC	11/27/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	117 E 8TH STREET	None	LONG BEACH	CA	90813	4397	19	06037	33.77660645	-118.1920095	Los Angeles County
161779	Fee-for-Service	1225168024	1225168024	1	1	GALDAMEZ, LUIS A MD INC	1/1/1995	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CLINICA MEDICA VIRGEN DE	2955 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5836	19	06037	33.97333678	-118.2163277	Los Angeles County
161804	Fee-for-Service	1982082186	1982082186	1	1	GOLDENBERG, BENJAMIN D MD	1/27/2022	208M00000X	NA	Other	026	PHYSICIANS	171414	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
161817	Fee-for-Service	1013102854	1013102854	1	1	GLENDALE COMMUNITY MEDICAL	4/3/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	45958	41	Internal Medicine	0	In state provider	GROUP	801 S CHEVY CHASE DR	STE 101	GLENDALE	CA	91205	4432	19	06037	34.136757	-118.2396195	Los Angeles County
161823	Fee-for-Service	1922039858	1922039858	1	1	GEBREAB, FREW H MD	3/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100275	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
161835	Fee-for-Service	1427099399	1427099399	1	1	GARFIELD BEACH CVS LLC	4/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	451 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5270	19	06037	34.138341	-118.101697	Los Angeles County
161846	Fee-for-Service	1124039953	1124039953	1	1	GEVER, DEBORAH L MD	7/19/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49737	01	General Practice	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
161850	Fee-for-Service	1336137934	1336137934	1	1	GRAF, GEORGE J MD	8/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	64260	05	Anesthesiology	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
161922	Fee-for-Service	1336443100	1336443100	1	1	GHAYAL, PUNEET MD	1/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137435	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1866 N ORANGE GROVE AVE	SUITE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
161938	Fee-for-Service	1568980191	1568980191	1	1	GARRETT, ANNE S	5/14/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
161966	Fee-for-Service	1285046854	1285046854	1	1	GORAYA, NADEEM MD	9/10/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144924	08	Family Practice	0	In state provider	None	3838 SAN DIMAS STREET	STE A200	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
161983	Fee-for-Service	1366044794	1366044794	1	1	GONZALEZ, CITLALLI V LMFT	2/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	765 N MAIN ST	STE #127	CORONA	CA	92880	1440	33	06065	33.892072	-117.5636837	Riverside County
162004	Fee-for-Service	1386684132	1386684132	1	1	GARVIN, ALAN A MD	2/28/1992	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	59373	42	Nuclear Medicine	0	In state provider	VALLEY HEART ASSOC MED	1540 FLORIDA AVE	STE 100	MODESTO	CA	95350	4430	50	06099	37.667115	-120.9962205	Stanislaus County
162006	Fee-for-Service	1346268059	1346268059	1	1	GUEORDJEVA,PETYA 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
162015	Fee-for-Service	1144370743	1144370743	1	1	GASTILLO, GINNA MD	3/1/2001	207RX0202X	NA	Oncology	026	PHYSICIANS	51963	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
162033	Fee-for-Service	1588068787	1588068787	1	1	GROWING MINDS PSYCHOLOGICAL	3/1/2019	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	771 DAILY DR	310	CAMARILLO	CA	93010	0780	56	06111	34.21844191	-119.0570006	Ventura County
162048	Fee-for-Service	1174673982	1174673982	1	1	GREYZ-YUSUPOV, NATALYA	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79520	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
162066	Fee-for-Service	1396740932	1396740932	1	1	GUEVARA, DAISY J MD	3/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	48966	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
162068	Fee-for-Service	1225168024	1225168024	1	1	GALDAMEZ, LUIS A MD INC	1/1/1995	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CLINICA MEDICA VIRGEN DE	2955 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5836	19	06037	33.97333678	-118.2163277	Los Angeles County
162082	Fee-for-Service	1023127032	1023127032	1	1	GROSS, GARY P MD	8/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	28387	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
162085	Fee-for-Service	1790838134	1790838134	1	1	GROSS, STEVEN A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25708	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
162088	Fee-for-Service	1578023826	1578023826	1	1	GREENSTEIN, DAVID MD	12/10/2024	207L00000X	NA	Other	026	PHYSICIANS	184934	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
162098	Fee-for-Service	1598304644	1598304644	1	1	GREATNESS HOSPICE INC	10/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	43180 BUSINESS PARK DR	SUITE 201	TEMECULA	CA	92590	3608	33	06065	33.502011	-117.16689	Riverside County
162103	Fee-for-Service	1013102854	1013102854	1	1	GLENDALE COMMUNITY MEDICAL	4/3/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	45958	45	Nephrology (Renal-Kidney)	0	In state provider	GROUP	801 S CHEVY CHASE DR	STE 101	GLENDALE	CA	91205	4432	19	06037	34.136757	-118.2396195	Los Angeles County
162107	Fee-for-Service	1215967997	1215967997	1	1	GOLDBERG, STEVEN L MD INC	1/22/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	27045	02	General Surgery	0	In state provider	None	2216 N CALIFORNIA ST	STE A	STOCKTON	CA	95204	5533	39	06077	37.97386974	-121.2903465	San Joaquin County
162143	Fee-for-Service	1396790044	1396790044	1	1	GRAY, ANDREW T MD	10/31/1992	207L00000X	NA	Other	026	PHYSICIANS	73206	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
162154	Fee-for-Service	1881360279	1881360279	1	1	GRACE I ROBINSON-WHIPPLE	9/30/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6572 N MARIPOSA ST	None	FRESNO	CA	93710	3820	10	06019	36.8332835	-119.7781537	Fresno County
162164	Fee-for-Service	1447334123	1447334123	1	1	GORWARA-DOHAD, ANITA M MD	4/15/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	74221	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
162180	Fee-for-Service	1376124123	1376124123	1	1	GOLDEN LIVING HEALTH	8/11/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	MANAGEMENT INC	3223 DUKE STREET	None	SAN DIEGO	CA	92110	5401	37	06073	32.75301964	-117.2185287	San Diego County
162195	Fee-for-Service	1457689010	1457689010	1	1	GILBERT, ELYSE L CNM	9/24/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	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
162227	Fee-for-Service	1841619822	1841619822	1	1	GREIFE, CATHERINE OT	9/18/2019	225X00000X	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
162237	Fee-for-Service	1285665562	1285665562	1	1	GASCON, DIANA Z MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89607	08	Family Practice	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95680	7967	34	06067	38.576079	-121.2938325	Sacramento County
162280	Fee-for-Service	1912928672	1912928672	1	1	GUJRAL, SATVINDER K MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72955	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
162287	Fee-for-Service	1609541929	1609541929	1	1	GOMEZ TELLO, MIRIAM L LCSW	2/1/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
162306	Fee-for-Service	1144370743	1144370743	1	1	GASTILLO, GINNA MD	3/1/2001	207RX0202X	NA	Oncology	026	PHYSICIANS	51963	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
162310	Fee-for-Service	1902821309	1902821309	1	1	GUY, SUSAN K MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63987	36	Psychiatry	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
162322	Fee-for-Service	1588068787	1588068787	1	1	GROWING MINDS PSYCHOLOGICAL	6/15/2020	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	771 DAILY DR	310	CAMARILLO	CA	93010	0780	56	06111	34.21844191	-119.0570006	Ventura County
162323	Fee-for-Service	1992369805	1992369805	1	1	GOLDFIEN, GABRIEL A MD	8/10/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177399	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
162373	Fee-for-Service	1790838134	1790838134	1	1	GROSS, STEVEN A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25708	06	Cardiovascular Disease (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
162383	Fee-for-Service	1902378862	1902378862	1	1	GALLEGOS, VIOLETA	3/8/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
162387	Fee-for-Service	1598304644	1598304644	1	1	GREATNESS HOSPICE INC	10/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	43180 BUSINESS PARK DR	SUITE 201	TEMECULA	CA	92590	3608	33	06065	33.502011	-117.16689	Riverside County
162449	Fee-for-Service	1669615001	1669615001	1	1	GREEN, SHOSHANA M LMFT	3/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
162473	Fee-for-Service	1730201377	1730201377	1	1	GYNECOLOGY CARE CENTER	1/1/1984	207T00000X	NA	General Surgery	026	PHYSICIANS	40480	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CALDERON, JORGE A MD AMC	751 MEDICAL CENTER COURT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
162483	Fee-for-Service	1649295635	1649295635	2	1	GENERAL, GERARDO, M MD	12/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	51732	41	Internal Medicine	0	In state provider	None	5385 WALNUT AVE	SUITE 5	CHINO	CA	91710	2605	36	06071	34.02627451	-117.6872175	San Bernardino County
162494	Fee-for-Service	1013175009	1013175009	1	1	GROSS, ERIN A MD	6/3/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	99544	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
162511	Fee-for-Service	1447272059	1447272059	2	1	GARFIELD BEACH CVS LLC	6/15/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	777 E COLORADO BLVD	None	PASADENA	CA	91101	2104	19	06037	34.1459175	-118.134891	Los Angeles County
162545	Fee-for-Service	1174242531	1174242531	1	1	GARCIA, ESMERALDA	2/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
162590	Fee-for-Service	1730190968	1730190968	1	1	GIAP, BRANDON C MD	8/17/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50461	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
162592	Fee-for-Service	1962588483	1962588483	1	1	GODLEY, DAVID R MD	12/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	19690	20	Orthopedic Surgery	0	In state provider	None	47 SAN BENANCIO ROAD	None	SALINAS	CA	93908	9133	27	06053	36.57635318	-121.7169598	Monterey County
162611	Fee-for-Service	1093993099	1093993099	1	1	GAKHAR, NEETU MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114645	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
162628	Fee-for-Service	1912111956	1912111956	1	1	GUDZENKO, VADYM MD	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101905	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
162653	Fee-for-Service	1417082272	1417082272	1	1	GLADER, BERTIL E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34194	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
162671	Fee-for-Service	1649705484	1649705484	1	1	GODDARD, SCOTT K DO	1/19/2023	207P00000X	NA	Other	026	PHYSICIANS	20290	None	None	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
162686	Fee-for-Service	1588970933	1588970933	1	1	GHODS, FARBOD MD	11/8/2018	207RS0012X	NA	Other	026	PHYSICIANS	122812	47	Miscellaneous	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
162690	Fee-for-Service	1770831489	1770831489	1	1	GUPTA, NEELAM MD INC	11/19/2018	261QS1200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	343 E MAIN ST	STE 106	SAN JACINTO	CA	92583	4206	33	06065	33.78395845	-116.9560296	Riverside County
162701	Fee-for-Service	1598806390	1598806390	1	1	GUPTA, VINEET MD	12/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96761	08	Family Practice	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
162712	Fee-for-Service	1881618031	1881618031	1	1	GALLAGHER, KERRY T MD	8/18/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74946	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
162734	Fee-for-Service	1336197177	1336197177	1	1	GORDON, RACHAEL E MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	73373	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
162736	Fee-for-Service	1073753356	1073753356	1	1	GHALY, ASH MD INC	10/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	50209	08	Family Practice	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
162756	Fee-for-Service	1881862811	1881862811	1	1	GARYS CUSTOM OPTIK	1/1/1979	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	8354 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.22289127	-118.5360614	Los Angeles County
162881	Fee-for-Service	1962588483	1962588483	1	1	GODLEY, DAVID R MD	3/1/2018	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	47 SAN BENANCIO ROAD	None	SALINAS	CA	93908	9133	27	06053	36.57635318	-121.7169598	Monterey County
162915	Fee-for-Service	1205089778	1205089778	1	1	GILL, GURJIWAN K DO	12/29/2012	207R00000X	NA	Other	026	PHYSICIANS	10243	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3306	10	06019	36.83626596	-119.7674879	Fresno County
162936	Fee-for-Service	1215113535	1215113535	1	1	GIRI, KAMINI V MD	5/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98640	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
162940	Fee-for-Service	1083680060	1083680060	1	1	GRAHAM, STUART N MD	6/30/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70035	40	Pediatrics	0	In state provider	None	8881 FLETCHER PKWY	STE 360	LA MESA	CA	91942	6103	37	06073	32.78442148	-117.0073814	San Diego County
162955	Fee-for-Service	1326250929	1326250929	1	1	GOLDBERG, JAMES N MD	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99067	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
162963	Fee-for-Service	1205915345	1205915345	1	1	GOULD, DEBORAH L MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	45051	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
163086	Fee-for-Service	1386154052	1386154052	1	1	GAWADE, SNEHA A	9/24/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND AVE	STE B2	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
163110	Fee-for-Service	1689865644	1689865644	1	1	GONZALEZ, EVANGELINA MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	98643	08	Family Practice	0	In state provider	None	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	19	06037	34.06750236	-117.925203	Los Angeles County
163135	Fee-for-Service	1689386815	1689386815	1	1	GEM MEDICAL GROUP CORPORATIO	3/31/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	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
163172	Fee-for-Service	1669667036	1669667036	1	1	GUPTA, JULIE	11/26/2012	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
163174	Fee-for-Service	1497072375	1497072375	1	1	GANDHAM, SINDHURA MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111416	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
163201	Fee-for-Service	1447842554	1447842554	1	2	GRAY, NATALIE A LMFT	1/5/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19526- B HILLSDALE DR.	None	SONORA	CA	95370	8997	55	06109	37.97725615	-120.3246589	Tuolumne County
163248	Fee-for-Service	1205915345	1205915345	1	1	GOULD, DEBORAH L MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	45051	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
163249	Fee-for-Service	1659356145	1659356145	1	1	GRABB, BRENDA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E BOULDER ST	None	COLORADO SPGS	CO	80909	5533	00	None	38.8388119	-104.7995065	El Paso County
163282	Fee-for-Service	1609951334	1609951334	1	1	GREFFE BRAIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 EAST 16TH AVE	None	AURORA	CO	80042	7106	00	None	39.742164	-104.8350375	Adams County
163287	Fee-for-Service	1093911661	1093911661	1	1	GILL, KARANBIR S MD	9/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104933	40	Pediatrics	0	In state provider	None	9281 OFFICE PARK CIRCLE	STE 120	ELK GROVE	CA	95758	8069	34	06067	38.418264	-121.39641	Sacramento County
163288	Fee-for-Service	1649292244	1649292244	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 NEW LOS ANGELES AVE	None	MOORPARK	CA	93021	3585	56	06111	34.27991805	-118.8680323	Ventura County
163298	Fee-for-Service	1881766632	1881766632	1	1	GUPTA, INDU MD	8/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79994	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
163320	Fee-for-Service	1457999740	1457999740	1	1	GOMEZ, ALEXIS PT	3/10/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
163325	Fee-for-Service	1346775004	1346775004	1	1	GARFIELD BEACH CVS LLC	11/27/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4255 CAMPUS DRIVE	STE A150	IRVINE	CA	92612	2668	30	06059	33.64910596	-117.8394276	Orange County
163345	Fee-for-Service	1598348468	1598348468	1	2	GARNICA, LAURA L OD	3/4/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1120 S MOUNT VERNON AVE	None	COLTON	CA	92324	4220	36	06071	34.049673	-117.3067155	San Bernardino County
163358	Fee-for-Service	1326435934	1326435934	1	1	GUPTA, KISHAN MD	5/10/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	160932	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
163416	Fee-for-Service	1255366514	1255366514	1	1	GILL, NIKITA K MD INC	4/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77028	41	Internal Medicine	0	In state provider	None	2644 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.570911	-122.3997975	Shasta County
163461	Fee-for-Service	1871140566	1871140566	1	1	GROFF, SAMANTHA CCC-SLP	2/24/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 S ANAHEIM BLVD	150	ANAHEIM	CA	92805	6205	30	06059	33.8143261	-117.9066647	Orange County
163507	Fee-for-Service	1962038992	1962038992	1	1	GIRAUD, CAMILLE MD	10/30/2023	207R00000X	NA	Other	026	PHYSICIANS	179101	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
163550	Fee-for-Service	1871537589	1871537589	1	1	GREENBERG, ERIC A MD	1/1/1998	207P00000X	NA	Other	026	PHYSICIANS	64666	66	Emergency Medicine (Urgent Care)	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
163565	Fee-for-Service	1467524207	1467524207	1	1	GULATI, PRIYA MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63025	22	Pathology (M.D. only)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
163589	Fee-for-Service	1952637118	1952637118	1	1	GEORGE, VIJAY A MD	6/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116915	22	Pathology (M.D. only)	0	In state provider	None	3701 S HIGUERA STREET	None	SAN LUIS OBISPO	CA	93401	7462	40	06079	35.2507845	-120.6712168	San Luis Obispo County
163610	Fee-for-Service	1770873234	1770873234	1	1	GRACE, LINDSEY A MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123545	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
163614	Fee-for-Service	1831353275	1831353275	1	1	GOODMAN, CAMMI MD	10/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93878	None	None	0	In state provider	None	1300 N VERMONT AVENUE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
163616	Fee-for-Service	1174665913	1174665913	1	1	GARY GULARTE M.D.	10/21/2014	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
163692	Fee-for-Service	1770996167	1770996167	1	1	GEISELER, ALEXANDER MD	1/30/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	145034	40	Pediatrics	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
163700	Fee-for-Service	1578600052	1578600052	1	1	GRANT, ADRIAN MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	45663	36	Psychiatry	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
163703	Fee-for-Service	1255366514	1255366514	1	1	GILL, NIKITA K MD INC	4/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77028	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2644 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.570911	-122.3997975	Shasta County
163756	Fee-for-Service	1104934199	1104934199	1	2	GRADMAN, WAYNE S MD	11/29/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	17696	33	Thoracic Surgery	0	In state provider	None	8631 W 3RD ST	STE 925E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
163765	Fee-for-Service	1902208085	1902208085	1	1	GARDNER, KELLEY CRNA INC	11/4/2014	367500000X	NA	Other	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
163797	Fee-for-Service	1720721269	1720721269	1	1	GOLD SPRINGS HHA	11/20/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14529 ARCHWOOD ST	STE 201	VAN NUYS	CA	91405	4602	19	06037	34.19296757	-118.4499467	Los Angeles County
163835	Fee-for-Service	1144865502	1144865502	1	1	GOLOVATSCKA, VIKTORIYA CNP	12/2/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
163839	Fee-for-Service	1245805373	1245805373	1	1	GOTTAM, BHARGAVESH MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
163843	Fee-for-Service	1144872052	1144872052	1	2	GOLDEN STATE IMAGING ASSOCIA	3/13/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TES INC	17100 EUCLID	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
163844	Fee-for-Service	1407934144	1407934144	1	1	GARDNER, BARBARA MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	48130	13	Neurology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
163874	Fee-for-Service	1144571688	1144571688	1	1	GARCIA MARAVILLAS, CHRISTIAN	10/2/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	B LMFT	308 E SAN JACINTO AVE	None	PERRIS	CA	92570	5398	33	06065	33.78658073	-117.2226438	Riverside County
163914	Fee-for-Service	1548568421	1548568421	1	6	GOLDEN VALLEY HEALTH CENTERS	1/29/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3109 E WHITMORE AVE	None	CERES	CA	95307	2906	50	06099	37.5947885	-120.937644	Stanislaus County
163925	Fee-for-Service	1124772363	1124772363	1	1	GODS WAY HOME HEALTH CARE	7/12/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3710 FOOTHILL BLVD	SUITE A	GLENDALE	CA	91214	1740	19	06037	34.23652736	-118.2599237	Los Angeles County
163943	Fee-for-Service	1598807687	1598807687	1	1	GAULEY, MARIE LMFT	12/3/2024	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
163944	Fee-for-Service	1891155586	1891155586	1	1	GALLO, AMY M	1/17/2017	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
163979	Fee-for-Service	1871629030	1871629030	1	1	GESUNDHEIT, NEIL MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	40267	67	Endocrinology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
164044	Fee-for-Service	1528300928	1528300928	1	1	GEMELOS, JOHNNA R DO	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13681	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
164071	Fee-for-Service	1477959674	1477959674	1	1	GERDE, MEGAN E PT	10/12/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4960 VERDUGO	None	CAMARILLO	CA	93012	8632	56	06111	34.21547303	-119.0040356	Ventura County
164103	Fee-for-Service	1417118332	1417118332	1	1	GOLDIN, MICHAEL S MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112109	25	Physical Medicine and Rehabilitation	0	In state provider	None	38690 STIVERS ST	STE A	FREMONT	CA	94536	5276	01	06001	37.55724607	-121.9830866	Alameda County
164126	Fee-for-Service	1306927926	1306927926	1	1	GILLARD, JASON E LCSW	6/12/2017	No Taxonomy Provided	NA	None	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
164173	Fee-for-Service	1861081119	1861081119	1	2	GT MED TRANS LLC	7/2/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4509 EAGLE ROCK BLVD	B	LOS ANGELES	CA	90041	3512	19	06037	34.12639986	-118.2189437	Los Angeles County
164185	Fee-for-Service	1598470254	1598470254	1	1	GITHUI, GRACE WANGU	8/29/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8178 ELDERKIN ST	None	EASTVALE	CA	92880	0903	19	06037	33.9401989	-117.6013695	Riverside County
164199	Fee-for-Service	1659479418	1659479418	1	1	GHOSH, KOUSHIK MD	6/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140314	05	Anesthesiology	0	In state provider	None	2635 G STREET	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38360448	-119.0223416	Kern County
164201	Fee-for-Service	1548568421	1548568421	1	6	GOLDEN VALLEY HEALTH CENTERS	8/6/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3109 E WHITMORE AVE	None	CERES	CA	95307	2906	50	06099	37.5947885	-120.937644	Stanislaus County
164249	Fee-for-Service	1396032660	1396032660	1	1	GOLD, JESSICA M MD	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135718	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
164317	Fee-for-Service	1023121183	1023121183	1	1	GABHART, LISA L MD	6/2/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68275	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
164320	Fee-for-Service	1184654642	1184654642	1	1	GAYLIS, BRENDAN MD	8/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49668	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
164332	Fee-for-Service	1912129222	1912129222	1	1	GENESIS LABS	9/1/1992	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	5750 DIVISION ST	STE 104	RIVERSIDE	CA	92506	3259	33	06065	33.947667	-117.380963	Riverside County
164371	Fee-for-Service	1306929708	1306929708	1	1	GILANI, ABDOLLAH MD	7/31/1984	208600000X	NA	General Surgery	026	PHYSICIANS	39975	02	General Surgery	0	In state provider	None	3392 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3712	19	06037	34.02780514	-118.4095758	Los Angeles County
164380	Fee-for-Service	1689717258	1689717258	1	1	GOOD SAMARITAN SHELTER	12/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	245 EAST INGER DRIVE	103B	SANTA MARIA	CA	93454	8669	42	06083	34.92661232	-120.4330162	Santa Barbara County
164388	Fee-for-Service	1447659255	1447659255	1	1	GARDENVIEW HEALTHCARE	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE LP	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
164401	Fee-for-Service	1134207954	1134207954	1	1	GILL, KANWAL S MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82155	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
164410	Fee-for-Service	1508935586	1508935586	1	1	GONZALES ROCCA, PATRICIA U L	12/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
164424	Fee-for-Service	1215351275	1215351275	1	1	GOLDEN ANGEL HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	280 N BENSON AVE	STE 11	UPLAND	CA	91786	5652	36	06071	34.097121	-117.680893	San Bernardino County
164431	Fee-for-Service	1033529110	1033529110	1	1	GILMORE, MARIAM M DO	9/14/2017	207R00000X	NA	Other	026	PHYSICIANS	14573	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
164472	Fee-for-Service	1790700458	1790700458	1	1	GILL, HARMANDEEP K MD	10/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51452	None	None	0	In state provider	None	43830 10TH ST W	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
164475	Fee-for-Service	1598470254	1598470254	1	1	GITHUI, GRACE WANGU	8/29/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8178 ELDERKIN ST	None	EASTVALE	CA	92880	0903	19	06037	33.9401989	-117.6013695	Riverside County
164490	Fee-for-Service	1548568421	1548568421	1	6	GOLDEN VALLEY HEALTH CENTERS	1/29/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3109 E WHITMORE AVE	None	CERES	CA	95307	2906	50	06099	37.5947885	-120.937644	Stanislaus County
164528	Fee-for-Service	1588683007	1588683007	1	1	GREGSON, ARIC L MD	11/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68156	77	Infectious Disease	0	In state provider	None	16133 VENTURA BLVD	SUITE 415	ENCINO	CA	91436	2429	19	06037	34.15656164	-118.4849569	Los Angeles County
164584	Fee-for-Service	1801329776	1801329776	1	1	GARCIA, KIRSTEN A MD	11/10/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158516	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
164606	Fee-for-Service	1265519110	1265519110	1	1	GOYA, DAVID S DO	4/20/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	5712	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
164693	Fee-for-Service	1487636445	1487636445	1	1	GILBERT, STEWART D MD	10/20/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	71382	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
164712	Fee-for-Service	1215351275	1215351275	1	1	GOLDEN ANGEL HOSPICE INC	1/25/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	280 N BENSON AVE	STE 11	UPLAND	CA	91786	5652	36	06071	34.097121	-117.680893	San Bernardino County
164724	Fee-for-Service	1154479129	1154479129	1	1	GILBOA, MARTIN M MD	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	27126	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
164816	Fee-for-Service	1588683007	1588683007	1	1	GREGSON, ARIC L MD	11/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68156	41	Internal Medicine	0	In state provider	None	16133 VENTURA BLVD	SUITE 415	ENCINO	CA	91436	2429	19	06037	34.15656164	-118.4849569	Los Angeles County
164820	Fee-for-Service	1700804879	1700804879	1	1	GELBERG, HARRIS J MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	31749	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2416 CASTILLO ST	STE A	SANTA BARBARA	CA	93105	5303	42	06083	34.43092329	-119.7247028	Santa Barbara County
164856	Fee-for-Service	1376295808	1376295808	1	1	GREWAL, JASKIRAN K OD	3/18/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	715-A JACKSON ST	None	RED BLUFF	CA	96080	3771	52	06103	40.17524703	-122.2405638	Tehama County
164862	Fee-for-Service	1750999009	1750999009	1	1	GOMES, GABRIELA C NP	10/20/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
164867	Fee-for-Service	1346675972	1346675972	1	1	GONZALEZ, JEANPAULO A LCSW	8/4/2021	103TP2700X	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	HING, AND CONSULTATION S	101 REDLANDS	234A	REDLANDS	CA	92373	4775	36	06071	34.05648141	-117.1833351	San Bernardino County
164893	Fee-for-Service	1841268737	1841268737	1	1	GILLIAM, EARNEST E JR CRNA	4/30/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
164920	Fee-for-Service	1871606764	1871606764	1	1	GLENS FALLS HOSPITAL, INC	4/3/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 PARK STREET	None	GLENS FALLS	NY	12801	9898	00	None	43.305588	-73.6486515	Warren County
164945	Fee-for-Service	1568963155	1568963155	1	1	GRAY, ABBY PT	10/9/2019	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3184 COLLINS DR	None	MERCED	CA	95348	3132	24	06047	37.32178614	-120.4760525	Merced County
164956	Fee-for-Service	1336248996	1336248996	1	1	GENE TREK INC	12/1/1995	207SC0300X	NA	Other	026	PHYSICIANS	48350	08	Family Practice	0	In state provider	GENE TREK MEDICAL CLINIC	421 E ANGELENO AVE	STE 204	BURBANK	CA	91501	2286	19	06037	34.18278568	-118.3048911	Los Angeles County
164962	Fee-for-Service	1336427939	1336427939	1	1	GUEVARA, SALVADOR G MD FACS	11/1/2014	208600000X	NA	General Surgery	026	PHYSICIANS	96379	None	None	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
165006	Fee-for-Service	1215100573	1215100573	1	1	GHAFOURI DARYANI, PARASTOO	12/10/2009	207R00000X	NA	Other	026	PHYSICIANS	105388	41	Internal Medicine	0	In state provider	MD	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
165040	Fee-for-Service	1386697878	1386697878	1	1	GOYAL, MADHAV MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	68478	30	Radiology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
165061	Fee-for-Service	1033792981	1033792981	1	1	GENOA HEALTHCARE LLC	3/1/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4444 CALLE REAL	P1	SANTA BARBARA	CA	93110	1002	42	06083	34.44240122	-119.7765542	Santa Barbara County
165104	Fee-for-Service	1508891797	1508891797	1	1	GOLDEN, OTASHE N MD	8/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70035	08	Family Practice	0	In state provider	None	9098 LAGUNA MAIN ST	STE 6	ELK GROVE	CA	95758	7449	34	06067	38.427129	-121.47138	Sacramento County
165182	Fee-for-Service	1417631615	1417631615	1	1	GATHURA, NJERI	9/13/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
165199	Fee-for-Service	1588225460	1588225460	1	1	GAYED, MARIAN LMFT	5/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
165210	Fee-for-Service	1871606764	1871606764	1	1	GLENS FALLS HOSPITAL, INC	4/3/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 PARK STREET	None	GLENS FALLS	NY	12801	9898	00	None	43.305588	-73.6486515	Warren County
165238	Fee-for-Service	1790704856	1790704856	1	1	GANNON, MICHAEL 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	2979 SQUALICUM PKWY	STE 203	BELLINGHAM	WA	98225	1813	00	None	48.77217093	-122.4726248	Whatcom County
165242	Fee-for-Service	1336248996	1336248996	1	1	GENE TREK INC	12/1/1995	207SC0300X	NA	Other	026	PHYSICIANS	48350	01	General Practice	0	In state provider	GENE TREK MEDICAL CLINIC	421 E ANGELENO AVE	STE 204	BURBANK	CA	91501	2286	19	06037	34.18278568	-118.3048911	Los Angeles County
165252	Fee-for-Service	1124603972	1124603972	1	1	GLOBAL PHYSICAL THERAPY AND	5/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	WELLNESS	12131 BROOKHURST ST STE	None	GARDEN GROVE	CA	92840	2863	30	06059	33.78651323	-117.9588405	Orange County
165303	Fee-for-Service	1285797704	1285797704	1	1	GEHLBACH, BRIAN K MD	1/4/2022	207RC0200X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
165308	Fee-for-Service	1740621010	1740621010	1	1	GAD, NIMISHA P OD	2/26/2018	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
165315	Fee-for-Service	1245655364	1245655364	1	1	GLOBAL EXPRESS PHARMACY INC	7/24/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10596 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1163	30	06059	33.7739907	-117.9476369	Orange County
165358	Fee-for-Service	1972715381	1972715381	1	1	GHOURY, ABDULLAH K MD	10/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96810	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
165388	Fee-for-Service	1831719616	1831719616	1	1	GILL, HARINDER S	5/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183599	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
165398	Fee-for-Service	1194892935	1194892935	1	1	GIN, RICHARD G OD	1/13/2014	No Taxonomy Provided	NA	None	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
165473	Fee-for-Service	1932409257	1932409257	1	1	GAW, BRIAN K MD INC	12/19/2014	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1669 WEST AVENUE J	STE 304	LANCASTER	CA	93534	2870	19	06037	34.68944746	-118.1608785	Los Angeles County
165491	Fee-for-Service	1063416410	1063416410	1	1	GUJRAL, INDERPAL S MD	7/6/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49536	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	24953 PASEO DE VALENCIA	#30A	LAGUNA HILLS	CA	92653	4343	30	06059	33.60028568	-117.7010887	Orange County
165501	Fee-for-Service	1871256404	1871256404	1	1	GOLDEN YEARS ELDERLY CARE	12/2/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	12772 HAWKS HILL ST	None	VICTORVILLE	CA	92395	9023	36	06071	34.48321535	-117.3011005	San Bernardino County
165545	Fee-for-Service	1467804526	1467804526	1	1	GUPTILL, BRIANA C	5/1/2024	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
165547	Fee-for-Service	1265882989	1265882989	1	1	GARCIA, ALLYSON MD	12/5/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169083	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
165645	Fee-for-Service	1609189224	1609189224	1	1	GODEBU, ELANA MD	12/18/2018	208800000X	NA	Other	026	PHYSICIANS	119468	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
165746	Fee-for-Service	1164790143	1164790143	1	1	GONZALEZ, ELENA K LMFT	4/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	815 MISSION AVE	204	OCEANSIDE	CA	92054	2862	37	06073	33.19754169	-117.3767154	San Diego County
165761	Fee-for-Service	1932409257	1932409257	1	1	GAW, BRIAN K MD INC	12/19/2014	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1669 WEST AVENUE J	STE 304	LANCASTER	CA	93534	2870	19	06037	34.68944746	-118.1608785	Los Angeles County
165775	Fee-for-Service	1063416410	1063416410	1	1	GUJRAL, INDERPAL S MD	7/6/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49536	41	Internal Medicine	0	In state provider	None	24953 PASEO DE VALENCIA	#30A	LAGUNA HILLS	CA	92653	4343	30	06059	33.60028568	-117.7010887	Orange County
165790	Fee-for-Service	1952742306	1952742306	1	1	GOREWITZ, JANET F PHD	10/9/2019	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
165805	Fee-for-Service	1073907341	1073907341	1	1	GANDHI, SHWETA H DO	7/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20442	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
165806	Fee-for-Service	1851556088	1851556088	1	1	GOPALAPURAM, RAJANI MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104756	08	Family Practice	0	In state provider	None	2720 LOW COURT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
165810	Fee-for-Service	1992756977	1992756977	1	1	GIAQUINTO, EDWARD JR PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	MOBILE CRISIS CARE	24425 WOOLSEY CANYON RD	SPC 11	CANOGA PARK	CA	91304	1121	19	06037	34.23703694	-118.6592793	Los Angeles County
165894	Fee-for-Service	1891304390	1891304390	1	1	GRS HOSPICE INC	8/5/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1390 MARKET ST	SUITE 200	SAN FRANCISCO	CA	94102	5404	38	06075	37.7769456	-122.4170521	San Francisco County
165929	Fee-for-Service	1972577286	1972577286	1	1	GERDES, MELISSA S	11/6/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151203	08	Family Practice	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
165930	Fee-for-Service	1578766366	1578766366	1	1	GREENE, DENISE F	8/28/2020	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
165970	Fee-for-Service	1225575293	1225575293	1	1	GRAY, CATHERINE L	6/6/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ED PSYCHOLOGIST	30 NORTH RAYMOND AVENUE	SUITE 403	PASADENA	CA	91103	4416	19	06037	34.14631307	-118.1488659	Los Angeles County
165989	Fee-for-Service	1265052633	1265052633	1	1	GHEISSARI, MARIAM DO	9/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19944	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
166007	Fee-for-Service	1427057298	1427057298	1	1	GAY, ROBERT	9/17/2024	207L00000X	NA	Other	026	PHYSICIANS	184019	05	Anesthesiology	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
166023	Fee-for-Service	1164898078	1164898078	1	1	GARDLEY, NIMRA LMFT	1/9/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97371	-	NOT APPLICABLE	0	In state provider	None	1334 LINCOLN BLVD	None	SANTA MONICA	CA	90401	1730	19	06037	34.0202001	-118.4922258	Los Angeles County
166028	Fee-for-Service	1164191417	1164191417	1	1	GLEN L XIONG, MD INC	2/7/2025	207R00000X	NA	Other	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	500 JESSIE AVE	None	SACRAMENTO	CA	95838	2609	34	06067	38.643435	-121.454145	Sacramento County
166039	Fee-for-Service	1275692931	1275692931	1	1	GUERRA, GEORGE A MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	53219	03	Allergy	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
166082	Fee-for-Service	1972512184	1972512184	1	1	GROOTENDORST, EDWARD DC	6/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHIROPRATIC CORP	900 W YOSEMITE AVE	None	MADERA	CA	93637	4555	20	06039	36.95534722	-120.0691832	Madera County
166125	Fee-for-Service	1538245543	1538245543	1	1	GALLARDO, ANA B MFT	3/3/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2050 W CHAPMAN AVE	STE 282	ORANGE	CA	92868	2602	30	06059	33.78787054	-117.87498	Orange County
166174	Fee-for-Service	1376773184	1376773184	1	1	GAMBOA, BEDA LCSW	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	61555	-	NOT APPLICABLE	0	In state provider	None	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	19	06037	33.98965917	-118.287673	Los Angeles County
166180	Fee-for-Service	1891304390	1891304390	1	1	GRS HOSPICE INC	8/5/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1390 MARKET ST	SUITE 200	SAN FRANCISCO	CA	94102	5404	38	06075	37.7769456	-122.4170521	San Francisco County
166311	Fee-for-Service	1023652914	1023652914	1	1	GRACE GERIATRIC CARE INC	10/13/2020	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	38	Geriatrics	0	In state provider	None	8883 WESTMINSTER AVE	None	GARDEN GROVE	CA	92844	2608	30	06059	33.75942652	-117.974097	Orange County
166313	Fee-for-Service	1306296884	1306296884	1	1	GUZMAN JOVEL, ALMA P LCSW	8/1/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
166328	Fee-for-Service	1275692931	1275692931	1	1	GUERRA, GEORGE A MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	53219	01	General 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
166340	Fee-for-Service	1467415919	1467415919	1	1	GHONIEM, GAMAL M MD	5/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54137	34	Urology and Urological Surgery	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
166370	Fee-for-Service	1871731398	1871731398	1	1	GROSBERG, DARYL	6/29/2011	No Taxonomy Provided	NA	None	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
166408	Fee-for-Service	1639722002	1639722002	1	1	GOLDEN LIVING IN SYLMAR INC.	12/11/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14060 ASTORIA STREET	None	SYLMAR	CA	91342	2949	19	06037	34.31056953	-118.4397467	Los Angeles County
166419	Fee-for-Service	1669792537	1669792537	1	1	GUTIERREZ, NOE MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118278	08	Family Practice	0	In state provider	None	2400 DEL PASO ROAD	SUITE 145	SACRAMENTO	CA	95834	9629	34	06067	38.654838	-121.516983	Sacramento County
166432	Fee-for-Service	1053706663	1053706663	1	1	GLOVER, KEITH J MD	9/4/2020	2086S0129X	NA	General Surgery	026	PHYSICIANS	169766	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
166439	Fee-for-Service	1740235233	1740235233	1	1	GADBERRY, SCOTT C CRNA	9/9/2020	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
166484	Fee-for-Service	1457813941	1457813941	1	1	GUPTA, KANAV P MD	5/16/2024	208M00000X	NA	Other	026	PHYSICIANS	179990	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
166526	Fee-for-Service	1366655128	1366655128	1	1	GOLDEN VALLEY HEALTH CTR	5/1/1999	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	301 HOWARD RD	None	WESTLEY	CA	95387	0000	50	06099	37.54449453	-121.1984213	Stanislaus County
166545	Fee-for-Service	1861823627	1861823627	1	1	GALVEZ, CHRISTINE LMFT	7/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8325 HAVEN AVE.	207	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.10122106	-117.5757252	San Bernardino County
166555	Fee-for-Service	1962737031	1962737031	1	1	GOGLIN, SARAH E MD	5/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117201	83	Rheumatology	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
166575	Fee-for-Service	1740203066	1740203066	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3944 GRAND AVE	None	CHINO	CA	91710	5422	36	06071	34.001946	-117.718731	San Bernardino County
166578	Fee-for-Service	1265617187	1265617187	1	1	GEFT, DAEL R MD	1/15/2009	207R00000X	NA	Other	026	PHYSICIANS	102122	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
166582	Fee-for-Service	1083685986	1083685986	1	2	GRANITE CITY ILLINOIS	8/11/2018	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL LLC	2100 MADISON AVENUE	None	GRANITE CITY	IL	62040	4713	00	None	38.70131686	-90.1443738	Madison County
166667	Fee-for-Service	1568484194	1568484194	2	1	GARFIELD BEACH CVS LLC	10/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1980 SANTA ROSA AVE	None	SANTA ROSA	CA	95407	7621	49	06097	38.417274	-122.709321	Sonoma County
166671	Fee-for-Service	1689926719	1689926719	1	1	GALLERIA MEDICAL SUPPLY	5/20/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3250 W OLYMPIC BLVD	STE 301	LOS ANGELES	CA	90006	2368	19	06037	34.05263234	-118.3077799	Los Angeles County
166697	Fee-for-Service	1497339618	1497339618	1	1	GREEN, ADRIEL J MD	6/3/2024	207P00000X	NA	Other	026	PHYSICIANS	186991	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
166716	Fee-for-Service	1508112574	1508112574	1	1	GARFIELD BEACH CVS LLC	12/27/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4110 N 1ST ST	None	SAN JOSE	CA	95134	1513	43	06085	37.41545376	-121.9543173	Santa Clara County
166749	Fee-for-Service	1629465521	1629465521	1	1	GO, RUTH MD	6/15/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	144950	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
166770	Fee-for-Service	1457813941	1457813941	1	1	GUPTA, KANAV P MD	5/16/2024	208M00000X	NA	Other	026	PHYSICIANS	179990	41	Internal Medicine	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
166777	Fee-for-Service	1457837304	1457837304	1	1	GARFIELD BEACH CVS, L.L.C.	3/25/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3029 UNIVERSITY AVE	None	SAN DIEGO	CA	92104	3036	37	06073	32.74846051	-117.1289385	San Diego County
166813	Fee-for-Service	1427048032	1427048032	1	1	GREEN, BILLIE E	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	44412	41	Internal Medicine	0	In state provider	None	8270 LA MESA BLVD	None	LA MESA	CA	91941	5257	37	06073	32.76479659	-117.0195721	San Diego County
166817	Fee-for-Service	1366655128	1366655128	1	1	GOLDEN VALLEY HEALTH CTR	5/1/1999	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	301 HOWARD RD	None	WESTLEY	CA	95387	0000	50	06099	37.54449453	-121.1984213	Stanislaus County
166822	Fee-for-Service	1043381015	1043381015	1	1	GOWRINATHAN, RANI N MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	39204	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
166839	Fee-for-Service	1659925808	1659925808	1	1	GARDUQUE, CHARINA A NP	10/14/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
166858	Fee-for-Service	1124415179	1124415179	1	1	GOPARAJU, KRISHNA MD	10/20/2023	207R00000X	NA	Other	026	PHYSICIANS	191015	None	None	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
166870	Fee-for-Service	1083685986	1083685986	1	2	GRANITE CITY ILLINOIS	8/11/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL LLC	2100 MADISON AVENUE	None	GRANITE CITY	IL	62040	4713	00	None	38.70131686	-90.1443738	Madison County
166892	Fee-for-Service	1487676011	1487676011	2	1	GARFIELD BEACH CVS LLC	1/18/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7600 N BLACKSTONE AVE	None	FRESNO	CA	93720	4300	10	06019	36.847512	-119.786481	Fresno County
166940	Fee-for-Service	1518070952	1518070952	1	1	GOLDBERG, ALBERT C MD	2/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9946	40	Pediatrics	0	In state provider	None	750 LAS GALLINAS AVE	None	SAN RAFAEL	CA	94903	3438	21	06041	38.00688138	-122.5463961	Marin County
166954	Fee-for-Service	1831576289	1831576289	1	1	GUTIERREZ, CLAUDIA P LMFT	4/26/2022	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
166955	Fee-for-Service	1629203237	1629203237	1	1	GAJENDRAN, VARUN K MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113323	20	Orthopedic Surgery	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
166988	Fee-for-Service	1164503017	1164503017	1	1	GOLD, JONATHAN L MD	10/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88496	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
166989	Fee-for-Service	1881742674	1881742674	1	1	GOODLOE, LYNNE J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44674	84	Surgery-Head and Neck	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
166999	Fee-for-Service	1902805062	1902805062	1	2	GREATER REGIONAL MEDICAL CEN	5/9/2020	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TER	1700 W TOWNLINE ST	None	CRESTON	IA	50801	1054	00	None	41.07115307	-94.3836219	Union County
167051	Fee-for-Service	1619906104	1619906104	1	1	GABRIEL, EDWARD A MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	63371	30	Radiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
167103	Fee-for-Service	1366655128	1366655128	1	1	GOLDEN VALLEY HEALTH CTR	9/21/2007	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	301 HOWARD RD	None	WESTLEY	CA	95387	0000	50	06099	37.54449453	-121.1984213	Stanislaus County
167140	Fee-for-Service	1770527020	1770527020	1	1	GARFIELD BEACH CVS LLC	6/3/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3350 PALM AVE	None	SAN DIEGO	CA	92154	1662	37	06073	32.58377649	-117.060705	San Diego County
167155	Fee-for-Service	1861568172	1861568172	1	1	GLEASON, PATROCINA S	6/12/2017	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
167178	Fee-for-Service	1417068222	1417068222	1	1	GLASS, HANNAH C MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95679	79	Neurology-Child	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
167187	Fee-for-Service	1427540434	1427540434	1	1	GILL, KIMBERLY S NP	4/15/2019	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
167224	Fee-for-Service	1922514892	1922514892	1	1	GODINEZ, DANIEL LMFT	9/2/2022	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
167275	Fee-for-Service	1881742674	1881742674	1	1	GOODLOE, LYNNE J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	44674	04	Otology, Laryngology, Rhinology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
167289	Fee-for-Service	1902805062	1902805062	1	2	GREATER REGIONAL MEDICAL CEN	5/9/2020	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TER	1700 W TOWNLINE ST	None	CRESTON	IA	50801	1054	00	None	41.07115307	-94.3836219	Union County
167297	Fee-for-Service	1700087129	1700087129	1	1	GARCIA, LEONARDO LMFT	10/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1124 W MURRAY AVE	None	VISALIA	CA	93291	4718	54	06107	36.333945	-119.3038425	Tulare County
167366	Fee-for-Service	1194900498	1194900498	1	1	GILBERT C WONG M.D.	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3895 W 7800 S	STE 202	WEST JORDAN	UT	84088	5616	00	None	40.60940654	-111.9843135	Salt Lake County
167434	Fee-for-Service	1366756447	1366756447	1	1	GOYAL, ABHINAV MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136213	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
167505	Fee-for-Service	1487706602	1487706602	1	1	GUYON, SCOTT A MD	1/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83394	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
167517	Fee-for-Service	1730701756	1730701756	1	1	GILBERT, MATTHEW MD	8/5/2023	207P00000X	NA	Other	026	PHYSICIANS	184814	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
167534	Fee-for-Service	1053305797	1053305797	1	3	GLENDALE PATHOLOGY ASSOC	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MED GRP OF GLENDALE	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
167581	Fee-for-Service	1548526346	1548526346	1	1	GONZALEZ, DAVID C MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123045	01	General Practice	0	In state provider	None	30300 RANCHO VIEJO RD	None	SAN JUAN CAPISTRA	CA	92675	1576	30	06059	33.52255638	-117.6650853	Orange County
167616	Fee-for-Service	1205010600	1205010600	1	1	GERSTEL, JEFFREY W DO	4/28/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	9870	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
167670	Fee-for-Service	1730375791	1730375791	1	1	GREEN, RYAN B MD	1/12/2009	207L00000X	NA	Other	026	PHYSICIANS	92082	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
167681	Fee-for-Service	1538214408	1538214408	1	1	GILANI, DURDANA MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	31993	01	General Practice	0	In state provider	None	624 W DUARTE RD	STE 103	ARCADIA	CA	91007	9258	19	06037	34.12637452	-118.0527313	Los Angeles County
167711	Fee-for-Service	1437199254	1437199254	1	1	GUSTAVSSON, 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	2801 N. GANTENBEIN	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
167742	Fee-for-Service	1841476652	1841476652	1	1	GROSSMONT SPRING VALLEY	11/24/1999	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	8788 JAMACHA RD	None	SPRING VALLEY	CA	91977	4035	37	06073	32.71482507	-117.0098243	San Diego County
167787	Fee-for-Service	1972858454	1972858454	1	1	GERSHENSON, ANTHONY J LMFT	10/29/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PKWY	SUITE 335	CITY OF INDUSTRY	CA	91745	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
167794	Fee-for-Service	1679728430	1679728430	1	1	GARDNER, RAQUEL C MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112323	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
167796	Fee-for-Service	1053473629	1053473629	1	1	GORDON, KEITH L MD	9/10/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42732	36	Psychiatry	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
167808	Fee-for-Service	1669408076	1669408076	1	1	GROUSE, DEBORAH J MD	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	71740	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
167832	Fee-for-Service	1467488130	1467488130	1	1	GENSKOW, GORDON L MD	7/22/2016	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
167848	Fee-for-Service	1215998679	1215998679	1	1	GRUNWALD, GREGORY S DO	5/25/2010	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2640 E BARNETT RD	None	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
167859	Fee-for-Service	1205972957	1205972957	1	1	GELVEZ, LILIANA R MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76652	40	Pediatrics	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
167878	Fee-for-Service	1962447284	1962447284	1	1	GARFIELD BEACH CVS LLC	6/2/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11426 WASHINGTON BLVD	None	WHITTIER	CA	90606	3122	19	06037	33.97102973	-118.067869	Los Angeles County
167881	Fee-for-Service	1144640152	1144640152	1	1	GREGG, ASHLEY MD	7/26/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162709	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
167890	Fee-for-Service	1033346531	1033346531	1	1	GUIDRY, CHARLES C MD	7/1/2011	2086S0102X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	None	5141 CRENSHAW BLVD	None	LOS ANGELES	CA	90043	1853	19	06037	33.9955892	-118.331023	Los Angeles County
167903	Fee-for-Service	1245678937	1245678937	1	1	GHANPUR BALAKRISHNA, SHASHMI	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138563	01	General Practice	0	In state provider	MD	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
167905	Fee-for-Service	1497721260	1497721260	1	2	GREEN, ALAN C MD	6/17/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	76287	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90807	4417	19	06037	33.8188341	-118.1923297	Los Angeles County
167922	Fee-for-Service	1871175422	1871175422	1	1	GUALY, SEBASTIAN MD	7/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
167958	Fee-for-Service	1861662884	1861662884	1	1	GESSNER, MARY C DO	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11744	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
168004	Fee-for-Service	1184623969	1184623969	1	1	GILL, KULDEEP S MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82057	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
168015	Fee-for-Service	1831292994	1831292994	1	1	GHUMMAN, AMRITA B MD	10/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89139	08	Family Practice	0	In state provider	None	13350 BIG BASIN WAY	None	BOULDER CREEK	CA	95006	9237	44	06087	37.12492123	-122.1245364	Santa Cruz County
168036	Fee-for-Service	1316200603	1316200603	1	1	GELOU, ALEXANDER C MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137568	01	General Practice	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
168119	Fee-for-Service	1225059306	1225059306	1	1	GHARAGOZLOU, PARHAM MD	8/20/2009	207R00000X	NA	Other	026	PHYSICIANS	92636	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
168197	Fee-for-Service	1205151248	1205151248	1	1	GHANTA, SWAPNA MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	158083	02	General Surgery	0	In state provider	None	112 LA CASA VIA	STE 340	WALNUT CREEK	CA	94598	3018	07	06013	37.91229899	-122.0423696	Contra Costa County
168222	Fee-for-Service	1538270749	1538270749	1	1	GAZARIAN, LEVON H MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	40804	41	Internal Medicine	0	In state provider	None	612 W DUARTE RD	STE 604	ARCADIA	CA	91007	9243	19	06037	34.12647805	-118.051994	Los Angeles County
168227	Fee-for-Service	1316047624	1316047624	1	1	GARFIELD BEACH CVS LLC	9/14/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30736 BENTON RD	None	WINCHESTER	CA	92596	8466	33	06065	33.59094099	-117.1224509	Riverside County
168281	Fee-for-Service	1659470144	1659470144	1	1	GOLDSTEIN, RONALD L OD	9/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	277 HAMPSHIRE RD	None	THOUSAND OAKS	CA	91361	2408	56	06111	34.164787	-118.8382165	Ventura County
168284	Fee-for-Service	1235646696	1235646696	1	1	GARFIELD BEACH CVS, LLC	5/7/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 N HOLLYWOOD WAY	None	BURBANK	CA	91505	2540	19	06037	34.16926471	-118.3477174	Los Angeles County
168286	Fee-for-Service	1376821728	1376821728	1	1	GLATSTEIN, GABRIEL P PSYD	10/25/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0613	10	06019	36.80478	-119.7724585	Fresno County
168291	Fee-for-Service	1184623969	1184623969	1	1	GILL, KULDEEP S MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82057	41	Internal Medicine	0	In state provider	None	1660 E HERNDON AVE	STE 101	FRESNO	CA	93720	3346	10	06019	36.8375615	-119.7575595	Fresno County
168329	Fee-for-Service	1265499123	1265499123	1	1	GEE, TIFFANY ANN MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79674	08	Family Practice	0	In state provider	None	2151 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75424753	-121.455621	San Joaquin County
168334	Fee-for-Service	1144583931	1144583931	1	1	GREENE, JACQUELINE MD	2/23/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	161242	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
168384	Fee-for-Service	1053508648	1053508648	1	1	GRAY, ASHLEY	2/26/2025	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
168392	Fee-for-Service	1144424714	1144424714	1	1	GROGHAN, MEGHAN MD	5/30/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
168447	Fee-for-Service	1205281250	1205281250	1	1	GHAMARIAN, PETER P MD	8/16/2021	208800000X	NA	Other	026	PHYSICIANS	151752	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
168451	Fee-for-Service	1407927452	1407927452	1	1	GUPTA, ANUPAM MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84431	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
168467	Fee-for-Service	1326508805	1326508805	1	1	GRISDELA, PHILLIP T MD	8/5/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
168493	Fee-for-Service	1699866327	1699866327	1	2	GOOD, WILLIAM	7/11/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	53692	None	None	0	In state provider	None	2100 WEBSTER ST	404	SAN FRANCISCO	CA	94115	2373	38	06075	37.7904826	-122.4324477	San Francisco County
168577	Fee-for-Service	1356396642	1356396642	1	1	GHEEN, GARRET A	4/3/2009	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2835 CHILDRESS DRIVE	None	ANDERSON	CA	96007	3563	45	06089	40.45498247	-122.2907255	Shasta County
168578	Fee-for-Service	1962004804	1962004804	1	1	GLEN P MOREHEAD MD INC	4/28/2021	207RX0202X	NA	Oncology	026	PHYSICIANS	None	None	None	0	In state provider	None	1180 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
168602	Fee-for-Service	1003851858	1003851858	1	1	GREER, DEBORAH A MD	7/1/2000	207P00000X	NA	Other	026	PHYSICIANS	64667	None	None	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
168653	Fee-for-Service	1447693585	1447693585	1	1	GOMEZ, ADAM MD	11/22/2024	208M00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
168657	Fee-for-Service	1467567776	1467567776	1	1	GREGORY A. PILETTE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7920 CARMEL AVE NE	STE 1	ALBUQUERQUE	NM	87122	3056	00	None	35.17714152	-106.5574845	Bernalillo County
168679	Fee-for-Service	1558715375	1558715375	1	1	GOLDBERG, ILIYA MD	10/10/2022	208600000X	NA	General Surgery	026	PHYSICIANS	170915	None	None	0	In state provider	None	401 E HIGHLAND AVE	STE 351	SAN BERNARDINO	CA	92404	3830	36	06071	34.1358627	-117.2757778	San Bernardino County
168704	Fee-for-Service	1043772437	1043772437	1	1	GREWAL, SARBJOT MD	7/25/2022	207R00000X	NA	Other	026	PHYSICIANS	179025	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
168739	Fee-for-Service	1871501288	1871501288	1	1	GARCIA, SERAFIN M MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26819	41	Internal Medicine	0	In state provider	None	1560 E CHEVY CHASE DR	STE 450	GLENDALE	CA	91206	4173	19	06037	34.15290734	-118.2302295	Los Angeles County
168752	Fee-for-Service	1821280629	1821280629	1	1	GEORGE, ALISTER A MD	5/24/2022	174400000X	NA	Other	026	PHYSICIANS	63795	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
168811	Fee-for-Service	1629488697	1629488697	1	1	GRACE, TREVOR R MD	5/6/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	139194	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
168829	Fee-for-Service	1053982629	1053982629	1	2	GIVRAD, MATTHEW M PSYD	9/29/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SERVICES	511 1ST ST	STE E-F	TUSTIN	CA	92780	3333	30	06059	33.7458254	-117.8189881	Orange County
168861	Fee-for-Service	1861868226	1861868226	1	1	GREENBERG, DANIEL	5/16/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	150 CATHERINE LANE	STE I	GRASS VALLEY	CA	95945	5715	29	06057	39.22894557	-121.0489578	Nevada County
168872	Fee-for-Service	1861694077	1861694077	1	1	GRAND, ALEXANDER MD	3/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110469	18	Ophthalmology	0	In state provider	None	1700 ALHAMBRA BLVD	STE 202	SACRAMENTO	CA	95816	7050	34	06067	38.564847	-121.469121	Sacramento County
168995	Fee-for-Service	1336140458	1336140458	1	1	GUPTA, ABHA S MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41163	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	801 N TUSTIN AVE	STE 201	SANTA ANA	CA	92705	3600	30	06059	33.752286	-117.8341735	Orange County
169006	Fee-for-Service	1023637691	1023637691	1	1	GRACE, SARAH	10/28/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176611	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
169027	Fee-for-Service	1619479581	1619479581	1	1	GIBSON, LACEY LCSW	2/10/2025	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
169067	Fee-for-Service	1508128554	1508128554	1	1	GOUVEIA, CHRISTOPHER J MD	4/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147610	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
169100	Fee-for-Service	1053549774	1053549774	1	1	GUTIERREZ, ANNIE PHD	8/16/2018	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
169107	Fee-for-Service	1881821825	1881821825	1	1	GANNAVARAPU, BHARGAVA MD	6/22/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	111996	10	Gastroenterology (M.D. only)	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
169122	Fee-for-Service	1285922310	1285922310	1	1	GROCK, ANDREW F MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135364	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
169123	Fee-for-Service	1861472318	1861472318	1	9	GENESISCARE USA OF CALIFORNI	2/25/2020	2085R0001X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CORPORATION	40055 BOB HOPE DR	SUITE B	RANCHO MIRAGE	CA	92270	3940	33	06065	33.75735051	-116.4082747	Riverside County
169139	Fee-for-Service	1538519863	1538519863	1	1	GERSTEIN, SHAWN DO	1/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19220	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
169148	Fee-for-Service	1144872052	1144872052	1	1	GOLDEN STATE IMAGING ASSOCIA	3/13/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TES INC	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
169163	Fee-for-Service	1124199625	1124199625	1	1	GOLD, RANDI F	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
169189	Fee-for-Service	1649779919	1649779919	1	3	GREEN PHYSICAL THERAPY, INC.	1/6/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	26881 JEFFERSON AVE.	C	MURRIETA	CA	92562	9119	33	06065	33.52789449	-117.1735624	Riverside County
169205	Fee-for-Service	1326317389	1326317389	1	1	GAJJAR, AARTI V MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
169220	Fee-for-Service	1679601496	1679601496	1	1	GELLER, LOREN M MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	92708	20	Orthopedic Surgery	0	In state provider	None	1818 VERDUGO BLVD	STE 402	GLENDALE	CA	91208	1422	19	06037	34.20560177	-118.216054	Los Angeles County
169223	Fee-for-Service	1891913356	1891913356	1	2	GENTLE HOME HEALTH	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	21104 DEVONSHIRE ST	None	CHATSWORTH	CA	91311	2316	19	06037	34.25720948	-118.593234	Los Angeles County
169234	Fee-for-Service	1255418109	1255418109	1	1	GREENE, KENNETH T MD	3/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	58394	41	Internal Medicine	0	In state provider	None	1515 FRUITVALE AVE	None	OAKLAND	CA	94601	2322	01	06001	37.77910723	-122.2251233	Alameda County
169256	Fee-for-Service	1356827323	1356827323	1	1	GHARZEDDINE, JENNA R MD	12/20/2019	390200000X	NA	Other	026	PHYSICIANS	160972	41	Internal Medicine	0	In state provider	None	434 S SAN VINCENTE BLVD	STE 100	LOS ANGELES	CA	90048	4108	19	06037	34.07053591	-118.375828	Los Angeles County
169269	Fee-for-Service	1679508600	1679508600	1	1	GLASSMAN, STUART J MD	5/12/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	175473	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
169284	Fee-for-Service	1760746135	1760746135	1	1	GOOD MORNING ACUPUNCTURE INC	4/3/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	12587 EAST CARSON STREET	None	HAWAIIAN GARDENS	CA	90716	1667	19	06037	33.83170046	-118.063647	Los Angeles County
169297	Fee-for-Service	1750523031	1750523031	1	1	GOULD-SIMON, ARON J MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119664	None	None	0	In state provider	None	6121 N THESTA	SUITE 207	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
169363	Fee-for-Service	1578821583	1578821583	1	1	GOLDSTEIN, RACHEL L MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126615	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
169395	Fee-for-Service	1902368079	1902368079	1	1	GNRX PHARMACY INC	11/5/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2440 S WESTERN AVE	29	SAN PEDRO	CA	90732	4334	19	06037	33.72325081	-118.3123796	Los Angeles County
169411	Fee-for-Service	1861472318	1861472318	1	9	GENESISCARE USA OF CALIFORNI	2/25/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	40055 BOB HOPE DR	SUITE B	RANCHO MIRAGE	CA	92270	3940	33	06065	33.75735051	-116.4082747	Riverside County
169439	Fee-for-Service	1063881571	1063881571	1	1	GONZALES, RAQUEL PSYD	12/20/2024	390200000X	NA	Other	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
169450	Fee-for-Service	1699298968	1699298968	1	1	GARFIELD BEACH CVS LLC	11/16/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3010 BERNAL AVE	None	PLEASANTON	CA	94566	6606	01	06001	37.66974808	-121.8577331	Alameda County
169454	Fee-for-Service	1952554917	1952554917	1	1	GUPTA, DEEPTI MD	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110895	01	General Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3009	56	06111	34.27623479	-119.2520218	Ventura County
169464	Fee-for-Service	1467476283	1467476283	1	1	GILL, DIANE B MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66396	05	Anesthesiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
169480	Fee-for-Service	1689741415	1689741415	1	1	GRIFFITHS, GEOFFREY P MD	12/1/1997	204D00000X	NA	Other	026	PHYSICIANS	76894	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
169523	Fee-for-Service	1003286873	1003286873	1	1	GOLDEN STAR HOME HEALTH CARE	2/20/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	440 W COLORADO ST	STE 205	GLENDALE	CA	91204	3056	19	06037	34.14249549	-118.2628035	Los Angeles County
169526	Fee-for-Service	1861854622	1861854622	1	1	GELUZ, JAYDEE ROSE F NP	6/15/2017	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
169550	Fee-for-Service	1992906457	1992906457	1	1	GRIGGS, KIMBERLY K LMFT	6/20/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5252 BALBOA AVE	803	SAN DIEGO	CA	92117	6906	37	06073	32.81892468	-117.1833243	San Diego County
169607	Fee-for-Service	1104974138	1104974138	1	1	GUNAWARDANA, CHANDANIKA	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72289	40	Pediatrics	0	In state provider	MD	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
169622	Fee-for-Service	1952540262	1952540262	1	1	GEREBOFF, AVNER G MD	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98638	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
169623	Fee-for-Service	1851637375	1851637375	1	1	GALLAGHER, CHRISTIAN C PT	6/11/2018	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
169631	Fee-for-Service	1174654818	1174654818	1	1	GILL, INDRANI MD	3/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	41654	78	Neoplastic Diseases/Oncology	0	In state provider	None	4000 14TH ST	STE 409	RIVERSIDE	CA	92501	4010	33	06065	33.97771007	-117.3818381	Riverside County
169661	Fee-for-Service	1215293477	1215293477	1	1	GARDNER, JAMES M MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129097	02	General Surgery	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
169669	Fee-for-Service	1164552931	1164552931	1	1	GARDNER FAMILY HLTH NTWK	6/6/2005	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	ALVISO HEALTH CENTER	1621 GOLD ST	None	ALVISO	CA	95002	1240	43	06085	37.42478519	-121.9760557	Santa Clara County
169699	Fee-for-Service	1710418686	1710418686	1	1	GARCIA, RUBI M NP	2/25/2019	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
169701	Fee-for-Service	1255680229	1255680229	1	1	GETTYSBURG MEDICAL CLINIC	12/16/2014	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1359 N FRESNO ST	SUITE B	FRESNO	CA	93703	3837	10	06019	36.76061876	-119.7815093	Fresno County
169724	Fee-for-Service	1841386489	1841386489	1	1	GRZESZKIEWICZ, TATIANA	4/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88967	07	Dermatology	0	In state provider	MD	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
169730	Fee-for-Service	1518462043	1518462043	1	1	GHARIB, SAHIR M MD	1/5/2023	390200000X	NA	Other	026	PHYSICIANS	180884	None	None	0	In state provider	None	12291 WASHINGTON BLVD	SUITE 500	WHITTIER	CA	90606	2500	19	06037	33.96734104	-118.0508773	Los Angeles County
169735	Fee-for-Service	1710122676	1710122676	1	1	GARLAPATI, ANITHA R MD	11/28/2008	282N00000X	NA	Hospitals	026	PHYSICIANS	83701	41	Internal Medicine	0	In state provider	INC	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
169751	Fee-for-Service	1285725812	1285725812	1	1	GUITY, AFRASSIAB MD	2/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	45919	14	Neurological Surgery	0	In state provider	None	2570 GOODWATER AVE	# 300	REDDING	CA	96002	1514	45	06089	40.57101509	-122.323099	Shasta County
169756	Fee-for-Service	1164058251	1164058251	1	1	GOLDMAN, MARNI LCSW	11/19/2021	1041C0700X	NA	Mental Health Outpatient Services	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
169772	Fee-for-Service	1275091423	1275091423	1	1	GEESLIN, ELIZABETH L LMFT	8/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	244 CALIFORNIA	STE 300	SAN FRANCISCO	CA	94111	4302	38	06075	37.79331375	-122.3995607	San Francisco County
169798	Fee-for-Service	1013926393	1013926393	1	1	GROW, ROBERT 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	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
169811	Fee-for-Service	1033308531	1033308531	1	1	GREENE, SKYLER W MD	4/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103292	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
169827	Fee-for-Service	1003828989	1003828989	1	1	GAINOR, JOHN W MD	12/19/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	10093	20	Orthopedic Surgery	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
169836	Fee-for-Service	1427099720	1427099720	1	1	GROSSMONT FAMILY MEDICAL	1/4/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP INC	5525 GROSSMONT CENTER DR	STE 200	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
169839	Fee-for-Service	1588869325	1588869325	1	1	GHOLE, SAIF A MD	10/31/2007	208600000X	NA	General Surgery	026	PHYSICIANS	92081	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
169854	Fee-for-Service	1720624158	1720624158	1	1	GONTARZ, DANIELLE D NP	3/13/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
169865	Fee-for-Service	1295462794	1295462794	1	1	GOOD AND WELL HOMES INC	8/31/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7014 SHIRLEY LN	None	BAKERSFIELD	CA	93307	3250	15	06029	35.34344087	-118.9262881	Kern County
169883	Fee-for-Service	1295285724	1295285724	1	1	GUTIERREZ, KAYLA A	3/22/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL 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
169958	Fee-for-Service	1164552931	1164552931	1	1	GARDNER FAMILY HLTH NTWK	12/14/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	ALVISO HEALTH CENTER	1621 GOLD ST	None	ALVISO	CA	95002	1240	43	06085	37.42478519	-121.9760557	Santa Clara County
169965	Fee-for-Service	1780024034	1780024034	1	1	GOODE, RONALD D LMFT	11/4/2022	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
170055	Fee-for-Service	1801214499	1801214499	1	1	GARCIA, ANDREW J MD	12/29/2020	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	167993	None	None	0	In state provider	None	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
170067	Fee-for-Service	1962618538	1962618538	1	1	GOLDEN ACRES ADULT DAY	11/24/1999	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE CENTER	12041 STRATHERN ST	None	NORTH HOLLYWOOD	CA	91605	1415	19	06037	34.21575506	-118.3955862	Los Angeles County
170102	Fee-for-Service	1225328859	1225328859	1	1	GARCIA, APRIL M LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
170111	Fee-for-Service	1639205347	1639205347	1	1	GOLDHABER-FIEBERT, SARA	10/2/2008	207L00000X	NA	Other	026	PHYSICIANS	104466	05	Anesthesiology	0	In state provider	MD	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
170119	Fee-for-Service	1730778614	1730778614	1	1	GEMELAS, JORDAN MD	2/23/2024	390200000X	NA	Other	026	PHYSICIANS	189221	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
170198	Fee-for-Service	1164489480	1164489480	1	1	GARBER, JASON E 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
170245	Fee-for-Service	1164552931	1164552931	1	1	GARDNER FAMILY HLTH NTWK	5/1/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALVISO HEALTH CENTER	1621 GOLD ST	None	ALVISO	CA	95002	1240	43	06085	37.42478519	-121.9760557	Santa Clara County
170309	Fee-for-Service	1427254937	1427254937	1	1	GONDA, DAVID D MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	107984	14	Neurological Surgery	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
170420	Fee-for-Service	1962803148	1962803148	1	1	GUTMAN, VIRGINIA S LCSW	5/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
170428	Fee-for-Service	1891377941	1891377941	1	1	GORDON, ELIZABETH LPCC	4/23/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
170429	Fee-for-Service	1912433202	1912433202	1	1	GILL, EKJYOT S MD	11/16/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	171592	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
170430	Fee-for-Service	1639112873	1639112873	1	1	GILL, NAVDEEP S	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67185	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
170464	Fee-for-Service	1134407844	1134407844	1	1	GUNDA, SATEESH K MD	3/17/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	149946	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
170492	Fee-for-Service	1841422599	1841422599	1	1	GODZICH, MICAELA C MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109054	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
170509	Fee-for-Service	1003301417	1003301417	1	1	GREEN, SALMA M DO	8/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19314	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
170536	Fee-for-Service	1164552931	1164552931	1	1	GARDNER FAMILY HLTH NTWK	5/1/2004	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALVISO HEALTH CENTER	1621 GOLD ST	None	ALVISO	CA	95002	1240	43	06085	37.42478519	-121.9760557	Santa Clara County
170562	Fee-for-Service	1710005707	1710005707	1	1	GALLENO, HUMBERTO A M D INC	10/26/2016	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	315 N 3RD AVE	STE 302	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
170563	Fee-for-Service	1245760776	1245760776	1	1	GRUN, NICOLA OT	1/6/2020	225XP0019X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
170570	Fee-for-Service	1144242645	1144242645	2	1	GORDON, RICHARD K MD	6/13/2011	174400000X	NA	Other	026	PHYSICIANS	56286	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 RESEDA BLVD	STE 204	NORTHRIDGE	CA	91324	4041	19	06037	34.229988	-118.536062	Los Angeles County
170574	Fee-for-Service	1790817351	1790817351	1	1	GUERRERO, JULIO C LMFT	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3333 SKY PARK DR	STE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
170591	Fee-for-Service	1043232820	1043232820	2	1	GARFIELD BEACH CVS LLC	6/9/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	950 E 33RD ST	None	SIGNAL HILL	CA	90755	5114	19	06037	33.81704848	-118.181493	Los Angeles County
170600	Fee-for-Service	1225038136	1225038136	1	1	GOLETA VALLEY COTTAGE	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSP	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
170613	Fee-for-Service	1225250046	1225250046	1	1	GUERRERO, GINA LMFT	10/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
170617	Fee-for-Service	1427420009	1427420009	1	1	GOLDSTAR PEDIATRICS PC	3/15/2016	261QP2300X	NA	Other	026	PHYSICIANS	118539	40	Pediatrics	0	In state provider	None	15290 SUMMIT AVE	STE B	FONTANA	CA	92336	0240	36	06071	34.1505303	-117.4711258	San Bernardino County
170618	Fee-for-Service	1336535475	1336535475	1	1	GOSAL, DARSHDEEP K DO	9/16/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15723	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
170624	Fee-for-Service	1154634251	1154634251	1	2	GARCIA, EDWIN MD	10/18/2023	208600000X	NA	General Surgery	026	PHYSICIANS	112577	None	None	0	In state provider	None	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	4108	19	06037	34.20369349	-118.629837	Los Angeles County
170632	Fee-for-Service	1376564401	1376564401	1	1	GHADISHAH, IRAJ MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50282	08	Family Practice	0	In state provider	None	9808 VENICE BLVD	STE 710	CULVER CITY	CA	90232	6829	19	06037	34.0236396	-118.3980847	Los Angeles County
170650	Fee-for-Service	1386774883	1386774883	2	1	GLENDALE HOME HEALTHCARE INC	2/3/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 VICTORY BLVD	STE 604	VAN NUYS	CA	91411	1620	19	06037	34.18668846	-118.450152	Los Angeles County
170677	Fee-for-Service	1871960534	1871960534	1	1	GAGLIANO, ERIN 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
170682	Fee-for-Service	1922453174	1922453174	1	1	GOODNOUGH, CANDIDA L MD	9/16/2020	207L00000X	NA	Other	026	PHYSICIANS	151705	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
170684	Fee-for-Service	1508881459	1508881459	1	1	GAULTER, CONSTANCE E MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	55765	08	Family Practice	0	In state provider	None	700 ZION ST	None	NEVADA CITY	CA	95959	2921	29	06057	39.25501228	-121.0253266	Nevada County
170697	Fee-for-Service	1881617058	1881617058	1	1	GUY, GEORGINA PHD	11/21/2007	103T00000X	NA	Mental Health Outpatient Services	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
170736	Fee-for-Service	1750630679	1750630679	1	1	GALLAGHER, LISA 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
170744	Fee-for-Service	1215097043	1215097043	1	1	GUPTA, ARUN MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72893	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
170770	Fee-for-Service	1366859449	1366859449	1	8	GOLDEN STATE PROVIDERS, A ME	1/14/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	7300 MEDICAL CENTER DRIV	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
170803	Fee-for-Service	1073605572	1073605572	1	1	GOLDWASSER, RICHARD A MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68426	36	Psychiatry	0	In state provider	None	655 REDWOOD HWY	STE 261	MILL VALLEY	CA	94941	3011	21	06041	37.8918372	-122.5169699	Marin County
170861	Fee-for-Service	1265080964	1265080964	1	1	GASPER, MICHELLE LMFT	12/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4091 RIVERSIDE DRIVE	103	CHINO	CA	91710	9135	36	06071	34.01888049	-117.715779	San Bernardino County
170882	Fee-for-Service	1285838359	1285838359	1	1	GILL, AMANDEEP S MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116016	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
170887	Fee-for-Service	1225038136	1225038136	1	1	GOLETA VALLEY COTTAGE	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSP	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
170905	Fee-for-Service	1346472552	1346472552	1	1	GALAVIS, JULIE M NP	5/31/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	515 MICHELTORENA ST	C	SANTA BARBARA	CA	93103	2257	42	06083	34.43172339	-119.7024817	Santa Barbara County
170917	Fee-for-Service	1376564401	1376564401	1	1	GHADISHAH, IRAJ MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50282	02	General Surgery	0	In state provider	None	9808 VENICE BLVD	STE 710	CULVER CITY	CA	90232	6829	19	06037	34.0236396	-118.3980847	Los Angeles County
170997	Fee-for-Service	1972596963	1972596963	1	1	GUERRERO, VICTOR M MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	50302	01	General Practice	0	In state provider	None	1145 E CLARK AVE	STE C	SANTA MARIA	CA	93455	5151	42	06083	34.8650893	-120.4170345	Santa Barbara County
171061	Fee-for-Service	1548426315	1548426315	1	1	GUST, MADELEINE J MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134417	24	Plastic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
171062	Fee-for-Service	1992060974	1992060974	1	1	GLENN, TARA J MD	7/1/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	170207	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
171064	Fee-for-Service	1144486390	1144486390	1	1	GORNEY, ROBERT R MD	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114118	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
171101	Fee-for-Service	1932120334	1932120334	1	1	GRAY, RICHARD N MD	4/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41884	None	None	0	In state provider	None	7601 HOSPITAL DR	SUITE 103	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
171149	Fee-for-Service	1093909624	1093909624	1	1	GREGORIAN, ARMEN MD	5/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	97331	02	General Surgery	0	In state provider	None	12462 E PUTNAM AVENUE	STE 303	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
171191	Fee-for-Service	1588084586	1588084586	1	1	GENOVA, JENNIFER L MD	6/15/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	148621	29	Pulmonary Diseases (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
171208	Fee-for-Service	1588607394	1588607394	1	1	GRECO, JOSEPH F MD	6/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95431	07	Dermatology	0	In state provider	None	200 UCLA MEDICAL PLZ	BLDG 465	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
171226	Fee-for-Service	1194809160	1194809160	1	1	GALBRAITH, ROBERT MD	8/22/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63791	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
171261	Fee-for-Service	1114959335	1114959335	1	1	GORDON, GREGORY J MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	1998	00	None	41.46242416	-81.69888235	Cuyahoga County
171295	Fee-for-Service	1669563391	1669563391	1	1	GANJOO, KRISTEN N MD	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85404	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
171314	Fee-for-Service	1336297209	1336297209	1	1	GAMBOA, JUAN G MD	9/1/1998	207R00000X	NA	Other	026	PHYSICIANS	61925	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
171337	Fee-for-Service	1558315556	1558315556	1	1	GONICK, GEOFFREY J MD	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	79480	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
171339	Fee-for-Service	1437399748	1437399748	1	1	GARRETT, MICHAEL J LMFT	7/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2525 CAMINO DEL RIO S ST	313	SAN DIEGO	CA	92108	3784	37	06073	32.76765181	-117.1387992	San Diego County
171401	Fee-for-Service	1225563026	1225563026	1	1	GANESH, KEVIN	2/21/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	169955	None	None	0	In state provider	None	15982 TUSCOLA RD	B	APPLE VALLEY	CA	92307	2111	36	06071	34.54161767	-117.2692848	San Bernardino County
171469	Fee-for-Service	1548282338	1548282338	2	1	GARFIELD BEACH CVS LLC	10/18/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 W IMPERIAL HWY	None	LA HABRA	CA	90631	6901	30	06059	33.91729553	-117.9574695	Orange County
171484	Fee-for-Service	1104837129	1104837129	1	1	GALLUS, KATERINA M MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	67126	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
171504	Fee-for-Service	1851754543	1851754543	1	1	GENG, YIPENG MD	8/4/2021	207ZP0102X	NA	Other	026	PHYSICIANS	163072	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
171513	Fee-for-Service	1194809160	1194809160	1	1	GALBRAITH, ROBERT MD	8/22/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63791	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
171525	Fee-for-Service	1750617015	1750617015	1	1	GOOD, GREGORY M LMFT	5/31/2023	101YM0800X	NA	Other	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
171546	Fee-for-Service	1639824659	1639824659	1	1	GOPEZ, ALEXANDER PT	3/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
171569	Fee-for-Service	1164406377	1164406377	1	1	GREEN, GLYNISS C PT	3/21/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23110 ATLANTIC CIR STE D	None	MORENO VALLEY	CA	92553	5920	33	06065	33.93308206	-117.2597707	Riverside County
171583	Fee-for-Service	1669563391	1669563391	1	1	GANJOO, KRISTEN N MD	2/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85404	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
171594	Fee-for-Service	1962570424	1962570424	1	1	GOMEZ-GARCIA, MIGUEL A LCSW	9/14/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
171612	Fee-for-Service	1386912806	1386912806	1	1	GIRION, ROGER L PHD	2/12/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1652 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1602957	Los Angeles County
171631	Fee-for-Service	1306095898	1306095898	1	1	GUPTA, ANUMEHA MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111639	41	Internal Medicine	0	In state provider	None	4311 THIRD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
171633	Fee-for-Service	1124657101	1124657101	1	1	GALVAN, JAVIER L MD	4/21/2023	390200000X	NA	Other	026	PHYSICIANS	176853	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
171635	Fee-for-Service	1801423470	1801423470	1	1	GUPTA, ARNAV A MD	11/13/2023	207P00000X	NA	Other	026	PHYSICIANS	188955	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
171739	Fee-for-Service	1265692818	1265692818	1	1	GARNETT, GWENDOLYN M MD	7/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117885	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
171779	Fee-for-Service	1801321682	1801321682	1	1	GUSTAFSSON, BO M MD	12/1/2021	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
171791	Fee-for-Service	1720021173	1720021173	1	1	GERTZ, MICHAEL A MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67874	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
171796	Fee-for-Service	1154325512	1154325512	1	1	GHC OF MODESTO, LLC	11/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2633 W RUMBLE RD	None	MODESTO	CA	95350	0154	50	06099	37.6822661	-121.0435185	Stanislaus County
171839	Fee-for-Service	1275729329	1275729329	1	1	GAERLAN-FINCH, VINESSA NP	9/7/2023	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
171923	Fee-for-Service	1154376010	1154376010	1	1	GUNAY, PERI O MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65685	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
171948	Fee-for-Service	1821401159	1821401159	1	1	GAILLIOT, BRITAIN MD	1/26/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175559	None	None	0	In state provider	None	1524 MCHENRY AVE	STE 100	MODESTO	CA	95350	4566	50	06099	37.666233	-120.993933	Stanislaus County
171959	Fee-for-Service	1174600019	1174600019	1	1	GERRINGSON, JANETTA MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69213	36	Psychiatry	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
171981	Fee-for-Service	1982047494	1982047494	1	1	GERKA STUYT, JOHN A MD	4/23/2020	363AS0400X	NA	Physician Assistant	026	PHYSICIANS	163283	84	Surgery-Head and Neck	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
171997	Fee-for-Service	1770162570	1770162570	1	1	GAERLAN, STEPHANIE R MD	9/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	75 ROWLAND WAY	SUITE 200	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
172012	Fee-for-Service	1780762658	1780762658	1	1	GHARADJEDAGHI, EHSAN PSYD	1/9/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1533 EAST 4TH STREET	None	SANTA ANA	CA	92701	5115	30	06059	33.74814149	-117.848421	Orange County
172097	Fee-for-Service	1538749155	1538749155	1	1	GOWDAR, AKSHATHA K MD	12/30/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
172147	Fee-for-Service	1700821600	1700821600	1	1	GARFIELD BEACH CVS, LLC	1/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4535 HOLT BLVD	None	MONTCLAIR	CA	91763	4710	36	06071	34.06309145	-117.7064063	San Bernardino County
172176	Fee-for-Service	1073638680	1073638680	1	1	GRANT, COLETTE L MD	4/30/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65865	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
172244	Fee-for-Service	1578509634	1578509634	1	1	GARFIELD BEACH CVS LLC	1/25/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25272 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	2901	30	06059	33.59591616	-117.6586221	Orange County
172254	Fee-for-Service	1144710559	1144710559	1	1	G & A CANTILLER, INC	7/8/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8006 BUCKS HARBOR WAY	None	SACRAMENTO	CA	95828	5435	34	06067	38.467062	-121.387509	Sacramento County
172268	Fee-for-Service	1912942814	1912942814	1	1	GARFIELD BEACH CVS LLC	10/12/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12358 POWAY RD	None	POWAY	CA	92064	4219	37	06073	32.9519463	-117.0635682	San Diego County
172278	Fee-for-Service	1558523654	1558523654	1	1	GUZMAN, DINORA PHD	5/17/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
172288	Fee-for-Service	1952716185	1952716185	1	1	GILL, MANROOP MD	10/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	172109	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
172312	Fee-for-Service	1558306456	1558306456	1	1	GARFIELD BEACH CVS, LLC	11/7/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2825 COCHRAN	None	SIMI VALLEY	CA	93065	2775	56	06111	34.27903453	-118.741095	Ventura County
172364	Fee-for-Service	1407224512	1407224512	1	1	GOTTUSO, ANN Y PHD	11/16/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
172369	Fee-for-Service	1497778773	1497778773	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1280 AUTO PARK WAY	None	ESCONDIDO	CA	92029	2231	37	06073	33.11240365	-117.1002108	San Diego County
172373	Fee-for-Service	1174775670	1174775670	1	1	GRUBBS, BRENDAN H MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99421	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1300 N VERMONT AVE	SUIT 302	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
172381	Fee-for-Service	1811901580	1811901580	1	1	GUPTA, LEENA K MD	6/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98907	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
172387	Fee-for-Service	1376799015	1376799015	1	1	GARLAPATI, BADRI N MD	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
172398	Fee-for-Service	1578900627	1578900627	1	1	GADE LLC	7/8/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	129 N MCKINLEY ST	STE 102	CORONA	CA	92879	6593	33	06065	33.88332497	-117.5153721	Riverside County
172460	Fee-for-Service	1467517557	1467517557	1	1	GONZALEZ-DIAZ, JOSE M MD	9/1/1999	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	20440 SHERMAN WAY	None	CANOGA PARK	CA	91306	3110	19	06037	34.20098249	-118.578753	Los Angeles County
172591	Fee-for-Service	1043445950	1043445950	1	1	GUPTA, DEEPAK MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114745	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
172598	Fee-for-Service	1639721822	1639721822	1	1	GUPTA, MANISHA CNP	11/25/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172657	Fee-for-Service	1699261057	1699261057	1	1	GROSS, CRYSTAL PT	2/25/2019	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
172669	Fee-for-Service	1104836238	1104836238	1	1	GUPTA, ROHIT MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142996	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
172671	Fee-for-Service	1184049793	1184049793	1	1	GREATER FRESNO HEALTH	7/1/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ORGANIZATION INC	4011 N MARKS AVENUE	None	FRESNO	CA	93722	4555	10	06019	36.794691	-119.8443365	Fresno County
172702	Fee-for-Service	1669807475	1669807475	1	1	GRAZIANO, SABRINA P OD	3/12/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5603 AUBURN ST	STE A	BAKERSFIELD	CA	93306	2979	15	06029	35.39788376	-118.9313961	Kern County
172725	Fee-for-Service	1013015569	1013015569	1	1	GUPTA, NAVEEN MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81440	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
172737	Fee-for-Service	1811086945	1811086945	1	1	GOLDEN, CARLA MD	3/1/1999	2080P0207X	NA	Hematology	026	PHYSICIANS	78640	68	Hematology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
172757	Fee-for-Service	1912167883	1912167883	1	1	GREEN-HOPKINS, ISAREL MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138343	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
172781	Fee-for-Service	1386167625	1386167625	1	1	GARFIELD BEACH CVS LLC	3/1/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 19TH AVE	None	SAN FRANCISCO	CA	94116	1250	38	06075	37.75211157	-122.4762664	San Francisco County
172783	Fee-for-Service	1639153786	1639153786	2	1	GROSS, ELLIOTT L MD	1/9/2011	174400000X	NA	Other	026	PHYSICIANS	28678	20	Orthopedic Surgery	0	In state provider	None	3831 HUGHES AVE	STE 506	CULVER CITY	CA	90232	6860	19	06037	34.02243278	-118.3981492	Los Angeles County
172787	Fee-for-Service	1619253697	1619253697	1	1	GUPTA, SERENA LMFT	2/25/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
172852	Fee-for-Service	1275064602	1275064602	1	1	GUPTA, VISHAL K MD	9/5/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	172642	68	Hematology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
172944	Fee-for-Service	1124049234	1124049234	1	1	GHADIA, ASHOKKUMAR R MD	4/14/2005	207R00000X	NA	Other	026	PHYSICIANS	88208	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
172958	Fee-for-Service	1184049793	1184049793	1	1	GREATER FRESNO HEALTH	7/1/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ORGANIZATION INC	4011 N MARKS AVENUE	None	FRESNO	CA	93722	4555	10	06019	36.794691	-119.8443365	Fresno County
172991	Fee-for-Service	1548786403	1548786403	1	1	GUDINO-GUTIERREZ, KAREN LCS	2/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
173023	Fee-for-Service	1811086945	1811086945	1	1	GOLDEN, CARLA MD	3/1/1999	2080P0207X	NA	Hematology	026	PHYSICIANS	78640	78	Neoplastic Diseases/Oncology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
173030	Fee-for-Service	1215973375	1215973375	1	1	GARFIELD BEACH CVS, LLC	12/12/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	22050 VENTURA BLVD	None	WOODLAND HILLS	CA	91364	1645	19	06037	34.1685257	-118.6075707	Los Angeles County
173045	Fee-for-Service	1912167883	1912167883	1	1	GREEN-HOPKINS, ISAREL MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138343	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173051	Fee-for-Service	1902520950	1902520950	1	1	GARFIELD BEACH CVS, L.L.C.	7/25/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1212 SOUTH FLOWER STREET	SUITE #100	LOS ANGELES	CA	90015	2123	19	06037	34.04123225	-118.2657303	Los Angeles County
173067	Fee-for-Service	1154750867	1154750867	1	1	GRACE COMMUNITY HOME HEALTH	7/14/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	229 POLARIS AVENUE	SUITE 5	MOUNTAIN VIEW	CA	94043	4579	43	06085	37.39855001	-122.0839612	Santa Clara County
173074	Fee-for-Service	1184736597	1184736597	1	1	GUZMAN, DANIEL D. MD	11/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVENUE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
173091	Fee-for-Service	1538234026	1538234026	1	1	GO, RANDALL OD	10/1/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2458 MISSION ST	None	SAN FRANCISCO	CA	94110	2415	38	06075	37.75766352	-122.4189992	San Francisco County
173092	Fee-for-Service	1033405030	1033405030	1	1	GRUBIC, JOSEPH D MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135581	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
173139	Fee-for-Service	1275064602	1275064602	1	1	GUPTA, VISHAL K MD	9/5/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	172642	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
173173	Fee-for-Service	1952614554	1952614554	1	1	GOMEZ, GABRIEL A MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112517	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
173181	Fee-for-Service	1689278517	1689278517	1	1	GARCIA, VANESSA R CNM	2/2/2021	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1665 ESPLANADE	None	CHICO	CA	95926	3312	04	06007	39.74388808	-121.8503372	Butte County
173189	Fee-for-Service	1114389111	1114389111	1	1	GREENE, KEVIN MD	10/17/2023	207P00000X	NA	Other	026	PHYSICIANS	185169	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
173210	Fee-for-Service	1073944088	1073944088	1	1	GENDRON, GERALYN C	3/28/2022	101YM0800X	NA	Other	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
173212	Fee-for-Service	1265529176	1265529176	1	1	GONZALEZ, SYLVIA E MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	62301	40	Pediatrics	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
173231	Fee-for-Service	1295795706	1295795706	1	1	GREENWOOD,LES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1120	00	None	41.091012	-111.995523	Davis County
173301	Fee-for-Service	1750461802	1750461802	2	1	GARGUS, JOHN J MD	10/23/2018	207SG0201X	NA	Other	026	PHYSICIANS	76579	01	General Practice	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
173346	Fee-for-Service	1306857701	1306857701	1	1	GUTIERREZ, AIREEN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77031	41	Internal Medicine	0	In state provider	None	9619 CHESAPEAKE DR	STE 102	SAN DIEGO	CA	92123	1373	37	06073	32.83359409	-117.1237093	San Diego County
173352	Fee-for-Service	1225129166	1225129166	1	1	GOLD, JEFFREY I PHD	10/15/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	36	Psychiatry	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
173360	Fee-for-Service	1003051145	1003051145	1	1	GARFIELD BEACH CVS LLC	5/17/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2175 E BARDSLEY AVE	None	TULARE	CA	93274	6145	54	06107	36.19667049	-119.3142105	Tulare County
173371	Fee-for-Service	1811398969	1811398969	1	1	GARCIA, MERLIENAIDA L NP	5/25/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
173403	Fee-for-Service	1730171265	1730171265	1	1	GARFIELD MEDICAL CENTER	11/1/2004	273Y00000X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1205	19	06037	34.06794352	-118.1229278	Los Angeles County
173410	Fee-for-Service	1003350646	1003350646	1	1	GHANSHANI, SERENA MD	9/28/2021	207R00000X	NA	Other	026	PHYSICIANS	165715	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
173491	Fee-for-Service	1063730612	1063730612	1	1	GRIESHOBER, JASON A MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136421	20	Orthopedic Surgery	0	In state provider	None	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4045	30	06059	33.714	-117.9333585	Orange County
173502	Fee-for-Service	1841484565	1841484565	1	1	GUERRERO, ALEX PSYD	6/14/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
173526	Fee-for-Service	1992818041	1992818041	1	1	GRAHAM, BENJAMIN MD	7/21/1994	207R00000X	NA	Other	026	PHYSICIANS	35252	41	Internal Medicine	0	In state provider	None	895 SEQUOIA CIR	None	FORT BRAGG	CA	95437	5422	23	06045	39.4300159	-123.8024883	Mendocino County
173555	Fee-for-Service	1548435977	1548435977	1	1	GRAVES, BENJAMIN R MD	11/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115463	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
173634	Fee-for-Service	1306857701	1306857701	1	1	GUTIERREZ, AIREEN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77031	38	Geriatrics	0	In state provider	None	9619 CHESAPEAKE DR	STE 102	SAN DIEGO	CA	92123	1373	37	06073	32.83359409	-117.1237093	San Diego County
173672	Fee-for-Service	1487883146	1487883146	1	1	GROMIS, DANIEL M MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120000	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 WEST STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
173677	Fee-for-Service	1730193756	1730193756	1	1	GRAHAM,SUSAN 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	3033 SOUTH PARKER RD	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
173679	Fee-for-Service	1144619099	1144619099	1	1	GEORGE GEMY	9/6/2017	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
173687	Fee-for-Service	1437109253	1437109253	1	1	GNADINGER, CHRISTOPER MD	9/23/2007	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
173690	Fee-for-Service	1730171265	1730171265	1	1	GARFIELD MEDICAL CENTER	11/1/2004	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1205	19	06037	34.06794352	-118.1229278	Los Angeles County
173691	Fee-for-Service	1063575074	1063575074	1	1	GARVIN, RENEE M	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
173696	Fee-for-Service	1093961047	1093961047	1	1	GEE, RICHARD S	11/15/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
173782	Fee-for-Service	1891029328	1891029328	1	1	GODWIN, PATRICK W 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
173817	Fee-for-Service	1922390533	1922390533	1	2	GRANT, TIFFANI PSYD	10/16/2024	103TF0200X	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
173949	Fee-for-Service	1376613497	1376613497	1	1	GUPTA, VANDANA MD	7/23/2024	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
173995	Fee-for-Service	1255504627	1255504627	1	1	GONZALES, JAMES J MD	9/14/2021	208600000X	NA	General Surgery	026	PHYSICIANS	75715	None	None	0	In state provider	None	100 MISSION BLVD	116B	JACKSON	CA	95642	2536	03	06005	38.35163001	-120.7670107	Amador County
173996	Fee-for-Service	1417045600	1417045600	1	1	GHOSH, TANYA MD	4/3/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65383	18	Ophthalmology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
173999	Fee-for-Service	1568858892	1568858892	1	1	GAL, DANA MD	9/28/2022	390200000X	NA	Other	026	PHYSICIANS	149662	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
174004	Fee-for-Service	1043314727	1043314727	1	1	GARFIELD BEACH CVS LLC	7/9/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15232 SHERMAN WAY	None	VAN NUYS	CA	91405	2022	19	06037	34.20109655	-118.4653485	Los Angeles County
174024	Fee-for-Service	1578595211	1578595211	1	1	GALLENTINE, WILLIAM B DO	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16479	79	Neurology-Child	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
174025	Fee-for-Service	1851130751	1851130751	1	1	GUELI, ALEXANDRA CRNA	6/4/2024	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
174051	Fee-for-Service	1225458839	1225458839	1	1	GALLOWAY, NICHOLAS MD	5/16/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161128	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
174065	Fee-for-Service	1871555334	1871555334	1	1	GUTHRIE, TODD B MD	4/20/2007	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	635 LASSEN LN	None	MOUNT SHASTA	CA	96067	9003	47	06093	41.31928889	-122.3275083	Siskiyou County
174079	Fee-for-Service	1316967805	1316967805	3	1	GOMER, PERIN MD	1/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	61192	13	Neurology (M.D. only)	0	In state provider	None	1881 COMMERCENTER EAST	SUITE 208	SAN BERNARDINO	CA	92408	3443	36	06071	34.06770327	-117.2822565	San Bernardino County
174082	Fee-for-Service	1629153515	1629153515	1	1	GUTIERREZ, GUILLERMINA MD	1/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	76597	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
174121	Fee-for-Service	1295991685	1295991685	1	1	GOSSAIN, AMIT K MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121734	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
174125	Fee-for-Service	1649377813	1649377813	1	1	GARG, DEEPANSHU MD	8/6/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1325 N LITCHFIELD RD	110	GOODYEAR	AZ	85395	1228	00	None	33.461118	-112.355739	Maricopa County
174179	Fee-for-Service	1689083578	1689083578	1	1	GRAY, JILL LMFT	11/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 AVENUE I	204	REDONDO BEACH	CA	90277	3701	19	06037	33.81905278	-118.3864232	Los Angeles County
174201	Fee-for-Service	1164453353	1164453353	1	1	GARCIA, JOHN E MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	57975	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PLAZA DR	None	SANTA MARIA	CA	93454	6907	42	06083	34.93736276	-120.4298781	Santa Barbara County
174244	Fee-for-Service	1174660450	1174660450	1	1	GRAY, KELSEY MD	5/31/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	119933	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
174276	Fee-for-Service	1053601047	1053601047	1	1	GILL, PARAMJIT K MD INC	12/10/2012	2084P0800X	NA	Psychiatry	026	PHYSICIANS	49224	None	None	0	In state provider	None	1805 N CALIFORNIA ST	STE 202	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
174283	Fee-for-Service	1356877609	1356877609	1	1	GRANADA POST ACUTE LP	3/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3565 E IMPERIAL HWY	None	LYNWOOD	CA	90262	5261	19	06037	33.93054462	-118.2064422	Los Angeles County
174284	Fee-for-Service	1417045600	1417045600	1	1	GHOSH, TANYA MD	4/3/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	65383	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
174296	Fee-for-Service	1114339942	1114339942	1	1	GADALETA, DOMINICK J MD	4/6/2021	207YS0123X	NA	ENT/Otolaryngology	026	PHYSICIANS	169091	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
174342	Fee-for-Service	1053723742	1053723742	1	1	GREWAL, RAJPREET S MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155976	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
174355	Fee-for-Service	1871555334	1871555334	1	1	GUTHRIE, TODD B MD	2/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60880	20	Orthopedic Surgery	0	In state provider	None	635 LASSEN LN	None	MOUNT SHASTA	CA	96067	9003	47	06093	41.31928889	-122.3275083	Siskiyou County
174363	Fee-for-Service	1215497490	1215497490	1	1	GARCIA, VIRIDIANA MD	6/8/2022	208M00000X	NA	Other	026	PHYSICIANS	177072	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
174403	Fee-for-Service	1881759421	1881759421	1	1	GRIMES, KEVIN V MD	10/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	51537	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	# A333	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
174413	Fee-for-Service	1356521389	1356521389	1	1	GERMAIN, RASHA S MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131813	14	Neurological Surgery	0	In state provider	None	525 DOYLE PARK DR	STE 102	SANTA ROSA	CA	95405	4562	49	06097	38.442636	-122.69889	Sonoma County
174463	Fee-for-Service	1154342343	1154342343	1	1	GELFAND, ELENA V MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66287	41	Internal Medicine	0	In state provider	None	300 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	6507	34	06067	38.570796	-121.415409	Sacramento County
174489	Fee-for-Service	1164453353	1164453353	1	1	GARCIA, JOHN E MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	57975	08	Family Practice	0	In state provider	None	505 PLAZA DR	None	SANTA MARIA	CA	93454	6907	42	06083	34.93736276	-120.4298781	Santa Barbara County
174522	Fee-for-Service	1649779919	1649779919	1	5	GREEN PHYSICAL THERAPY, INC.	1/14/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	277 RANCHEROS DR	150	SAN MARCOS	CA	92069	2976	37	06073	33.13859391	-117.1604009	San Diego County
174523	Fee-for-Service	1285745539	1285745539	1	1	GLASER, ARTHUR H MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31085	08	Family Practice	0	In state provider	None	3585 CLAYTON RD	None	CONCORD	CA	94519	2423	07	06013	37.97007651	-122.0093067	Contra Costa County
174532	Fee-for-Service	1174660450	1174660450	1	1	GRAY, KELSEY MD	5/31/2012	207RP1001X	NA	Pulmonology	026	PHYSICIANS	119933	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
174556	Fee-for-Service	1992268395	1992268395	1	1	GALLO, ROBERT J MD	10/26/2022	208M00000X	NA	Other	026	PHYSICIANS	177143	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
174617	Fee-for-Service	1023325289	1023325289	1	1	GRECO, NICHOLAS W MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113953	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
174639	Fee-for-Service	1033213087	1033213087	2	1	GOOD PRICE CORPORATION	12/13/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6000 N FIGUEROA ST	SUITE 102	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
174710	Fee-for-Service	1346727716	1346727716	1	1	GARCIA ANTUNEZ, WENDY LCSW	9/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
174711	Fee-for-Service	1730329210	1730329210	1	1	GAMINO, RENA M	8/16/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
174750	Fee-for-Service	1154342343	1154342343	1	1	GELFAND, ELENA V MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66287	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 UNIVERSITY AVE	STE 100	SACRAMENTO	CA	95825	6507	34	06067	38.570796	-121.415409	Sacramento County
174761	Fee-for-Service	1558411322	1558411322	1	2	GOGNA, HARJIT MD	3/8/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1130 COFFEE RD	3B	MODESTO	CA	95355	4228	50	06099	37.65884948	-120.9755938	Stanislaus County
174775	Fee-for-Service	1790053528	1790053528	1	1	GOMEZ, RICARDO M MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134736	41	Internal Medicine	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
174811	Fee-for-Service	1285745539	1285745539	1	1	GLASER, ARTHUR H MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31085	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3585 CLAYTON RD	None	CONCORD	CA	94519	2423	07	06013	37.97007651	-122.0093067	Contra Costa County
174827	Fee-for-Service	1295242410	1295242410	1	1	GUINEY, DYLAN T NP	9/12/2018	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
174933	Fee-for-Service	1083636872	1083636872	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26932 LA PAZ RD	None	ALISO VIEJO	CA	92656	3038	30	06059	33.5714689	-117.7073963	Orange County
174962	Fee-for-Service	1417534009	1417534009	1	1	GLICK, SAMUEL O MD	4/23/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
174969	Fee-for-Service	1750733176	1750733176	1	1	GARABEDYAN, TIGRAN DO INC	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11397	None	None	0	In state provider	None	13711 FOOTHILL BLVD	STE B	SYLMAR	CA	91342	3138	19	06037	34.30897303	-118.4322303	Los Angeles County
175020	Fee-for-Service	1700984291	1700984291	1	1	GARFIELD BEACH CVS LLC	11/23/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15333 CULVER DR	STE 300	IRVINE	CA	92604	3051	30	06059	33.69534179	-117.7972555	Orange County
175036	Fee-for-Service	1487951869	1487951869	1	1	GUILLEN, MARCO LMFT	7/5/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
175045	Fee-for-Service	1952585838	1952585838	1	1	GUPTA, INDU MD	12/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54706	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
175055	Fee-for-Service	1447842554	1447842554	1	1	GRAY, NATALIE A LMFT	2/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1317 OAKDALE ROAD	SUITE 100	MODESTO	CA	95355	3362	50	06099	37.662489	-120.957588	Stanislaus County
175134	Fee-for-Service	1548294267	1548294267	1	1	GARCIA, FRANCISCO MD	5/27/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68226	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
175139	Fee-for-Service	1164599973	1164599973	1	1	GHODSIZADEH, NIOOSHA MD	2/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76928	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
175141	Fee-for-Service	1992937031	1992937031	1	1	GARFIELD BEACH CVS LLC	9/15/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6500 S UNION AVE	None	BAKERSFIELD	CA	93307	5707	15	06029	35.295174	-119.0029835	Kern County
175157	Fee-for-Service	1659885325	1659885325	1	1	GOLDEN SPRINGS SURGICAL CENT	1/28/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ER	67555 E PALM CANYON DR	117,118	CATHEDRAL CITY	CA	92234	5467	33	06065	33.78899689	-116.4834161	Riverside County
175167	Fee-for-Service	1952357782	1952357782	1	1	GIBBS, GARY N MD	9/6/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	42132	05	Anesthesiology	0	In state provider	None	792 W TOWN AND COUNTRY R	None	ORANGE	CA	92868	4710	30	06059	33.77649954	-117.860409	Orange County
175210	Fee-for-Service	1053352963	1053352963	2	1	GARFIELD BEACH CVS, LLC	1/27/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1550 PUENTE AVE.	None	BALDWIN PARK	CA	91706	5923	19	06037	34.06387504	-117.9686283	Los Angeles County
175211	Fee-for-Service	1952311367	1952311367	1	1	GAYMON, ALFRED C MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87813	10	Gastroenterology (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
175231	Fee-for-Service	1740623420	1740623420	1	1	GREENBERG, MEGAN NP	12/18/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITE 370	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
175255	Fee-for-Service	1184762346	1184762346	1	1	GORDON, SHEENA M MD	10/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	82330	40	Pediatrics	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
175305	Fee-for-Service	1952357741	1952357741	1	1	GERACI, THOMAS A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	5373	41	Internal Medicine	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
175309	Fee-for-Service	1104841212	1104841212	1	1	GUITERREZ, ROLANDO MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93879	08	Family Practice	0	In state provider	None	501 N ORANGE AVENUE	STE 200	GLENDALE	CA	91203	1911	19	06037	34.15323119	-118.2565389	Los Angeles County
175318	Fee-for-Service	1821409145	1821409145	1	1	GEORGE, ELIZABETH MD	6/2/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160424	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
175345	Fee-for-Service	1407350622	1407350622	1	1	GARBUTT, ASHTON M MD	2/9/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165899	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
175386	Fee-for-Service	1588608830	1588608830	1	1	GARFIELD BEACH CVS, LLC	12/12/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5501 BALL ROAD	None	CYPRESS	CA	90630	3856	30	06059	33.8170995	-118.035882	Orange County
175404	Fee-for-Service	1922083773	1922083773	1	1	GALLETTA, JOSEPH A	6/27/2013	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
175419	Fee-for-Service	1548294267	1548294267	1	1	GARCIA, FRANCISCO MD	5/27/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68226	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7248 S LAND PARK DR	STE 205	SACRAMENTO	CA	95831	3661	34	06067	38.494602	-121.513743	Sacramento County
175424	Fee-for-Service	1972613032	1972613032	2	1	GARCIA, FRANCISCO J MD	8/30/2022	2080P0204X	NA	Other	026	PHYSICIANS	62774	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
175456	Fee-for-Service	1366859449	1366859449	1	10	GOLDEN STATE PROVIDERS, A ME	1/14/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
175506	Fee-for-Service	1457385924	1457385924	1	1	GOODWIN, MEREDITH A MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	64592	01	General Practice	0	In state provider	None	4700 NORTHGATE BLVD	STE 100	SACRAMENTO	CA	95834	1128	34	06067	38.654262	-121.4770455	Sacramento County
175530	Fee-for-Service	1801056536	1801056536	1	1	GIGLIA, LAUREN B MD DO	11/23/2017	207P00000X	NA	Other	026	PHYSICIANS	15410	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4304	37	06073	32.63282707	-117.0829101	San Diego County
175594	Fee-for-Service	1952357741	1952357741	1	1	GERACI, THOMAS A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	5373	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
175605	Fee-for-Service	1861406506	1861406506	1	1	GREENFIELD, JOHN H III MD	1/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91052	20	Orthopedic Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
175616	Fee-for-Service	1699718866	1699718866	1	1	GARFIELD BEACH CVS, LLC	2/3/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3741 CRENSHAW BLVD	None	LOS ANGELES	CA	90016	5803	19	06037	34.01868804	-118.3351325	Los Angeles County
175620	Fee-for-Service	1649695800	1649695800	2	1	GOKUL CORPORATION	3/22/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	587 E ELDER ST	STE C	FALLBROOK	CA	92028	3089	37	06073	33.38014649	-117.245448	San Diego County
175635	Fee-for-Service	1326290222	1326290222	1	1	GARFIELD BEACH CVS LLC	8/13/2009	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	84010 AVENUE 50	None	COACHELLA	CA	92236	9661	33	06065	33.68548846	-116.1983565	Riverside County
175648	Fee-for-Service	1912087065	1912087065	1	1	GREENFIELD, SHELDON MD	12/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	23427	41	Internal Medicine	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
175650	Fee-for-Service	1700809365	1700809365	1	1	GONZALES, CHRISTINE A	3/1/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	68646	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
175662	Fee-for-Service	1861485112	1861485112	1	1	GALITZ, JEFFREY L MD	10/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55637	02	General Surgery	0	In state provider	None	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	19	06037	34.21957849	-118.6082685	Los Angeles County
175676	Fee-for-Service	1346654522	1346654522	1	1	GEE, JANICE L MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140515	01	General Practice	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
175730	Fee-for-Service	1437849353	1437849353	1	1	GEM MEDICAL ASSOCIATES INC	7/11/2024	282N00000X	NA	Hospitals	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
175765	Fee-for-Service	1710137872	1710137872	1	1	GUY, JENNIFER E MD	6/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86055	10	Gastroenterology (M.D. only)	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
175798	Fee-for-Service	1215233010	1215233010	1	1	GIANNIKOPOULOS, PETROS MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103133	22	Pathology (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
175827	Fee-for-Service	1417150764	1417150764	1	1	GANDHI, RIPAL T MD	10/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86346	30	Radiology	0	In state provider	None	72855 FRED WARING DR	None	PALM DESERT	CA	92260	9367	33	06065	33.72858055	-116.3943135	Riverside County
175875	Fee-for-Service	1023054186	1023054186	1	1	GARFIELD BEACH CVS, LLC	2/24/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5399 WEST CENTINELA AVE.	None	LOS ANGELES	CA	90045	2003	19	06037	33.97747874	-118.3738832	Los Angeles County
175918	Fee-for-Service	1972939247	1972939247	1	1	GUERRA, BELEN B LCSW	6/1/2021	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
175930	Fee-for-Service	1316335797	1316335797	1	1	GOWEY, DEANNE OT	2/13/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	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
175948	Fee-for-Service	1023344389	1023344389	1	1	GADEA, SHELLY A	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
175954	Fee-for-Service	1538219340	1538219340	1	1	GUEST, ALISON	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
175969	Fee-for-Service	1427284033	1427284033	1	1	GOSS, BRIAN C MD	2/4/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
176002	Fee-for-Service	1528156221	1528156221	1	1	GAINES, JANICE LCSW	4/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
176052	Fee-for-Service	1710137872	1710137872	1	1	GUY, JENNIFER E MD	6/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86055	41	Internal Medicine	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
176054	Fee-for-Service	1003873795	1003873795	1	1	GLYNN, THOMAS P MD	8/26/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55275	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
176077	Fee-for-Service	1790512127	1790512127	1	1	GOCARE HOMES, INC.	10/15/2024	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6051 SAN YSIDRO CIRCLE	None	BUENA PARK	CA	90620	2849	30	06059	33.8444135	-118.0270916	Orange County
176092	Fee-for-Service	1982356648	1982356648	1	1	GOOD PEOPLE HOME HEALTH INC	2/23/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1309 W VALENCIA DR	STE H	FULLERTON	CA	92833	4045	30	06059	33.86656664	-117.948519	Orange County
176093	Fee-for-Service	1376787077	1376787077	1	1	GAUDILLIERE, BRICE L MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113580	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
176097	Fee-for-Service	1053540575	1053540575	1	1	GRAVOIS, JILL J LCSW	8/10/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	STE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
176131	Fee-for-Service	1144279522	1144279522	1	1	GHATAN, ROBERT B MD INC	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	30201	20	Orthopedic Surgery	0	In state provider	None	207 S SANTA ANITA ST	STE 336	SAN GABRIEL	CA	91776	1160	19	06037	34.10072807	-118.1066296	Los Angeles County
176169	Fee-for-Service	1689850745	1689850745	1	1	GUELMAN, LORI 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
176212	Fee-for-Service	1285997593	1285997593	1	1	GORDON, AUGUSTA LCSW	1/15/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	641 HIGUERA ST	STE 220	SAN LUIS OBISPO	CA	93401	3548	40	06079	35.27821723	-120.6655382	San Luis Obispo County
176220	Fee-for-Service	1417160045	1417160045	2	1	GOLDEN AGE HOME HEALTH INC	3/4/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15600 DEVONSHIRE ST	SUITE 206	GRANADA HILLS	CA	91344	7242	19	06037	34.25730352	-118.473084	Los Angeles County
176380	Fee-for-Service	1184628554	1184628554	1	1	GHC OF SANTEE, LLC	10/1/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8778 CUYAMACA ST	None	SANTEE	CA	92071	4255	37	06073	32.83473094	-116.983917	San Diego County
176389	Fee-for-Service	1245263243	1245263243	1	1	GLOVER, KELTY &	11/1/1997	291U00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SCHULTHEIS MD'S	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
176399	Fee-for-Service	1083837363	1083837363	1	1	GOLDBERG, TINA LAC	3/14/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	73661 HIGHWAY 111	STE F	PALM DESERT	CA	92260	4012	33	06065	33.72103792	-116.3794712	Riverside County
176420	Fee-for-Service	1376588277	1376588277	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8425 LAUREL CANYON BLVD	None	SUN VALLEY	CA	91352	3817	19	06037	34.22421117	-118.3964897	Los Angeles County
176454	Fee-for-Service	1841202066	1841202066	1	1	GONZALEZ-LONG, DESIREE G MFT	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47138	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
176541	Fee-for-Service	1790359586	1790359586	1	1	GHAFFARI DEHKHARGHANI, SEYED	4/9/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	REZA MD	200 STEIN PLAZA	B- 254	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
176585	Fee-for-Service	1528319803	1528319803	1	1	GUZZO, VALERIE M	4/13/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 OLD NEWPORT BLVD	STE 101	NEWPORT BEACH	CA	92663	4234	30	06059	33.62961361	-117.9255034	Orange County
176623	Fee-for-Service	1366859449	1366859449	1	14	GOLDEN STATE PROVIDERS, A ME	1/14/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
176664	Fee-for-Service	1649483041	1649483041	1	1	GONZALEZ, ELAINE D	6/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90701	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
176734	Fee-for-Service	1184493025	1184493025	1	1	GUIANG, DELANEY CCC-SLP	4/18/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2051 STATHAM BLVD	None	OXNARD	CA	93033	3901	56	06111	34.17967669	-119.1655477	Ventura County
176772	Fee-for-Service	1487602942	1487602942	1	1	GOSS, ERICK K	12/23/2004	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CASCADE PHYSICAL THERAPY	1007 DANA DR	STE E	REDDING	CA	96003	4036	45	06089	40.58621005	-122.3526419	Shasta County
176796	Fee-for-Service	1437179637	1437179637	1	1	GERHART, SHERELLEN B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	70307	41	Internal Medicine	0	In state provider	None	2175 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7024	09	06017	38.91234551	-119.9972565	El Dorado County
176816	Fee-for-Service	1649234014	1649234014	1	1	GILL, INDERBIR S MD	1/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53678	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVE	NOR 7416	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
176842	Fee-for-Service	1710962865	1710962865	1	1	GLENDALE EYE MEDICAL GROUP	1/1/1979	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	500 N CENTRAL AVENUE	4TH FL	GLENDALE	CA	91203	1928	19	06037	34.15321627	-118.2578985	Los Angeles County
176853	Fee-for-Service	1184727026	1184727026	1	1	GALAN, HENRY L MD	3/13/2017	207VM0101X	NA	Obstetrics & Gynecology	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
176859	Fee-for-Service	1043203946	1043203946	1	1	GREENFIELD, DANIEL J MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86356	None	None	0	In state provider	None	PUEBLO AT BATH STREET	None	SANTA BARBARA	CA	93102	0000	42	06083	34.430526	-119.72196	Santa Barbara County
176865	Fee-for-Service	1992719967	1992719967	1	1	GERTSER, ELAINE MD	11/4/2014	207R00000X	NA	Other	026	PHYSICIANS	56281	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6367 ALVARADO CT	SUITE 202	SAN DIEGO	CA	92120	4915	37	06073	32.77665968	-117.0614306	San Diego County
176876	Fee-for-Service	1235525247	1235525247	1	1	GOODNOUGH, LAWRENCE H MD	8/3/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	144054	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
176892	Fee-for-Service	1811706575	1811706575	1	1	GILL, GURPREET K NP	3/6/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	15	06029	35.3687456	-119.1106561	Kern County
176930	Fee-for-Service	1639368079	1639368079	1	1	GARCIA LEE & CONCEPCION	6/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	RIVER BEND MED ASSOC	2101 STONE BLVD	STE 190	WEST SACRAMENTO	CA	95691	4055	57	06113	38.56318049	-121.5379228	Yolo County
176932	Fee-for-Service	1851795264	1851795264	1	1	GUZMAN, JOVITA	11/21/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
176937	Fee-for-Service	1326572058	1326572058	1	1	GORUKANTI, ANURADHA L MD	6/24/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	157301	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
176965	Fee-for-Service	1629657689	1629657689	1	1	GRIFFITHS-RANDOLPH, URSULA	5/16/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	183640	40	Pediatrics	0	In state provider	MD	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
176966	Fee-for-Service	1801982467	1801982467	1	1	GINN, GREGORY E MD	4/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	58391	01	General Practice	0	In state provider	None	1090 3RD ST	STE 2	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
176978	Fee-for-Service	1013048461	1013048461	1	1	GASTROENTEROLOGY DIAG	10/8/1990	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER	880 S ATLANTIC BLVD	STE G10	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
177000	Fee-for-Service	1982091740	1982091740	1	1	GANESAN, ANUSHA PREETHI MD	4/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147249	78	Neoplastic Diseases/Oncology	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
177022	Fee-for-Service	1487632998	1487632998	1	2	GENEDX, LLC	1/31/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	207 PERRY PKWY	None	GAITHERSBURG	MD	20877	2142	00	None	39.14380932	-77.21236587	Montgomery County
177043	Fee-for-Service	1851489975	1851489975	1	1	GEE, KENNETH K MD	12/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	58052	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
177121	Fee-for-Service	1538570817	1538570817	1	1	GEALY, DANIEL J MD	6/14/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
177127	Fee-for-Service	1710962865	1710962865	1	1	GLENDALE EYE MEDICAL GROUP	2/12/2018	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	500 N CENTRAL AVENUE	4TH FL	GLENDALE	CA	91203	1928	19	06037	34.15321627	-118.2578985	Los Angeles County
177135	Fee-for-Service	1578504486	1578504486	1	1	GARFIELD BEACH CVS, LLC	12/19/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	551 S. VENTURA	None	OXNARD	CA	93030	6523	56	06111	34.19685	-119.1949075	Ventura County
177150	Fee-for-Service	1922494897	1922494897	1	1	GILLETTE, MARSHALL T MD	7/19/2019	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	145430	08	Family Practice	0	In state provider	None	3828 SCHAUFELE AVENUE	SUITE 200	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
177154	Fee-for-Service	1992719967	1992719967	1	1	GERTSER, ELAINE MD	11/4/2014	207R00000X	NA	Other	026	PHYSICIANS	56281	41	Internal Medicine	0	In state provider	None	6367 ALVARADO CT	SUITE 202	SAN DIEGO	CA	92120	4915	37	06073	32.77665968	-117.0614306	San Diego County
177159	Fee-for-Service	1144330416	1144330416	1	1	GUPTA, NEEL K MD	6/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111492	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
177173	Fee-for-Service	1801047964	1801047964	2	1	GRACE COMMUNITY PHARMACY, IN	11/21/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4881 LA PALMA AVE	None	LA PALMA	CA	90623	2019	30	06059	33.84635449	-118.0476675	Orange County
177202	Fee-for-Service	1790844397	1790844397	1	1	GUPTA, MANDHIR MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54449	40	Pediatrics	0	In state provider	None	3816 WOODRUFF AVE	STE 204	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
177219	Fee-for-Service	1578665535	1578665535	1	1	GRANT, JAMES G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	38783	41	Internal Medicine	0	In state provider	None	505 CENTRAL AVE	STE 302	PACIFIC GROVE	CA	93950	2755	27	06053	36.62163848	-121.9151648	Monterey County
177244	Fee-for-Service	1265444129	1265444129	1	1	GOMEZ-GARCIA, MARCO MD	12/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84263	41	Internal Medicine	0	In state provider	None	2915 SANTA MONICA BLVD	STE 2	SANTA MONICA	CA	90404	2438	19	06037	34.03592657	-118.4710747	Los Angeles County
177250	Fee-for-Service	1801982467	1801982467	1	1	GINN, GREGORY E MD	4/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	58391	33	Thoracic Surgery	0	In state provider	None	1090 3RD ST	STE 2	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
177287	Fee-for-Service	1982091740	1982091740	1	1	GANESAN, ANUSHA PREETHI MD	4/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147249	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
177336	Fee-for-Service	1922106400	1922106400	1	1	GARFIELD BEACH CVS LLC	12/14/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2330 S MAIN ST	None	SANTA ANA	CA	92707	3253	30	06059	33.71506077	-117.8679808	Orange County
177347	Fee-for-Service	1205455862	1205455862	1	1	GOODMAN, ANN LMFT	9/25/2024	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
177360	Fee-for-Service	1780046243	1780046243	1	1	GRIGORIEVA OLSON, OLGA MD	8/5/2020	207R00000X	NA	Other	026	PHYSICIANS	162175	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
177389	Fee-for-Service	1194122069	1194122069	1	1	GILL, SATINDER K PSYD	5/5/2015	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
177397	Fee-for-Service	1649807652	1649807652	1	1	GUZMAN, RHIANNON MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
177422	Fee-for-Service	1134368517	1134368517	1	1	GOKMEN FOWLER, FUSUN O	8/3/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	180384	None	None	0	In state provider	None	8120 TIMBERLAKE WAY	STE 211	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
177447	Fee-for-Service	1144330416	1144330416	1	1	GUPTA, NEEL K MD	6/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111492	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
177481	Fee-for-Service	1194986570	1194986570	1	1	GARDNER, WILLIAM S PHD	2/2/2012	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
177511	Fee-for-Service	1861033870	1861033870	1	1	GUTIERREZ, JESSICA NP	11/29/2022	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
177537	Fee-for-Service	1982963427	1982963427	1	1	GILBERT, AUBREY L MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148878	18	Ophthalmology	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
177552	Fee-for-Service	1376688531	1376688531	1	1	GERACIMOS, RYAN MD	1/30/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	166869	None	None	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
177574	Fee-for-Service	1982091740	1982091740	1	1	GANESAN, ANUSHA PREETHI MD	4/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147249	68	Hematology	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
177575	Fee-for-Service	1043483175	1043483175	1	1	GALVEZ, MICHELLE A MD	10/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122310	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
177633	Fee-for-Service	1124233408	1124233408	1	1	GLENN-LAWSON, JUNE L MD	1/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48164	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
177643	Fee-for-Service	1073611562	1073611562	1	1	GARFIELD BEACH CVS LLC	12/14/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	816 E MAIN ST	None	ALHAMBRA	CA	91801	4054	19	06037	34.09914537	-118.1184031	Los Angeles County
177645	Fee-for-Service	1033542006	1033542006	1	1	GUO, YUEYANG MD	6/11/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	132313	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
177708	Fee-for-Service	1104250612	1104250612	1	1	GARAY LOZANO, GEORGINA LMFT	1/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11145 TAMPA AVENUE	SUITE 24A	PORTER RANCH	CA	91326	1001	19	06037	34.27373836	-118.5564202	Los Angeles County
177723	Fee-for-Service	1861108631	1861108631	1	1	GOOD SAMARITAN HOSPITAL CA	12/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	146 NORTH HILL STREET	None	ARVIN	CA	93203	1014	15	06029	35.210097	-118.8309345	Kern County
177753	Fee-for-Service	1003892241	1003892241	1	1	GOODNOW, THOMAS M CRNA	8/1/2002	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
177761	Fee-for-Service	1548730237	1548730237	1	1	GREGORIO, CARLA C CRNA	7/9/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
177770	Fee-for-Service	1588784334	1588784334	1	1	GOUD, PRAVIN T MD	7/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104184	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
177789	Fee-for-Service	1306052915	1306052915	1	1	GUPTILL, DANIEL	2/20/2008	207L00000X	NA	Other	025	PHYSICAL THERAPISTS	-	05	Anesthesiology	0	In state provider	None	480 4TH AVE	STE 301	CHULA VISTA	CA	91910	4403	37	06073	32.63411298	-117.0816772	San Diego County
177831	Fee-for-Service	1699855528	1699855528	1	1	GALE, VANJA A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 CAMINO DEL RIO S	STE 212	SAN DIEGO	CA	92108	4016	37	06073	32.77756386	-117.1185135	San Diego County
177834	Fee-for-Service	1255365441	1255365441	1	1	GRUMBACH, KATHRYN MD	10/4/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	186938	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
177849	Fee-for-Service	1861930067	1861930067	1	1	GALUSTIAN, SILVIA LMFT	8/25/2023	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
177876	Fee-for-Service	1831721893	1831721893	1	1	GREEN PARADISE HOSPICE CARE	12/11/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	5658 SEPULVEDA BLVD	SUITE 201	VAN NUYS	CA	91411	2951	19	06037	34.173774	-118.466123	Los Angeles County
177887	Fee-for-Service	1790769156	1790769156	2	1	GUALTIERI, CHRISTOPHER J MD	5/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73020	18	Ophthalmology	0	In state provider	None	3969 4TH AVE	STE 300	SAN DIEGO	CA	92103	3165	37	06073	32.74948151	-117.1615826	San Diego County
177888	Fee-for-Service	1417398546	1417398546	1	1	GARCIA, VIOLETA LCSW	12/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1135 INGERSON AVE	None	SAN FRANCISCO	CA	94124	3513	38	06075	37.72043824	-122.3953942	San Francisco County
177900	Fee-for-Service	1245258219	1245258219	1	1	GRIGGS, BENJAMIN G MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	42608	36	Psychiatry	0	In state provider	None	334 N SAN MATEO DR	None	SAN MATEO	CA	94401	2514	41	06081	37.57162459	-122.3318507	San Mateo County
177906	Fee-for-Service	1629171046	1629171046	1	1	GONZALEZ, CARMEN R MD	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144065	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
177949	Fee-for-Service	1457676140	1457676140	1	1	GROBEL, HANA MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117799	08	Family Practice	0	In state provider	None	3883 AIRWAY DR #202	None	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
177982	Fee-for-Service	1811900129	1811900129	1	1	GORE, GWENDOLYN S MD	12/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52292	41	Internal Medicine	0	In state provider	None	29472 AVENIDA DE LAS BAN	None	RANCHO SANTA MARG	CA	92688	2651	30	06059	33.61980987	-117.6107148	Orange County
178010	Fee-for-Service	1861108631	1861108631	1	1	GOOD SAMARITAN HOSPITAL CA	12/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	146 NORTH HILL STREET	None	ARVIN	CA	93203	1014	15	06029	35.210097	-118.8309345	Kern County
178015	Fee-for-Service	1932123866	1932123866	1	1	GREENE, DOUGLAS G MD	1/5/1995	207L00000X	NA	Other	026	PHYSICIANS	47872	05	Anesthesiology	0	In state provider	None	955 BLANCO CIR	STE A	SALINAS	CA	93901	4452	27	06053	36.65564507	-121.6367659	Monterey County
178023	Fee-for-Service	1598348468	1598348468	1	1	GARNICA, LAURA L OD	10/27/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
178027	Fee-for-Service	1841415353	1841415353	1	1	GOLDEN VALLEY HEALTH CTR	7/31/1991	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	0000	24	06047	37.28825369	-120.4963159	Merced County
178032	Fee-for-Service	1346299211	1346299211	1	1	GAREY ORTHOPEDIC MED GRP	4/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
178035	Fee-for-Service	1619466059	1619466059	1	1	GOODSON, RUTH B MD	9/26/2019	390200000X	NA	Other	026	PHYSICIANS	164341	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
178135	Fee-for-Service	1770650798	1770650798	1	1	GARDNER, DOUGLAS A MD	1/31/1989	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	61113	41	Internal Medicine	0	In state provider	None	400 S SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	6814	19	06037	33.87583364	-118.3958985	Los Angeles County
178144	Fee-for-Service	1447309067	1447309067	1	1	GRIFFITH, RICHARD D MD	8/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97460	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
178145	Fee-for-Service	1700231339	1700231339	1	1	GUTFLAIS, ERIC MD	8/30/2021	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	168587	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
178163	Fee-for-Service	1831721893	1831721893	1	1	GREEN PARADISE HOSPICE CARE	12/11/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	5658 SEPULVEDA BLVD	SUITE 201	VAN NUYS	CA	91411	2951	19	06037	34.173774	-118.466123	Los Angeles County
178176	Fee-for-Service	1790769156	1790769156	2	1	GUALTIERI, CHRISTOPHER J MD	5/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73020	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3969 4TH AVE	STE 300	SAN DIEGO	CA	92103	3165	37	06073	32.74948151	-117.1615826	San Diego County
178186	Fee-for-Service	1245258219	1245258219	1	1	GRIGGS, BENJAMIN G MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	42608	26	Psychiatry (child)	0	In state provider	None	334 N SAN MATEO DR	None	SAN MATEO	CA	94401	2514	41	06081	37.57162459	-122.3318507	San Mateo County
178255	Fee-for-Service	1093923088	1093923088	1	1	GARCIA PACHECO SUAREZ, RALPH	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110188	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
178263	Fee-for-Service	1811900129	1811900129	1	1	GORE, GWENDOLYN S MD	12/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52292	40	Pediatrics	0	In state provider	None	29472 AVENIDA DE LAS BAN	None	RANCHO SANTA MARG	CA	92688	2651	30	06059	33.61980987	-117.6107148	Orange County
178321	Fee-for-Service	1447338108	1447338108	1	1	GARDNER, ROBERT B MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	36894	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
178342	Fee-for-Service	1285740811	1285740811	1	1	GHALAMBOR, MASOUD MD	8/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94111	20	Orthopedic Surgery	0	In state provider	None	2801 K ST	STE 310	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
178348	Fee-for-Service	1750735635	1750735635	1	1	GENOVEZ, MARX P MD	12/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168988	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
178354	Fee-for-Service	1982137956	1982137956	1	1	GARCIA, ADRIAN MD	6/19/2020	390200000X	NA	Other	026	PHYSICIANS	162285	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
178418	Fee-for-Service	1164757837	1164757837	1	1	GENIZA, CHRISTINE D	3/28/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	20601	-	NOT APPLICABLE	0	In state provider	None	3594 FOURTH AVENUE	None	SAN DIEGO	CA	92103	4940	37	06073	32.74318084	-117.1615865	San Diego County
178426	Fee-for-Service	1770650798	1770650798	1	1	GARDNER, DOUGLAS A MD	1/31/1989	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	61113	10	Gastroenterology (M.D. only)	0	In state provider	None	400 S SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	6814	19	06037	33.87583364	-118.3958985	Los Angeles County
178482	Fee-for-Service	1205093176	1205093176	1	1	GELFAND, DMITRI V MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80877	02	General Surgery	0	In state provider	None	2545 WEST HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
178505	Fee-for-Service	1306874110	1306874110	1	1	GETZ, MICHAEL F MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	36919	20	Orthopedic Surgery	0	In state provider	None	435 ARDEN AVE	STE 530	GLENDALE	CA	91203	1140	19	06037	34.15848148	-118.2628845	Los Angeles County
178533	Fee-for-Service	1669858809	1669858809	1	1	GILMORE, TASHA CNP	1/15/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
178544	Fee-for-Service	1093923088	1093923088	1	1	GARCIA PACHECO SUAREZ, RALPH	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110188	41	Internal Medicine	0	In state provider	MD	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
178560	Fee-for-Service	1487684924	1487684924	1	1	GLATT, ANDREW H MD	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87831	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
178561	Fee-for-Service	1033185772	1033185772	1	1	GANATRA, JYOTSOM B MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78524	18	Ophthalmology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
178627	Fee-for-Service	1477652949	1477652949	1	1	GARIBYAN, MELANYA OD	12/19/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	149 S GLENOAKS BLVD	None	BURBANK	CA	91502	1315	19	06037	34.18256574	-118.3054194	Los Angeles County
178641	Fee-for-Service	1528429206	1528429206	1	1	GARDNER, GABRIELLE LMFT	5/3/2024	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
178689	Fee-for-Service	1699753202	1699753202	1	1	GLAUBER, JAMES H MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70965	40	Pediatrics	0	In state provider	None	1505 SAINT ALPHONSUS CT	None	ALAMO	CA	94507	1533	07	06013	37.85356704	-122.03496	Contra Costa County
178698	Fee-for-Service	1235180563	1235180563	1	1	GONZALEZ, JAIME MD, INC	12/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87328	08	Family Practice	0	In state provider	None	716 E MISSION BLVD	STE D	POMONA	CA	91766	2040	19	06037	34.05523981	-117.743173	Los Angeles County
178750	Fee-for-Service	1992099147	1992099147	1	1	GARCIA, ERIKA	2/4/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
178758	Fee-for-Service	1083905715	1083905715	1	1	GONZALEZ, VERONICA V MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124749	38	Geriatrics	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
178762	Fee-for-Service	1912968041	1912968041	1	1	GORDON, ANTHONY K MD	4/6/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	59522	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
178783	Fee-for-Service	1265636013	1265636013	1	1	GRISELL, MARGARET K MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116231	20	Orthopedic Surgery	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
178786	Fee-for-Service	1528334877	1528334877	1	1	GIDWANEY, RITA MD	5/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118504	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
178805	Fee-for-Service	1255395315	1255395315	1	1	GENEVIEVE BENNETT	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
178832	Fee-for-Service	1093923088	1093923088	1	1	GARCIA PACHECO SUAREZ, RALPH	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110188	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
178836	Fee-for-Service	1154404127	1154404127	1	1	GUEVARA, JOSE L DO	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14559	01	General Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
178854	Fee-for-Service	1831446251	1831446251	1	1	GOTANDA, HIROSHI MD	1/17/2020	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	134636	38	Geriatrics	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
178900	Fee-for-Service	1225107006	1225107006	1	1	GU, DAVID G DO	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	6851	41	Internal Medicine	0	In state provider	None	300 W HUNTINGTON DRIVE	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
178908	Fee-for-Service	1982689295	1982689295	1	1	GABRILLO, WARREN R MD	7/9/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51794	08	Family Practice	0	In state provider	None	5472 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.0263573	-117.6852719	San Bernardino County
178938	Fee-for-Service	1538315056	1538315056	1	1	GARFIELD BEACH CVS LLC	6/21/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	53 E OLIVE AVE	None	PORTERVILLE	CA	93257	4827	54	06107	36.06510547	-119.015307	Tulare County
178963	Fee-for-Service	1740290329	1740290329	1	1	GREENYEH, ROBBIN J MD	1/1/1996	174400000X	NA	Other	026	PHYSICIANS	6757	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
178966	Fee-for-Service	1295589323	1295589323	1	1	GREEN, PATRICIA LMFT	5/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 E LELAND RD	C	PITTSBURG	CA	94565	4983	07	06013	38.01186589	-121.8902232	Contra Costa County
179043	Fee-for-Service	1235201989	1235201989	1	1	GULATI, APARN A MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71247	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
179047	Fee-for-Service	1083905715	1083905715	1	1	GONZALEZ, VERONICA V MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124749	01	General Practice	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
179051	Fee-for-Service	1851589485	1851589485	1	1	GUAGENTI, JOHN J MD INC	3/26/2009	174400000X	NA	Other	026	PHYSICIANS	32900	07	Dermatology	0	In state provider	None	1510 S CENTRAL AVE	STE 470	GLENDALE	CA	91204	2514	19	06037	34.12709764	-118.2577911	Los Angeles County
179069	Fee-for-Service	1922374990	1922374990	1	1	GORIT, GIDEON R MD	1/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130255	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
179075	Fee-for-Service	1265636013	1265636013	1	1	GRISELL, MARGARET K MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116231	40	Pediatrics	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
179099	Fee-for-Service	1235108747	1235108747	1	1	GREGORY, DONALD WAYNE MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43445	66	Emergency Medicine (Urgent Care)	0	In state provider	EMERGENCY & ACUTE CARE	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
179100	Fee-for-Service	1508115684	1508115684	1	1	GOLDEN GATE HOSPITALISTS	11/6/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	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
179117	Fee-for-Service	1952491029	1952491029	1	1	GOOD, MARGARET L NP	1/6/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
179127	Fee-for-Service	1821278912	1821278912	1	1	GLOSS, DAVID S MD	6/2/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	107624	41	Internal Medicine	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	6975	19	06037	34.06473399	-118.445865	Los Angeles County
179134	Fee-for-Service	1689752206	1689752206	1	1	GHADIALI, MURTUZA Z MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77487	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
179198	Fee-for-Service	1891145082	1891145082	1	1	GHAEMMAGHAMI, SAEID MD	7/8/2019	208M00000X	NA	Other	026	PHYSICIANS	158856	41	Internal Medicine	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
179251	Fee-for-Service	1275685414	1275685414	2	1	GATEWAY MEDICAL CENTER INC	1/1/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2760 BALLS FERRY RD	None	ANDERSON	CA	96007	3537	45	06089	40.45489921	-122.2878254	Shasta County
179252	Fee-for-Service	1821133273	1821133273	1	1	GLEASON, LISA T LMFT	7/4/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST 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
179257	Fee-for-Service	1699278416	1699278416	1	1	GOLDTHREAD TRANSPORTATION	2/20/2019	No Taxonomy Provided	NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SERVICE LLC	180 PROMENADE CIRCLE	STE 300	SACRAMENTO	CA	95834	2952	34	06067	38.636649	-121.49838	Sacramento County
179261	Fee-for-Service	1144495326	1144495326	1	1	GELBER, STEVEN I MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110927	41	Internal Medicine	0	In state provider	None	5900 STATE FARM DR	None	ROHNERT PARK	CA	94928	2149	49	06097	38.35358835	-122.7073105	Sonoma County
179268	Fee-for-Service	1932249653	1932249653	1	1	GILBERT HOSPITAL LLC	9/24/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5656 S POWER RD	STE 133	GILBERT	AZ	85295	8490	00	None	33.31386	-111.6877185	Maricopa County
179319	Fee-for-Service	1750398491	1750398491	1	1	GIACONI, MIRKO A MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25678	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1360 W 6TH	STE 205	SAN PEDRO	CA	90732	3567	19	06037	33.73886546	-118.3075065	Los Angeles County
179328	Fee-for-Service	1093766057	1093766057	1	1	GREWAL, JEFFREY MD	6/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84874	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
179329	Fee-for-Service	1851554372	1851554372	1	1	GILL, MUHAMMAD A MD	6/1/2008	207R00000X	NA	Other	026	PHYSICIANS	103683	None	None	0	In state provider	None	632 W GIBSON ROAD	None	WOODLAND	CA	95695	5143	57	06113	38.66314048	-121.794696	Yolo County
179370	Fee-for-Service	1235193418	1235193418	1	1	GARRY, MARK 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	915 MOUNTAIN VIEW RD	None	RAPID CITY	SD	57702	3414	00	None	44.077779	-103.2520995	Pennington County
179389	Fee-for-Service	1235108747	1235108747	1	1	GREGORY, DONALD WAYNE MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43445	06	Cardiovascular Disease (M.D. only)	0	In state provider	EMERGENCY & ACUTE CARE	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
179400	Fee-for-Service	1396776738	1396776738	1	1	GUTMAN, DONALD MD	2/1/2000	207R00000X	NA	Other	026	PHYSICIANS	32946	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 CREEKSIDE DR	STE 3700	FOLSOM	CA	95630	3446	34	06067	38.669994	-121.147488	Sacramento County
179410	Fee-for-Service	1477840064	1477840064	1	1	GARVIN, CHRISTINA M DPM	8/30/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6620 COYLE AVE	STE 202	CARMICHAEL	CA	95608	6337	34	06067	38.66751	-121.310028	Sacramento County
179414	Fee-for-Service	1649779919	1649779919	1	1	GREEN PHYSICAL THERAPY, INC.	3/21/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23100 EUCALYPTUS AVE	SUITE C	MORENO VALLEY	CA	92553	5439	33	06065	33.93157977	-117.2598359	Riverside County
179419	Fee-for-Service	1821278912	1821278912	1	1	GLOSS, DAVID S MD	6/2/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	107624	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	6975	19	06037	34.06473399	-118.445865	Los Angeles County
179452	Fee-for-Service	1285717819	1285717819	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6700 TOPANGA CANYON BLVD	None	CANOGA PARK	CA	91303	2624	19	06037	34.191819	-118.602594	Los Angeles County
179469	Fee-for-Service	1881720951	1881720951	2	1	G & S TRANSPORTATION SVC INC	5/26/2009	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LIFE CARE TRANSPORTATION	425 S FAIRFAX AVE	STE 214	LOS ANGELES	CA	90036	3541	19	06037	34.069284	-118.3614385	Los Angeles County
179545	Fee-for-Service	1275685414	1275685414	2	1	GATEWAY MEDICAL CENTER INC	1/1/2007	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2760 BALLS FERRY RD	None	ANDERSON	CA	96007	3537	45	06089	40.45489921	-122.2878254	Shasta County
179546	Fee-for-Service	1881694776	1881694776	1	1	GURTCH, TIM P	3/20/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50806	None	None	0	In state provider	None	4276 54TH PL	None	SAN DIEGO	CA	92115	6011	37	06073	32.75444691	-117.0788921	San Diego County
179552	Fee-for-Service	1831516251	1831516251	1	1	GEORGES, JOSEPH DO	4/16/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	18644	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
179554	Fee-for-Service	1932249653	1932249653	1	1	GILBERT HOSPITAL LLC	9/24/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5656 S POWER RD	STE 133	GILBERT	AZ	85295	8490	00	None	33.31386	-111.6877185	Maricopa County
179606	Fee-for-Service	1255996328	1255996328	1	1	GODSEY, JESSIE	6/27/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	8280 W WARM SPRINGS RD	None	LAS VEGAS	NV	89113	3612	00	None	36.057384	-115.2721395	Clark County
179646	Fee-for-Service	1194821975	1194821975	3	1	GRIDLEY DAN	9/25/2017	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
179674	Fee-for-Service	1235108747	1235108747	1	1	GREGORY, DONALD WAYNE MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	43445	01	General Practice	0	In state provider	EMERGENCY & ACUTE CARE	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
179688	Fee-for-Service	1437182870	1437182870	1	1	GIBBS, LILIANE H MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75094	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
179690	Fee-for-Service	1396776738	1396776738	1	1	GUTMAN, DONALD MD	2/1/2000	207R00000X	NA	Other	026	PHYSICIANS	32946	41	Internal Medicine	0	In state provider	None	1600 CREEKSIDE DR	STE 3700	FOLSOM	CA	95630	3446	34	06067	38.669994	-121.147488	Sacramento County
179751	Fee-for-Service	1053651497	1053651497	1	1	GEISS, JOHN M DO	4/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12647	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
179773	Fee-for-Service	1699230300	1699230300	1	1	GOGO MEDICAL TRANSPORT INC.	4/20/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8628 UTICA AVE	300	RANCHO CUCAMONGA	CA	91730	4824	36	06071	34.096572	-117.5730055	San Bernardino County
179782	Fee-for-Service	1962726869	1962726869	1	1	GOLDWATER, DEENA S MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143381	38	Geriatrics	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
179784	Fee-for-Service	1215077102	1215077102	1	1	GALLANT, ROGER D MD	8/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54770	66	Emergency Medicine (Urgent Care)	0	In state provider	None	240 SPRUCE STREET	None	GRIDLEY	CA	95948	2216	04	06007	39.36701046	-121.6895355	Butte County
179810	Fee-for-Service	1457392664	1457392664	1	1	GREGORY HATFIELD 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	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
179811	Fee-for-Service	1427566611	1427566611	1	1	GALEANA, MAIREL LPCC	11/3/2023	101YA0400X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
179813	Fee-for-Service	1932527983	1932527983	1	1	GUENTHER, MARIAM W MD	10/22/2024	207K00000X	NA	Other	026	PHYSICIANS	None	03	Allergy	0	In state provider	None	51 HITCHCOCK WAY	None	SANTA BARBARA	CA	93105	3101	42	06083	34.43833587	-119.7444336	Santa Barbara County
179935	Fee-for-Service	1023597374	1023597374	1	1	GARFIELD BEACH CVS, L.L.C.	6/4/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	965 TOWN CENTER DR	None	LA CANADA FLINTRI	CA	91011	1638	19	06037	34.20497144	-118.1989244	Los Angeles County
179950	Fee-for-Service	1528111598	1528111598	1	1	GARRETT, WAYNE DO	3/31/2025	207ZC0006X	NA	Other	026	PHYSICIANS	5450	22	Pathology (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
179970	Fee-for-Service	1467850859	1467850859	1	1	GENOMIND INC	2/21/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2200 RENAISSANCE BLVD	SUITE 100	KING OF PRUSSIA	PA	19406	2755	00	None	40.08439014	-75.3377825	Montgomery County
179972	Fee-for-Service	1770623282	1770623282	1	1	GARUDA, RINA S MD	9/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55750	01	General Practice	0	In state provider	None	87 FENTON STREET	STE 210	LIVERMORE	CA	94550	4100	01	06001	37.676565	-121.7834555	Alameda County
179999	Fee-for-Service	1790255883	1790255883	1	1	GLEITSMAN, KONA M LMFT	10/30/2023	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
180058	Fee-for-Service	1588898845	1588898845	1	1	GAREY, DONNA M MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90167	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
180071	Fee-for-Service	1962726869	1962726869	1	1	GOLDWATER, DEENA S MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143381	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365,420,120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
180076	Fee-for-Service	1346760295	1346760295	1	1	G&H HOME HEALTH	9/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14652 VENTURA BLVD	STE 201	SHERMAN OAKS	CA	91403	3686	19	06037	34.15155836	-118.4527431	Los Angeles County
180105	Fee-for-Service	1609380930	1609380930	1	1	GOMES COSTARDI, GABRIELA PH	7/20/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1151 DOVE ST	113	NEWPORT BEACH	CA	92660	2804	30	06059	33.66079655	-117.8652168	Orange County
180162	Fee-for-Service	1154515039	1154515039	1	2	GOLDEN YEARS HOME HEALTH INC	9/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	550 W CIENEGA AVE	SUITE H	SAN DIMAS	CA	91773	2977	19	06037	34.10299374	-117.8175875	Los Angeles County
180193	Fee-for-Service	1699390161	1699390161	1	1	GOMEZ, MONICA D CCC-SLP	8/15/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
180206	Fee-for-Service	1962798496	1962798496	1	1	GONG, YU N MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151554	22	Pathology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
180236	Fee-for-Service	1528111598	1528111598	1	1	GARRETT, WAYNE DO	3/31/2025	207ZC0006X	NA	Other	026	PHYSICIANS	5450	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
180344	Fee-for-Service	1255351029	1255351029	1	1	GOENNE, MATTHEW P DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4380 FELTON ST	None	SAN DIEGO	CA	92104	1421	37	06073	32.756778	-117.1211455	San Diego County
180345	Fee-for-Service	1588898845	1588898845	1	1	GAREY, DONNA M MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90167	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
180401	Fee-for-Service	1003304031	1003304031	1	1	GOLDEN, JENNIFER M DO	8/31/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17692	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
180412	Fee-for-Service	1104483031	1104483031	1	1	GOMEZ NUNEZ, MONTSERRAT LPC	12/29/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C	8110 BIRMINGHAM WAY	BLDG 28	SAN DIEGO	CA	92123	2758	37	06073	32.79648424	-117.1521397	San Diego County
180416	Fee-for-Service	1619959517	1619959517	1	1	GAUHAR, FATIMA A MD	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86048	41	Internal Medicine	0	In state provider	None	830 MAGNOLIA AVE	None	RIVERSIDE	CA	92879	3128	33	06065	33.86017131	-117.5520534	Riverside
180427	Fee-for-Service	1033641568	1033641568	1	1	GUJA, KIP E MD	9/23/2023	207U00000X	NA	Other	026	PHYSICIANS	163841	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180469	Fee-for-Service	1881720340	1881720340	1	1	GANDHI, GAUTAM N MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	31792	41	Internal Medicine	0	In state provider	None	7501 HOSPITAL DR	STE 305	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
180471	Fee-for-Service	1477526929	1477526929	1	1	GROSSMAN, PAUL B MD	5/21/2018	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
180496	Fee-for-Service	1568091791	1568091791	1	1	GOTTERER, LAUREN A PSYD	7/19/2023	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
180511	Fee-for-Service	1487634895	1487634895	1	1	GROSSMAN, ROBIN M LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3356 2ND AVE	STE A	SAN DIEGO	CA	92103	5636	37	06073	32.74048649	-117.1631499	San Diego County
180587	Fee-for-Service	1366859449	1366859449	1	11	GOLDEN STATE PROVIDERS, A ME	1/14/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	225 N JACKSON AVE	SUITE 501	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
180612	Fee-for-Service	1285708594	1285708594	1	1	GOMEZ, MICHELE A MD	7/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77883	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
180624	Fee-for-Service	1932456282	1932456282	1	1	GOMEZ, YESIKA LMFT	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
180634	Fee-for-Service	1053577494	1053577494	1	2	GOODALL, JENNY C LMFT	1/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	220 SANSOME	400	SAN FRANCISCO	CA	94104	2321	38	06075	37.79250132	-122.4009823	San Francisco County
180644	Fee-for-Service	1083440572	1083440572	1	1	GEARHART, CASSADIE F	9/12/2024	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
180669	Fee-for-Service	1013448091	1013448091	1	1	GE, XUAN MD	8/18/2023	390200000X	NA	Other	026	PHYSICIANS	170553	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
180733	Fee-for-Service	1538353610	1538353610	2	1	GARFIELD BEACH CVS LLC	7/13/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1621 S ALAMEDA ST	None	COMPTON	CA	90220	4973	19	06037	33.88019638	-118.2180632	Los Angeles County
180777	Fee-for-Service	1164824249	1164824249	1	1	GHORBANIFARAJZADEH, ALI R DP	6/12/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	M	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
180789	Fee-for-Service	1952807349	1952807349	1	1	GOLDSWORTHY, OWEN P DO	9/13/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	17795	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
180844	Fee-for-Service	1700643137	1700643137	1	1	GORDON, EBONY R BIRTH DOULA	4/1/2024	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
180856	Fee-for-Service	1770817744	1770817744	1	1	GARCHA, AMARINDER MD	2/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152511	45	Nephrology (Renal-Kidney)	0	In state provider	None	202 W WILLOW AVE	SUITE 302	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
180887	Fee-for-Service	1366636391	1366636391	1	1	GONZALEZ, CELINA I LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
180914	Fee-for-Service	1235635368	1235635368	1	1	GIL, RYAN M MD	8/1/2024	207RC0200X	NA	Other	026	PHYSICIANS	None	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
180925	Fee-for-Service	1760703482	1760703482	1	1	GALLAGHER, BRENDAN L MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124661	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
180931	Fee-for-Service	1053871533	1053871533	1	1	GABRIEL, MICHAEL MD	8/17/2023	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	178469	None	None	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
180941	Fee-for-Service	1780678433	1780678433	1	1	GORDON, H W MD MEDICAL CORP	10/1/1983	207ZP0102X	NA	Other	026	PHYSICIANS	20719	22	Pathology (M.D. only)	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
180947	Fee-for-Service	1962561175	1962561175	1	1	GUTIERREZ WOOLRIDGE, LAURA	1/19/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
181024	Fee-for-Service	1962444158	1962444158	1	1	GARFIELD BEACH CVS, LLC	1/15/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26686 PORTOLA PKWY	None	FOOTHILL RANCH	CA	92610	1755	30	06059	33.68073233	-117.6651082	Orange County
181032	Fee-for-Service	1053305797	1053305797	1	2	GLENDALE PATHOLOGY ASSOC	8/24/1987	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
181094	Fee-for-Service	1194805242	1194805242	1	1	GONG, PEIXIAN MD	9/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80365	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
181101	Fee-for-Service	1316089667	1316089667	1	1	GONZALES, CLAUDIA R LMFT	5/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3130 W MAIN ST	STE C	VISALIA	CA	93291	5776	54	06107	36.328122	-119.325447	Tulare County
181133	Fee-for-Service	1164599064	1164599064	1	1	GHOLMIEH, GHASSAN MD	11/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89141	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
181147	Fee-for-Service	1043303357	1043303357	1	1	GOLD, GARRY E MD	5/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	78074	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
181159	Fee-for-Service	1386664522	1386664522	1	1	GUPTA, SUNDEEP K MD	7/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62224	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
181169	Fee-for-Service	1972586006	1972586006	1	1	GASSEN, JOSEPH A MD	3/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89521	3861	00	None	39.52483792	-119.7968314	Washoe County
181201	Fee-for-Service	1609500438	1609500438	1	1	GUAMA, ANN W	8/4/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4704 RODEO LN	APT 4	LOS ANGELES	CA	90016	5622	19	06037	34.02113889	-118.3486588	Los Angeles County
181202	Fee-for-Service	1235635368	1235635368	1	1	GIL, RYAN M MD	8/1/2024	207RC0200X	NA	Other	026	PHYSICIANS	None	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
181217	Fee-for-Service	1063857951	1063857951	1	1	GIRN, RUPINDER K CRNA	10/14/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
181231	Fee-for-Service	1780678433	1780678433	1	1	GORDON, H W MD MEDICAL CORP	10/1/1983	207ZP0102X	NA	Other	026	PHYSICIANS	20719	68	Hematology	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
181265	Fee-for-Service	1649779919	1649779919	1	4	GREEN PHYSICAL THERAPY, INC.	6/29/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	32605 TEMECULA PKWY	103	TEMECULA	CA	92592	6837	33	06065	33.48367403	-117.088031	Riverside County
181332	Fee-for-Service	1861917064	1861917064	1	1	GIANNINI, ASHLEY	12/5/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
181364	Fee-for-Service	1669827010	1669827010	1	1	GOLLNICK-LICENIK, APRIL LMF	5/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
181406	Fee-for-Service	1114292372	1114292372	1	1	GOYAL, NISHANT MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133450	40	Pediatrics	0	In state provider	None	4050 DUBLIN BLVD	None	ALAMEDA	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda
181429	Fee-for-Service	1609331677	1609331677	1	1	GOOD HOPE PSYCHOLOGICAL SERV	7/25/2019	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ICES	39755 MURRIETA HOT SPRIN	STE D-160	MURRIETA	CA	92563	9113	33	06065	33.55575954	-117.1627899	Riverside County
181441	Fee-for-Service	1972705655	1972705655	1	1	GAMBRELL, DEBRA H DO	4/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9801	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
181459	Fee-for-Service	1972586006	1972586006	1	1	GASSEN, JOSEPH A MD	3/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89521	3861	00	None	39.52483792	-119.7968314	Washoe County
181490	Fee-for-Service	1609500438	1609500438	1	1	GUAMA, ANN W	8/4/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4704 RODEO LN	APT 4	LOS ANGELES	CA	90016	5622	19	06037	34.02113889	-118.3486588	Los Angeles County
181498	Fee-for-Service	1952503484	1952503484	1	1	GARCIA, MICHELE MD	3/8/2023	207P00000X	NA	Other	026	PHYSICIANS	184262	None	None	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
181499	Fee-for-Service	1194831784	1194831784	1	1	GURUPRASAD,RAJU MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	AZ INPATIENT MED ASSOC	5301 E GRANT RD	None	TUCSON	AZ	85712	0000	00	None	32.252391	-110.8790055	Pima County
181534	Fee-for-Service	1184632291	1184632291	1	1	GREEN, RICHARD K LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3518 CROWELL ST	None	SAN DIEGO	CA	92103	4730	37	06073	32.7426604	-117.1773501	San Diego County
181619	Fee-for-Service	1427180470	1427180470	1	1	GOUIN, MYRANDA M LCSW	6/29/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
181650	Fee-for-Service	1851497911	1851497911	1	1	GONZALEZ, CASIMIRO MD	12/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66511	18	Ophthalmology	0	In state provider	BUENA VISTA EYE MED CTR	4566 FLORENCE AVE	STE 3	CUDAHY	CA	90201	4346	19	06037	33.97004595	-118.1858787	Los Angeles County
181702	Fee-for-Service	1760423677	1760423677	1	1	GARFIELD BEACH CVS LLC	4/9/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1747 N CAHUENGA BLVD	None	HOLLYWOOD	CA	90028	5101	19	06037	34.103223	-118.3295775	Los Angeles County
181707	Fee-for-Service	1205137189	1205137189	1	1	GLENOAKS IMAGING	2/22/2012	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONALS INC	1731 W GLENOAKS BLVD	# 101	GLENDALE	CA	91201	1599	19	06037	34.17201073	-118.2907193	Los Angeles County
181708	Fee-for-Service	1700894003	1700894003	1	1	GOORE, ZOEY J MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67214	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
181718	Fee-for-Service	1609331677	1609331677	1	1	GOOD HOPE PSYCHOLOGICAL SERV	7/25/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ICES	39755 MURRIETA HOT SPRIN	STE D-160	MURRIETA	CA	92563	9113	33	06065	33.55575954	-117.1627899	Riverside County
181728	Fee-for-Service	1972705655	1972705655	1	1	GAMBRELL, DEBRA H DO	4/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9801	05	Anesthesiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
181746	Fee-for-Service	1407835572	1407835572	1	1	GODDARD, DWIGHT	12/11/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63539	08	Family Practice	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
181753	Fee-for-Service	1598832495	1598832495	1	1	GEE, CAROL S MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41858	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
181795	Fee-for-Service	1447600655	1447600655	1	1	GREEN, CHRISTOPHER R MD	7/31/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	168965	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
181830	Fee-for-Service	1841311305	1841311305	1	1	GLAZER, HOWARD B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43718	30	Radiology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
181844	Fee-for-Service	1740329499	1740329499	1	1	GOLD, VADIM PT	5/23/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6221 WILSHIRE BLVD	#616	LOS ANGELES	CA	90048	5201	19	06037	34.06329534	-118.3640031	Los Angeles County
181856	Fee-for-Service	1801374939	1801374939	1	1	GARRETT, SUZANNE LCSW	2/7/2025	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	408 PANTHER CREEK RD.	None	WILLOW CREEK	CA	95573	0151	12	06023	40.93399555	-123.6298372	Humboldt County
181911	Fee-for-Service	1619364577	1619364577	1	1	GILLETTE, KELLEY C MD	6/8/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143943	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
181918	Fee-for-Service	1407941586	1407941586	1	1	GANDHI, SHOBHANA MD INC	7/1/2003	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1300 N VERMONT AVE	SUITE 307	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
181936	Fee-for-Service	1619031556	1619031556	1	1	GERTSIK, LEV G MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54951	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
182002	Fee-for-Service	1366855405	1366855405	1	1	GOLDENBERG, DAVID E MD	6/3/2020	207R00000X	NA	Other	026	PHYSICIANS	149308	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
182151	Fee-for-Service	1740893551	1740893551	1	1	GALENUS HOSPICE CARE INC	8/2/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	159 E HUNTINGTON DR	SUITE 6	ARCADIA	CA	91006	3225	19	06037	34.14017618	-118.0259279	Los Angeles County
182223	Fee-for-Service	1619031556	1619031556	1	1	GERTSIK, LEV G MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54951	26	Psychiatry (child)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
182246	Fee-for-Service	1801002134	1801002134	1	1	GIDVANI, SANDEEP N MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120186	20	Orthopedic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
182281	Fee-for-Service	1518019363	1518019363	1	1	GEONETTA, NELIDA PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
182300	Fee-for-Service	1336258235	1336258235	2	1	GHARRAEE, ZAHRA MD	10/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	81280	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
182309	Fee-for-Service	1982626776	1982626776	2	1	GARFIELD BEACH CVS LLC	6/9/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11525 SOUTH ST	None	CERRITOS	CA	90703	6627	19	06037	33.85851951	-118.0873485	Los Angeles County
182359	Fee-for-Service	1386911782	1386911782	1	1	GOYAL, MEGHA MD	9/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130995	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
182363	Fee-for-Service	1164432597	1164432597	1	1	GOEL, HITESH MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
182446	Fee-for-Service	1740893551	1740893551	1	1	GALENUS HOSPICE CARE INC	8/2/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	159 E HUNTINGTON DR	SUITE 6	ARCADIA	CA	91006	3225	19	06037	34.14017618	-118.0259279	Los Angeles County
182461	Fee-for-Service	1902329246	1902329246	1	1	GARFIELD BEACH CVS LLC	1/2/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15180 KENSINGTON PARK DR	None	TUSTIN	CA	92782	9136	30	06059	33.710724	-117.8168355	Orange County
182488	Fee-for-Service	1174866214	1174866214	1	1	GAUTAM, SUBANI MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	235 W 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
182506	Fee-for-Service	1194786137	1194786137	1	1	GOPALAKRISHNAN, THANDAVARAJA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11721 FUQUA ST	None	HOUSTON	TX	77034	4541	00	None	29.62044792	-95.20998705	Harris County
182535	Fee-for-Service	1609349646	1609349646	1	1	GEIGER, SARAH R NP	3/2/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3700 MALL VIEW RD	None	BAKERSFIELD	CA	93306	3050	15	06029	35.39462173	-118.9518506	Kern County
182613	Fee-for-Service	1396884094	1396884094	1	1	GOODLOW, GERALD R MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58392	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
182651	Fee-for-Service	1720421332	1720421332	1	1	GONZALEZ, BIANCA R LCSW	3/15/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
182664	Fee-for-Service	1255183943	1255183943	1	1	GONZALEZ SALDIVAR, ROQUE	2/13/2025	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4345 GLENCOE AVENUE	C12A	MARINA DEL REY	CA	90292	6466	19	06037	33.98663694	-118.4397916	Los Angeles County
182676	Fee-for-Service	1215234257	1215234257	1	1	GOLDHOFF, PATRICIA E MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123318	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
182701	Fee-for-Service	1194229625	1194229625	1	1	GUAN, PATRICIA MD	8/1/2023	207L00000X	NA	Other	026	PHYSICIANS	165311	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
182727	Fee-for-Service	1265454870	1265454870	2	1	GARFIELD BEACH CVS LLC	10/25/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2525 4TH ST	None	EUREKA	CA	95501	0823	12	06023	40.80479218	-124.1437764	Humboldt County
182735	Fee-for-Service	1104889344	1104889344	1	1	GREEN-MARTIN, GERMAINE V	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	54334	40	Pediatrics	0	In state provider	None	1500 S CENTRAL AVE	STE 100	GLENDALE	CA	91204	2585	19	06037	34.12736888	-118.257777	Los Angeles County
182755	Fee-for-Service	1326125659	1326125659	1	1	GUERRERO, EDGAR L MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	56186	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
182770	Fee-for-Service	1558692012	1558692012	1	1	GAINER, MAISHA LMFT	4/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
182795	Fee-for-Service	1770532525	1770532525	1	1	GWYNETTE, GRETCHEN W MD	5/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78296	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
182798	Fee-for-Service	1851693378	1851693378	1	1	GHIMIRE, SHANKAR P MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114532	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
182856	Fee-for-Service	1659888543	1659888543	1	1	GOLDMAN, IRIT DR PSYD	8/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LICENSED MARRIAGE AND FA	1604 FORD AVE	SUITE 1	MODESTO	CA	95350	4649	50	06099	37.66748595	-120.9836064	Stanislaus County
182883	Fee-for-Service	1043798218	1043798218	1	1	GOLAS, LILIYA MD INC	11/14/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	156865	01	General Practice	0	In state provider	None	11216 TRINITY RIVER DR	None	RANCHO CORDOVA	CA	95670	2968	34	06067	38.622906	-121.2684705	Sacramento County
182902	Fee-for-Service	1962866400	1962866400	1	1	GRIFFITH, TRAVIS PSYD	4/25/2025	No Taxonomy Provided	NA	None	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
182903	Fee-for-Service	1396884094	1396884094	1	1	GOODLOW, GERALD R MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58392	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
182908	Fee-for-Service	1386686202	1386686202	1	1	GOODMAN, KAREN M MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52263	01	General Practice	0	In state provider	None	217 W CENTRAL AVE	STE G	LOMPOC	CA	93436	2830	42	06083	34.66084049	-120.460302	Santa Barbara County
182910	Fee-for-Service	1194290288	1194290288	1	1	GOLDEN ENVISION OPTOMETRY IN	5/15/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	C	655 W DUARTE RD # B	None	ARCADIA	CA	91007	7332	19	06037	34.12630473	-118.05356	Los Angeles County
182911	Fee-for-Service	1083949853	1083949853	1	1	GROVES, JUDITH H MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110009	07	Dermatology	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
182932	Fee-for-Service	1639148596	1639148596	1	1	GREGORY, MARIA G MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (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
182945	Fee-for-Service	1982030870	1982030870	1	1	GARCIA-ALCAZAR, MARIA D	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
182951	Fee-for-Service	1740738103	1740738103	1	1	GHOSH, SHWETA PHD	2/20/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
182957	Fee-for-Service	1821387499	1821387499	1	1	GIUSTINI, MELISSA A MD	7/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	131731	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
182958	Fee-for-Service	1891722369	1891722369	1	1	GONZALEZ, CARLOS R MD	8/28/1992	174400000X	NA	Other	026	PHYSICIANS	43562	41	Internal Medicine	0	In state provider	None	401 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	3620	19	06037	34.01634247	-118.1020649	Los Angeles County
183016	Fee-for-Service	1326453861	1326453861	1	1	GOSIS, JULIA MD	4/22/2019	390200000X	NA	Other	026	PHYSICIANS	138646	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
183076	Fee-for-Service	1518915768	1518915768	1	1	GOLDSTEIN, JEFFREY D MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132019	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
183077	Fee-for-Service	1154345254	1154345254	1	1	GREEN, GARY A MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63969	20	Orthopedic Surgery	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
183105	Fee-for-Service	1225668148	1225668148	1	1	GOLDEN EMPIRE TRANSIT DISTRI	5/8/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CT	1830 GOLDEN STATE AVE	None	BAKERSFIELD	CA	93301	1012	15	06029	35.39225422	-119.0260627	Kern County
183106	Fee-for-Service	1821514811	1821514811	1	1	GREWAL, SIMRAN NP	1/19/2021	363LA2100X	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
183172	Fee-for-Service	1043798218	1043798218	1	1	GOLAS, LILIYA MD INC	11/14/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	156865	18	Ophthalmology	0	In state provider	None	11216 TRINITY RIVER DR	None	RANCHO CORDOVA	CA	95670	2968	34	06067	38.622906	-121.2684705	Sacramento County
183192	Fee-for-Service	1679766026	1679766026	2	1	GALLAGHER, KIMBER LEE	11/13/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	696 E SANTA CLARA ST	STE 110	SAN JOSE	CA	95112	1911	43	06085	37.34280728	-121.876519	Santa Clara County
183207	Fee-for-Service	1831585827	1831585827	1	1	GAULTNEY, AMY C MD	8/20/2021	2080P0216X	NA	Other	026	PHYSICIANS	156065	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
183215	Fee-for-Service	1588079503	1588079503	1	1	GHASEMIZADEH, DARA DO	12/11/2019	207R00000X	NA	Other	026	PHYSICIANS	17318	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
183246	Fee-for-Service	1891722369	1891722369	1	1	GONZALEZ, CARLOS R MD	8/28/1992	174400000X	NA	Other	026	PHYSICIANS	43562	45	Nephrology (Renal-Kidney)	0	In state provider	None	401 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	3620	19	06037	34.01634247	-118.1020649	Los Angeles County
183275	Fee-for-Service	1508225673	1508225673	1	1	GEBHART, JASON A	5/31/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
183306	Fee-for-Service	1114563616	1114563616	1	1	GUARDIAN ANGEL HOME CARE OF	8/5/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	VENTURA LLC	2590 E MAIN ST	SUITE 101	VENTURA	CA	93003	2619	56	06111	34.27490911	-119.261894	Ventura County
183315	Fee-for-Service	1649205493	1649205493	1	1	GREENBAUM, JASON L MD	6/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55249	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
183330	Fee-for-Service	1033309836	1033309836	1	1	GOLLA, SAILAJA MD	5/5/2021	2084N0402X	NA	Neurology	026	PHYSICIANS	171744	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
183364	Fee-for-Service	1154345254	1154345254	1	1	GREEN, GARY A MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63969	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
183400	Fee-for-Service	1902223092	1902223092	1	1	GAN, ANTHONY L DO	7/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14345	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
183429	Fee-for-Service	1417464363	1417464363	1	1	GUPTA, PRANJAL MD	9/9/2024	207P00000X	NA	Other	026	PHYSICIANS	183886	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
183436	Fee-for-Service	1770661571	1770661571	1	1	GRITZ, DAVID C MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	64422	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
183441	Fee-for-Service	1205082476	1205082476	2	1	GLEN PARK AT GLENDALE	1/27/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1250 S BOYNTON ST	None	GLENDALE	CA	91205	3451	19	06037	34.13103708	-118.2487971	Los Angeles County
183477	Fee-for-Service	1316988223	1316988223	1	1	GARFIELD BEACH CVS, LLC	9/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3010 S. SEPULVEDA BLVD	None	LOS ANGELES	CA	90034	4202	19	06037	34.02641411	-118.4278801	Los Angeles County
183535	Fee-for-Service	1679934756	1679934756	1	1	GONZALEZ, MARYBEL LMFT	9/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17130 SEQUOIA ST	STE. 103	HESPERIA	CA	92345	1827	36	06071	34.46911749	-117.289755	San Bernardino County
183632	Fee-for-Service	1053815001	1053815001	1	1	GHANSAH, ISAAC K MD	5/26/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	166605	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
183638	Fee-for-Service	1952497745	1952497745	1	1	GLASS, RICHARD A JR MD	2/11/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	80513	36	Psychiatry	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
183644	Fee-for-Service	1306836366	1306836366	1	1	GRAHAM, JOHN M MD	1/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72388	08	Family Practice	0	In state provider	None	5 BON AIR RD	STE 101	LARKSPUR	CA	94939	1134	21	06041	37.9438204	-122.5395357	Marin County
183652	Fee-for-Service	1154345254	1154345254	1	1	GREEN, GARY A MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63969	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
183653	Fee-for-Service	1134167810	1134167810	1	1	GIRON, PEDRO MD	1/3/2005	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	221 MAHALANI STREET	None	WAILUKU	HI	96793	2526	00	None	20.88554026	-156.4902142	Maui County
183722	Fee-for-Service	1770661571	1770661571	1	1	GRITZ, DAVID C MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	64422	01	General Practice	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
183816	Fee-for-Service	1033344148	1033344148	1	1	GANAPATHI, KARTHIK A MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142581	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
183817	Fee-for-Service	1689322158	1689322158	1	1	GILLILAND, TYLER PT	6/26/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
183845	Fee-for-Service	1457760852	1457760852	1	1	GARRETT, LATOYA LMFT	8/29/2024	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
183857	Fee-for-Service	1922390533	1922390533	1	1	GRANT, TIFFANI PSYD	11/9/2019	103TF0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	(GPS)	310 N IRWIN ST	14	HANFORD	CA	93230	4479	16	06031	36.32789942	-119.6476719	Kings County
183869	Fee-for-Service	1770014391	1770014391	1	1	GAFFAR, SHEEMA MD	11/11/2022	390200000X	NA	Other	026	PHYSICIANS	169954	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
183953	Fee-for-Service	1023163789	1023163789	1	1	GARRETT, TERESA E PHD	3/14/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2060 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
183955	Fee-for-Service	1487831046	1487831046	1	1	GRADMAN, WAYNE S MD INC	11/30/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	450 N ROXBURY DR	STE 275	BEVERLY HILLS	CA	90210	4241	19	06037	34.06820793	-118.4070317	Los Angeles County
183973	Fee-for-Service	1669449773	1669449773	2	1	GUTIERREZ-GO, MARIA N MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	51819	None	None	0	In state provider	None	81880 DR CARREON BLVD	STE B209	INDIO	CA	92201	5585	33	06065	33.70742953	-116.23572	Riverside County
183984	Fee-for-Service	1568471837	1568471837	1	1	GIANGRECO, LIZZIE C MD	3/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	74705	40	Pediatrics	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
184012	Fee-for-Service	1639440704	1639440704	1	1	GOLECHHA, PRITI MD	4/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121234	40	Pediatrics	0	In state provider	None	200 C STREET	None	PATTERSON	CA	95363	2701	50	06099	37.46733509	-121.1258615	Stanislaus County
184013	Fee-for-Service	1508073396	1508073396	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	888 W ARROW HWY	None	SAN DIMAS	CA	91773	2495	19	06037	34.104285	-117.82386	Los Angeles County
184014	Fee-for-Service	1053571950	1053571950	1	1	GEORGETTE, PAMELA L LMFT	12/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12725 VENTURA BLVD	SUITE G	STUDIO CITY	CA	91604	2437	19	06037	34.1447989	-118.4101229	Los Angeles County
184079	Fee-for-Service	1649881400	1649881400	1	1	GUINTO, JOYCE MARIE LCSW	9/14/2023	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
184081	Fee-for-Service	1710942255	1710942255	1	1	GARFIELD IMAGING CENTER	2/6/1985	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	A CALIFORNIA PARTNERSHIP	555 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
184124	Fee-for-Service	1427307784	1427307784	1	1	GARRETT, LEGINA M NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
184145	Fee-for-Service	1194717520	1194717520	1	1	GOLDEN STATE MEDICAL	1/1/1992	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	200 LINDEN AVENUE	STE 100	AUBURN	CA	95603	5280	31	06061	38.89877906	-121.0693783	Placer County
184149	Fee-for-Service	1932514379	1932514379	1	1	GILROY, DENNIS DO	1/7/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23558	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
184193	Fee-for-Service	1992162911	1992162911	1	1	GORDIAN MEDICAL IV INC	6/27/2017	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1430 3RD STREET	STE 6	RIVERSIDE	CA	92507	3457	33	06065	33.98298096	-117.3432357	Riverside County
184251	Fee-for-Service	1194808980	1194808980	1	1	GATUS, LEANDRO G MD	2/8/2015	2084P0802X	NA	Psychiatry	026	PHYSICIANS	45231	36	Psychiatry	0	In state provider	None	14400 ROSCOE BLVD	STE D	PANORAMA CITY	CA	91402	3001	19	06037	34.2215399	-118.4475682	Los Angeles County
184297	Fee-for-Service	1699782516	1699782516	1	3	GARCIA, JEFFREY	2/7/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1046 WHITLEY AVE	None	CORCORAN	CA	93212	2324	16	06031	36.09808646	-119.5607295	Kings County
184302	Fee-for-Service	1033747555	1033747555	1	1	GOMEZ LOPEZ, MONICA MD	8/22/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
184397	Fee-for-Service	1306816186	1306816186	1	1	GUSHIKEN, BRYAN MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	94-800 UKEE ST	STE 303	WAIPAHU	HI	96797	0000	00	None	21.41257872	-158.0008603	Honolulu County
184444	Fee-for-Service	1760061568	1760061568	1	1	GUBBELS, ALEXANDRA MD	7/12/2024	207P00000X	NA	Other	026	PHYSICIANS	188692	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
184470	Fee-for-Service	1437216116	1437216116	1	1	GIBSON, CATHY PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE	PARKWAY	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
184507	Fee-for-Service	1164593067	1164593067	1	1	GRAYSON, LUCIA S MD	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	36863	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
184525	Fee-for-Service	1891758686	1891758686	1	1	GREEN, WILLIAM J MD	8/30/1990	207P00000X	NA	Other	026	PHYSICIANS	70480	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
184537	Fee-for-Service	1366575003	1366575003	1	1	GOWDA, ALPANA R MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91983	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
184541	Fee-for-Service	1558893719	1558893719	1	1	GAINES, DIRK MD	7/26/2022	208M00000X	NA	Other	026	PHYSICIANS	161078	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
184543	Fee-for-Service	1770142382	1770142382	1	1	GARFIELD BEACH CVS LLC	10/11/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1026 S BROADWAY # A	None	LOS ANGELES	CA	90015	4086	19	06037	34.04029954	-118.2580882	Los Angeles County
184547	Fee-for-Service	1396410965	1396410965	1	1	GATHER YOUR STRENGTH MARRIAG	7/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ING	2525 CAMINO DEL RIO S	STE 313	SAN DIEGO	CA	92108	3784	37	06073	32.76765181	-117.1387992	San Diego County
184558	Fee-for-Service	1043827629	1043827629	1	1	GAO HOSPICE CARE INC	8/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8117 FOOTHILL BLVD	None	SUNLAND	CA	91040	2955	19	06037	34.2596885	-118.3097925	Los Angeles County
184594	Fee-for-Service	1629624077	1629624077	1	1	GOLDSMITH, LAURA G CNP	8/1/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
184596	Fee-for-Service	1164866182	1164866182	1	1	GAIROLA, CHETAN K DO	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14483	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
184597	Fee-for-Service	1245490820	1245490820	1	1	GAMBALA, GERALD T CRNA	9/24/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	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
184640	Fee-for-Service	1932194545	1932194545	1	1	GELORMINI, RUSSELL G DO	4/1/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	10490	30	Radiology	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5606	34	06067	38.571237	-121.469958	Sacramento County
184656	Fee-for-Service	1295145522	1295145522	1	1	GESSNER, DANIEL M MD	6/24/2019	207L00000X	NA	Other	026	PHYSICIANS	156431	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
184713	Fee-for-Service	1992307607	1992307607	1	1	GOLDEN OAK PEDIATRICS	1/3/2021	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	27141 HIDAWAY AVE	STE 105	SANTA CLARITA	CA	91351	4137	19	06037	34.41483	-118.469039	Los Angeles County
184752	Fee-for-Service	1740368505	1740368505	1	1	GOODFELLOW, ROBYN J MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	46613	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
184815	Fee-for-Service	1437268323	1437268323	1	1	GARDNER, DAVID G MD	6/30/1983	207RE0101X	NA	Endocrinology	026	PHYSICIANS	41086	67	Endocrinology	0	In state provider	DEPT OF MEDICINE UCSF	505 PARNASSUS AVE	# M997	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
184818	Fee-for-Service	1851825335	1851825335	1	1	GENG, JUNE Z MD	7/10/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172568	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
184821	Fee-for-Service	1952319964	1952319964	1	1	GOETZ, STEPHEN C MD	1/1/1979	207N00000X	NA	Dermatology	026	PHYSICIANS	32226	07	Dermatology	0	In state provider	None	6401 COYLE AVE	STE 315	CARMICHAEL	CA	95608	0310	34	06067	38.668698	-121.3148745	Sacramento County
184826	Fee-for-Service	1659344224	1659344224	1	1	GARRETT-BROWN, REBECCA CNW	12/1/2011	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	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
184841	Fee-for-Service	1053305797	1053305797	1	1	GLENDALE PATHOLOGY ASSOC	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MED GRP OF GLENDALE	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
184845	Fee-for-Service	1043827629	1043827629	1	1	GAO HOSPICE CARE INC	8/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8117 FOOTHILL BLVD	None	SUNLAND	CA	91040	2955	19	06037	34.2596885	-118.3097925	Los Angeles County
184855	Fee-for-Service	1366639858	1366639858	1	1	GUZMAN, RAPAEL MD	10/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
184862	Fee-for-Service	1679769954	1679769954	1	1	GABRIEL, ZENOVIA H MD	5/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89799	07	Dermatology	0	In state provider	None	1045 ATLANTIC AVE	# 819	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
184886	Fee-for-Service	1609058544	1609058544	1	1	GHATAN, ROBERT B MD INC	1/1/1979	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	30201	20	Orthopedic Surgery	0	In state provider	ADVANCED ORTHOPAEDICS	207 S SANTA ANITA ST	STE 336	SAN GABRIEL	CA	91776	1160	19	06037	34.10072807	-118.1066296	Los Angeles County
184925	Fee-for-Service	1245817022	1245817022	1	1	GOYAL, RAGHAV K MD	10/12/2024	207P00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
185038	Fee-for-Service	1164926929	1164926929	1	1	GARCIA, MARISA C	1/15/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
185047	Fee-for-Service	1215036728	1215036728	1	1	GALKO, ANNE M CNM	10/14/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3779 PIEDMONT AVENUE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
185083	Fee-for-Service	1780966796	1780966796	1	1	GREEN VALLEY HOME	10/3/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HEALTH & HOSPICE INC	3009 DOUGLAS BLVD	SUITE 160	ROSEVILLE	CA	95661	3859	31	06061	38.74413911	-121.2328404	Placer County
185089	Fee-for-Service	1033259767	1033259767	1	1	GREG & MARCEE HIRST	5/29/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	BENTLEY HOUSE	11350 BENTLEY ST	None	RIVERSIDE	CA	92505	2257	33	06065	33.94948372	-117.5125353	Riverside County
185092	Fee-for-Service	1124551130	1124551130	1	1	GARCIA, DANIEL A MD	8/3/2021	207L00000X	NA	Other	026	PHYSICIANS	159943	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
185098	Fee-for-Service	1003806381	1003806381	1	1	GUISLER, PAUL D MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	842 EAST MAIN ST	None	MEDFORD	OR	97504	7134	00	None	42.32787853	-122.863311	Jackson County
185112	Fee-for-Service	1295867513	1295867513	1	1	GUNAWARDANA, RAJAH P MD INC	1/30/2006	193400000X	NA	Other	026	PHYSICIANS	72389	05	Anesthesiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
185117	Fee-for-Service	1982674560	1982674560	1	1	GARRISON MEMORIAL HOSP	7/8/2008	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	407 3RD AVE SE	None	GARRISON	ND	58540	7235	00	None	47.64837346	-101.4107506	McLean County
185131	Fee-for-Service	1669598330	1669598330	1	1	GOLDEN, EVE R MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65264	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
185163	Fee-for-Service	1437110566	1437110566	1	1	GARCIA, RICHARD L MD	5/7/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68526	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
185178	Fee-for-Service	1104865898	1104865898	1	1	GROSS, KENNETH G MD	4/11/1996	207NS0135X	NA	Dermatology	026	PHYSICIANS	37440	07	Dermatology	0	In state provider	None	5222 BALBOA AVE	FL 6	SAN DIEGO	CA	92117	6963	37	06073	32.81873589	-117.1838368	San Diego County
185182	Fee-for-Service	1376593442	1376593442	1	1	GUNDERSEN LUTHERAN HEALTH	11/10/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SYSTEM	1910 SOUTH AVE	None	LA CROSSE	WI	54601	5467	00	None	43.79473653	-91.24623835	La Crosse County
185183	Fee-for-Service	1548204811	1548204811	1	1	GARFIELD BEACH CVS, LLC	9/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4345 W. CENTURY BLVD	None	INGLEWOOD	CA	90304	1519	19	06037	33.94546846	-118.3518	Los Angeles County
185210	Fee-for-Service	1245817022	1245817022	1	1	GOYAL, RAGHAV K MD	10/12/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	39	06077	38.12188356	-121.285872	San Joaquin County
185249	Fee-for-Service	1912151408	1912151408	1	1	GOHATA, LAURIE K	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
185259	Fee-for-Service	1801055538	1801055538	1	1	GOODEN, SHANTI L MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140789	26	Psychiatry (child)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
185261	Fee-for-Service	1295177053	1295177053	1	1	GABI, JENAN N MD	3/12/2025	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	67	Endocrinology	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
185328	Fee-for-Service	1649368754	1649368754	2	1	GARLAND, ADELLA M MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81720	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
185347	Fee-for-Service	1639696180	1639696180	1	1	GUARDIAN FLIGHT LLC	12/29/2019	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	2502 CLARK CARR LOOP	None	ALBUQUERQUE	NM	87106	5606	00	None	35.03788351	-106.618617	Bernalillo County
185366	Fee-for-Service	1285712067	1285712067	1	1	GOLDBERG, CHARLES M MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48290	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
185372	Fee-for-Service	1780966796	1780966796	1	1	GREEN VALLEY HOME	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HEALTH & HOSPICE INC	3009 DOUGLAS BLVD	SUITE 160	ROSEVILLE	CA	95661	3859	31	06061	38.74413911	-121.2328404	Placer County
185404	Fee-for-Service	1982674560	1982674560	1	1	GARRISON MEMORIAL HOSP	7/8/2008	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	407 3RD AVE SE	None	GARRISON	ND	58540	7235	00	None	47.64837346	-101.4107506	McLean County
185408	Fee-for-Service	1780872671	1780872671	1	1	GOLDBAN, WALLACE F MD	12/12/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	77969	None	None	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E130	PALM SPRINGS	CA	92262	4834	33	06065	33.839505	-116.5455735	Riverside County
185427	Fee-for-Service	1730244096	1730244096	1	1	GHOO, MELISSA OD	4/14/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 E 4TH STREET	None	SANTA ANA	CA	92705	3910	30	06059	33.74805463	-117.8400671	Orange County
185442	Fee-for-Service	1033806260	1033806260	1	1	GRAJALES, STEPHANIE LCSW	1/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
185445	Fee-for-Service	1356987085	1356987085	1	1	GUARDIAN ANGEL HOME CARE OF	12/6/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGL LLC	3505 CAMINO DEL RIO S	SUITE 220	SAN DIEGO	CA	92108	4002	37	06073	32.77756386	-117.1185135	San Diego County
185470	Fee-for-Service	1376593442	1376593442	1	1	GUNDERSEN LUTHERAN HEALTH	11/10/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SYSTEM	1910 SOUTH AVE	None	LA CROSSE	WI	54601	5467	00	None	43.79473653	-91.24623835	La Crosse County
185489	Fee-for-Service	1275570756	1275570756	1	1	GIURGIUS, MOATAZ MD INC	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53359	36	Psychiatry	0	In state provider	None	15651 IMPERIAL HWY	STE 203	LA MIRADA	CA	90638	1653	19	06037	33.91736136	-117.9972197	Los Angeles County
185549	Fee-for-Service	1801055538	1801055538	1	1	GOODEN, SHANTI L MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140789	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
185558	Fee-for-Service	1033441035	1033441035	1	1	GOHN, SUSAN LYNN	12/9/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8017 BLACK WALNUT COURT	None	CITRUS HEIGHTS	CA	95610	4603	34	06067	38.690055	-121.2654645	Sacramento County
185566	Fee-for-Service	1184815722	1184815722	1	1	GATES, JEFFREY J MD	1/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92247	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
185599	Fee-for-Service	1831103506	1831103506	1	2	GOLDWASSER, JEROME E MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	8635 W 3RD ST	STE 970W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
185607	Fee-for-Service	1740233808	1740233808	1	1	GADHE, BALU M MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50258	08	Family Practice	0	In state provider	None	340 W CENTRAL AVE	None	BREA	CA	92821	3006	30	06059	33.93198898	-117.9008269	Orange County
185624	Fee-for-Service	1518989201	1518989201	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8800 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2658	19	06037	34.00205052	-118.0857646	Los Angeles County
185626	Fee-for-Service	1104179217	1104179217	1	1	GUDINO, DAVID	5/20/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
185668	Fee-for-Service	1346880283	1346880283	1	1	GLAZER ROSOFF, KERA E PHD	9/3/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9600 CENTER AVE	160	RANCHO CUCAMONGA	CA	91730	5838	36	06071	34.07922138	-117.5796173	San Bernardino County
185697	Fee-for-Service	1760504278	1760504278	1	1	GARZA, JUDITH MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88650	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
185715	Fee-for-Service	1669805594	1669805594	1	1	GODDARD, HEIDI M	8/1/2019	207P00000X	NA	Other	026	PHYSICIANS	159958	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
185724	Fee-for-Service	1558323105	1558323105	1	1	GONG, GERALD D MD	3/1/2017	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
185738	Fee-for-Service	1578619839	1578619839	1	1	GUTIERREZ, EDITH LCSW	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 DISCOVERY DR	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
185796	Fee-for-Service	1245206705	1245206705	1	1	GREEN, ROLLIN M	8/5/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	23339	07	Dermatology	0	In state provider	None	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	30	06059	33.61321911	-117.8722084	Orange County
185827	Fee-for-Service	1043390735	1043390735	1	1	GREENO, RONALD A MD	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60795	41	Internal Medicine	0	In state provider	None	2300 S FLOWER ST	STE 106	LOS ANGELES	CA	90007	2689	19	06037	34.0294397	-118.2734132	Los Angeles County
185845	Fee-for-Service	1033441035	1033441035	1	1	GOHN, SUSAN LYNN	12/9/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8017 BLACK WALNUT COURT	None	CITRUS HEIGHTS	CA	95610	4603	34	06067	38.690055	-121.2654645	Sacramento County
185893	Fee-for-Service	1831103506	1831103506	1	2	GOLDWASSER, JEROME E MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	8635 W 3RD ST	STE 970W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
185902	Fee-for-Service	1962745752	1962745752	1	1	GREENBERG, ADAM W MD	9/1/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	136220	10	Gastroenterology (M.D. only)	0	In state provider	None	7095 N CHESTNUT AVE	STE 101	FRESNO	CA	93720	0360	10	06019	36.83995818	-119.7370077	Fresno County
185989	Fee-for-Service	1548697931	1548697931	1	1	GONZALES-REED, MICHELLE LMF	2/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
185991	Fee-for-Service	1366038259	1366038259	1	1	GUIDING EMPATHY INC	4/27/2021	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7755 CENTER AVE	SUITE 1100 OFFICE 1118	HUNTINGTON BEACH	CA	92647	3007	30	06059	33.73394977	-117.9950044	Orange County
186005	Fee-for-Service	1851485049	1851485049	1	1	GEOLA, FLOR LEE MD	8/31/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31360	67	Endocrinology	0	In state provider	None	11600 WILSHIRE BLVD	STE 210	LOS ANGELES	CA	90025	1782	19	06037	34.05055194	-118.4594619	Los Angeles County
186071	Fee-for-Service	1306889787	1306889787	1	1	GARFIELD BEACH CVS,LLC	11/14/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3880 WEST ROSECRANS BLVD	None	HAWTHORNE	CA	90250	8018	19	06037	33.90188447	-118.3422375	Los Angeles County
186117	Fee-for-Service	1043390735	1043390735	1	1	GREENO, RONALD A MD	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60795	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2300 S FLOWER ST	STE 106	LOS ANGELES	CA	90007	2689	19	06037	34.0294397	-118.2734132	Los Angeles County
186118	Fee-for-Service	1427004894	1427004894	5	2	GRCY PHARMACIES LLC	3/21/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2707 VIA DE LA VALLE	None	DEL MAR	CA	92014	1905	37	06073	32.98053887	-117.2495557	San Diego County
186134	Fee-for-Service	1376962233	1376962233	1	1	GILL, NAVPREET K MD	9/27/2017	2086S0120X	NA	General Surgery	026	PHYSICIANS	135921	85	Surgery-Pediatric	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
186143	Fee-for-Service	1992140289	1992140289	1	1	GARCIA, JOHN T MD	4/1/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	134796	01	General Practice	0	In state provider	None	5300 SNYDER LN	STE A	ROHNERT PARK	CA	94928	2915	49	06097	38.346426	-122.6855205	Sonoma County
186144	Fee-for-Service	1558576918	1558576918	1	1	GIFFORD, SHAUN M MD	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149477	02	General Surgery	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94553	3552	48	06095	38.26109552	-122.0470245	Solano County
186190	Fee-for-Service	1962745752	1962745752	1	1	GREENBERG, ADAM W MD	9/1/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	136220	41	Internal Medicine	0	In state provider	None	7095 N CHESTNUT AVE	STE 101	FRESNO	CA	93720	0360	10	06019	36.83995818	-119.7370077	Fresno County
186253	Fee-for-Service	1730185877	1730185877	1	1	GREEN, LELAND M MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	40178	68	Hematology	0	In state provider	#605	2080 CENTURY PARK E	None	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
186264	Fee-for-Service	1437340973	1437340973	1	1	GALLI, CLAUDIA P MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100936	08	Family Practice	0	In state provider	None	475 PIONEER AVE	#400	WOODLAND	CA	95776	4905	57	06113	38.67357823	-121.7456787	Yolo County
186287	Fee-for-Service	1790841278	1790841278	1	1	GROTKE, HAL L MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78266	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
186292	Fee-for-Service	1851485049	1851485049	1	1	GEOLA, FLOR LEE MD	8/31/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31360	41	Internal Medicine	0	In state provider	None	11600 WILSHIRE BLVD	STE 210	LOS ANGELES	CA	90025	1782	19	06037	34.05055194	-118.4594619	Los Angeles County
186310	Fee-for-Service	1356446074	1356446074	2	1	GELLMAN, RICHARD E MD	5/20/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	78599	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95350	1159	50	06099	37.668645	-120.9756715	Stanislaus County
186344	Fee-for-Service	1023009297	1023009297	1	1	GOTHAM, DAVID R DO	8/31/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8894	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
186350	Fee-for-Service	1316123573	1316123573	1	1	GILBERT, PAUL K MD APC	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54181	20	Orthopedic Surgery	0	In state provider	None	39 CONGRESS STREET	STE 201	PASADENA	CA	91105	3022	19	06037	34.13407645	-118.151226	Los Angeles County
186363	Fee-for-Service	1467584565	1467584565	2	1	GRIFFIN, MICHAEL L M D INC	9/4/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	CHILDREN'S CARDIO OF	2051 PIONEER CT	None	SAN MATEO	CA	94403	1719	41	06081	37.54634234	-122.3117373	San Mateo County
186388	Fee-for-Service	1447246640	1447246640	1	1	GIBSON, MICHAEL S MD	1/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54766	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
186403	Fee-for-Service	1750332698	1750332698	1	1	GREEN, CARLOS E OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2117 E LINCOLN AVE	None	ANAHEIM	CA	92806	4105	30	06059	33.83971421	-117.887438	Orange County
186440	Fee-for-Service	1891839270	1891839270	1	1	GARDENS MEDICAL CENTER INC	8/15/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	7218 GARFIELD AVE	None	BELL GARDENS	CA	90201	4812	19	06037	33.96583518	-118.1512554	Los Angeles County
186452	Fee-for-Service	1447485909	1447485909	1	1	GARCIA, DAGOBERTO J JR MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	5545 SW 8TH STREET	STE 102	MIAMI	FL	33134	2276	00	None	25.76368923	-80.28501851	Miami-Dade County
186481	Fee-for-Service	1730508979	1730508979	1	1	GANDE, ABHIRAM MD	10/5/2020	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	138072	20	Orthopedic Surgery	0	In state provider	None	7485 MISSION VALLEY RD	STE 104A	SAN DIEGO	CA	92108	4422	37	06073	32.77950357	-117.1604951	San Diego County
186483	Fee-for-Service	1952430415	1952430415	1	1	GLINN AND GIORDANO PHYSICAL	9/27/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	RAPY, INC.	701 CENTRAL VALLEY HWY	STE B & C	SHAFTER	CA	93263	2076	15	06029	35.50107282	-119.272308	Kern County
186527	Fee-for-Service	1760400907	1760400907	1	1	GOLDIE, WILLIAM D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29265	79	Neurology-Child	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
186532	Fee-for-Service	1316346075	1316346075	1	1	GOODRIDGE, YVETTE NP	10/9/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
186577	Fee-for-Service	1790841278	1790841278	1	1	GROTKE, HAL L MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78266	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
186634	Fee-for-Service	1225050388	1225050388	1	1	GREENE, RICHARD M JR PHD	2/8/2015	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2181 S EL CAMINO REAL	STE 201	OCEANSIDE	CA	92054	6222	37	06073	33.18767693	-117.3284773	San Diego County
186693	Fee-for-Service	1568824001	1568824001	1	1	GELBER, JONATHAN MD	5/27/2020	207P00000X	NA	Other	026	PHYSICIANS	153000	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
186740	Fee-for-Service	1649216672	1649216672	1	1	GOLDEN, SHELDON M OD	2/1/1998	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GOLDEN OPTOMETRIC GROUP	1026 W WEST COVINA PKWY	STE B	WEST COVINA	CA	91790	8212	19	06037	34.06855822	-117.9319371	Los Angeles County
186762	Fee-for-Service	1689600389	1689600389	1	1	GENTIVA CERTIFIED HEALTHCARE	1/1/1996	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CORP	3240 EL CAMINO REAL	SUITE 190	IRVINE	CA	92602	1385	30	06059	33.71954842	-117.7883174	Orange County
186817	Fee-for-Service	1760400907	1760400907	1	1	GOLDIE, WILLIAM D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29265	13	Neurology (M.D. only)	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
186842	Fee-for-Service	1588750343	1588750343	1	1	GILBERT, MICHAEL W MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59081	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
186881	Fee-for-Service	1093863953	1093863953	1	1	GUTTA, MADHAVI MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84498	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
186891	Fee-for-Service	1407809288	1407809288	1	1	GARCIA, JUAN C MD	4/23/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64810	None	None	0	In state provider	None	337 S 10TH ST	STE H	TAFT	CA	93268	3300	15	06029	35.13716256	-119.4651601	Kern County
186897	Fee-for-Service	1821541715	1821541715	1	1	GUEVARA, ARILYN LMFT	3/12/2021	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
186900	Fee-for-Service	1225493448	1225493448	1	1	GAETA, YADIRA LMFT	12/21/2020	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
186905	Fee-for-Service	1568555308	1568555308	1	1	GUTIERREZ, YVONNE B MD	7/3/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78443	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
186914	Fee-for-Service	1083658223	1083658223	1	1	GALEN INPATIENT PHYSICIA	1/1/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
186956	Fee-for-Service	1386738458	1386738458	1	1	GAYAGOY, JOSEPH D MD	7/22/2009	207R00000X	NA	Other	026	PHYSICIANS	56352	41	Internal Medicine	0	In state provider	None	999 S FAIRMONT AVE	STE 135	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
186957	Fee-for-Service	1972532083	1972532083	1	1	GULLER, TARANNUM MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89244	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
186963	Fee-for-Service	1629158340	1629158340	1	1	GREENLEAF, EDWARD C MD	8/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51488	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
186967	Fee-for-Service	1083659817	1083659817	1	1	GOSS, GARY J MD	12/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36906	30	Radiology	0	In state provider	None	380 W CENTRAL AVE	None	BREA	CA	92821	3002	30	06059	33.93197087	-117.901779	Orange County
186979	Fee-for-Service	1639114531	1639114531	1	1	GARFIELD BEACH CVS, LLC	8/29/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	671 EAST 1ST ST.	None	TUSTIN	CA	92780	3417	30	06059	33.74584048	-117.815805	Orange County
187015	Fee-for-Service	1497968010	1497968010	1	1	GOLDEN VALLEY HEALTH CTR	2/19/2020	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	WEST MODESTO MEDICAL CTR	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
187031	Fee-for-Service	1487910238	1487910238	1	1	GIBSON, MATTHEW MD	8/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	128104	None	None	0	In state provider	None	7601 HOSPITAL DR	SUITE 103	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
187032	Fee-for-Service	1689135006	1689135006	1	1	GLINES, KATELYN DO	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
187037	Fee-for-Service	1831265495	1831265495	1	1	GENESIS HOUSE, INC	9/15/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1149 WARREN AVE	None	VALLEJO	CA	94591	7512	48	06095	38.08809527	-122.2141876	Solano County
187077	Fee-for-Service	1205023249	1205023249	1	2	GONZALO GONZALEZ MARTINEZ MD	11/9/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	38460 5TH ST. WEST	D	PALMDALE	CA	93551	1411	19	06037	34.58128989	-118.1384766	Los Angeles County
187083	Fee-for-Service	1790194769	1790194769	1	1	GRAND AVENUE HEALTHCARE &	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTRE, LP	1730 GRAND AVE	None	LONG BEACH	CA	90804	2011	19	06037	33.788196	-118.1480335	Los Angeles County
187124	Fee-for-Service	1952550097	1952550097	1	1	GOLDENCAST MEDICAL	7/8/2008	193400000X	NA	Other	026	PHYSICIANS	96880	41	Internal Medicine	0	In state provider	CORPORATION	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
187137	Fee-for-Service	1962082313	1962082313	1	1	GANDHI, NEIL R MD	11/14/2023	2279E0002X	NA	Other	026	PHYSICIANS	185087	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
187140	Fee-for-Service	1215935713	1215935713	1	1	GANEY, JOHN T MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83253	68	Hematology	0	In state provider	None	3220 LONE TREE WAY	STE 100	ANTIOCH	CA	94509	5511	07	06013	37.98963061	-121.8077212	Contra Costa County
187183	Fee-for-Service	1851465553	1851465553	1	1	GALANTER, VICTORIA NP	10/31/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
187219	Fee-for-Service	1376561720	1376561720	1	1	GROSSETT, ROBERT 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	250 THOMPSON ST	None	SAINT PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
187232	Fee-for-Service	1891225652	1891225652	1	1	GINSBERG, DAVID N MD	11/14/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	172571	None	None	0	In state provider	None	6719 ALVARADO RD	207	SAN DIEGO	CA	92120	5252	37	06073	32.77684978	-117.055137	San Diego County
187252	Fee-for-Service	1922249077	1922249077	1	1	GOLDEN VALLEY HEALTH CENTER	11/19/2009	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 W MAIN ST	None	TURLOCK	CA	95380	3411	50	06099	37.4926695	-120.862917	Stanislaus County
187275	Fee-for-Service	1396917548	1396917548	1	1	GOLD, ALEX MD AMC	2/21/2017	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2021 SANTA MONICA BLVD	STE 440E	SANTA MONICA	CA	90404	2154	19	06037	34.02922048	-118.4793681	Los Angeles County
187286	Fee-for-Service	1578582755	1578582755	1	1	GORE, RUFUS W MD	4/8/1994	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	63651	18	Ophthalmology	0	In state provider	None	1040 ELM AVE	STE 100	LONG BEACH	CA	90813	3265	19	06037	33.779799	-118.1879535	Los Angeles County
187314	Fee-for-Service	1245941012	1245941012	1	1	GHANI, VALERIE	6/22/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1268 S LA CIENEGA BLVD	None	LOS ANGELES	CA	90035	2548	19	06037	34.05353604	-118.3761483	Los Angeles County
187326	Fee-for-Service	1679152029	1679152029	1	1	GRIFFIN, SARAH DO	7/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22950	08	Family Practice	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
187377	Fee-for-Service	1720465453	1720465453	1	1	GEORGESCU, BIANCA R PSYD	2/22/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
187382	Fee-for-Service	1396778437	1396778437	1	1	GADE, GOPAL REDDY MD	4/30/1980	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	35041	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	6183 N FRESNO ST	STE 105	FRESNO	CA	93710	8611	10	06019	36.82625378	-119.7814317	Fresno County
187411	Fee-for-Service	1922297357	1922297357	1	1	GHAYOORI, RAMIN MD	7/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104182	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
187424	Fee-for-Service	1700812658	1700812658	1	2	GUARCELLO, FRED P OD	11/10/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1263 PLEASANT GROVE BLVD	STE 100	ROSEVILLE	CA	95747	5858	31	06061	38.77233838	-121.3143437	Placer County
187429	Fee-for-Service	1215935713	1215935713	1	1	GANEY, JOHN T MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83253	78	Neoplastic Diseases/Oncology	0	In state provider	None	3220 LONE TREE WAY	STE 100	ANTIOCH	CA	94509	5511	07	06013	37.98963061	-121.8077212	Contra Costa County
187446	Fee-for-Service	1104132539	1104132539	1	1	GALLO, ISMAEL S	7/15/2011	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
187498	Fee-for-Service	1316363708	1316363708	1	1	GOLDSTAR HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4629 VAN NUYS BLVD	SUITE G	SHERMAN OAKS	CA	91403	6437	19	06037	34.15567998	-118.448716	Los Angeles County
187500	Fee-for-Service	1851384143	1851384143	1	1	GORDON,LUTHER E MD	9/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 LINCOLN WAY	None	COEUR D ALENE	ID	83814	0000	00	None	47.69465937	-116.7917936	Kootenai County
187535	Fee-for-Service	1457392375	1457392375	1	1	GARFIELD BEACH CVS, LLC	2/3/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10889 WELLWORTH	None	LOS ANGELES	CA	90024	4918	19	06037	34.05707768	-118.4424488	Los Angeles County
187540	Fee-for-Service	1922249077	1922249077	1	1	GOLDEN VALLEY HEALTH CENTER	6/1/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1200 W MAIN ST	None	TURLOCK	CA	95380	3411	50	06099	37.4926695	-120.862917	Stanislaus County
187603	Fee-for-Service	1255812889	1255812889	1	1	GALEN INPATIENT PHYSICIANS P	10/15/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
187611	Fee-for-Service	1992853949	1992853949	1	1	GOVERNSKI, DAVID A MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	34372	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
187625	Fee-for-Service	1447007398	1447007398	1	1	GAKOBO, WINNIE WANJIRU	8/13/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12215 HERITAGE SPRINGS	DRIVE UNIT 103-15	SANTA FE SPRINGS	CA	90670	6925	19	06037	33.93990915	-118.0714911	Los Angeles County
187626	Fee-for-Service	1639673858	1639673858	1	1	GARCIA, REGINA NP	2/8/2025	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
187639	Fee-for-Service	1639494784	1639494784	1	1	GONZALES, JOHN P C MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141386	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
187688	Fee-for-Service	1013992890	1013992890	1	1	GELFORD, BRENDON L MD	3/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	73154	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
187733	Fee-for-Service	1245307172	1245307172	1	1	GLIDEWELL, MAYLENE M MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	62775	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
187784	Fee-for-Service	1316363708	1316363708	1	1	GOLDSTAR HOSPICE INC	5/19/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4629 VAN NUYS BLVD	SUITE G	SHERMAN OAKS	CA	91403	6437	19	06037	34.15567998	-118.448716	Los Angeles County
187790	Fee-for-Service	1477814119	1477814119	1	1	GOLDWASSER,BERNARD	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY SOUTH	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
187794	Fee-for-Service	1477750321	1477750321	1	1	GULATI, MITTUL MD	4/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90597	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
187803	Fee-for-Service	1548298656	1548298656	1	1	GROSS, MITCHELL E MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55762	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
187811	Fee-for-Service	1437980067	1437980067	1	1	GONZALEZ MEJIA, JOSE PT	9/30/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2339 W HAMMER LN	STE K	STOCKTON	CA	95209	2368	39	06077	38.02138826	-121.344545	San Joaquin County
187818	Fee-for-Service	1174048334	1174048334	1	1	GONDAL, PARDEEP MD	12/24/2020	207R00000X	NA	Other	026	PHYSICIANS	166656	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
187824	Fee-for-Service	1093756900	1093756900	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12315 VENICE BLVD	None	MAR VISTA	CA	90066	3801	19	06037	34.00418567	-118.4327988	Los Angeles County
187829	Fee-for-Service	1922249077	1922249077	1	1	GOLDEN VALLEY HEALTH CENTER	1/2/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1200 W MAIN ST	None	TURLOCK	CA	95380	3411	50	06099	37.4926695	-120.862917	Stanislaus County
187839	Fee-for-Service	1578587739	1578587739	1	1	GUNNARSON, HEATHER E MD	1/20/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87816	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
187848	Fee-for-Service	1982689097	1982689097	1	1	GROW, MATTHEW P MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73269	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
187862	Fee-for-Service	1396700019	1396700019	1	1	GANDHI, MONICA MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65564	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
187880	Fee-for-Service	1407932916	1407932916	1	1	GABALI, FREDERICK F MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34863	40	Pediatrics	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
187885	Fee-for-Service	1538178025	1538178025	1	1	GIETZEN, JOHN N JR MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2400 SOUTH AVE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
187890	Fee-for-Service	1255812889	1255812889	1	1	GALEN INPATIENT PHYSICIANS P	10/15/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	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
187897	Fee-for-Service	1992853949	1992853949	1	1	GOVERNSKI, DAVID A MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	34372	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
187911	Fee-for-Service	1447007398	1447007398	1	1	GAKOBO, WINNIE WANJIRU	8/13/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12215 HERITAGE SPRINGS	DRIVE UNIT 103-15	SANTA FE SPRINGS	CA	90670	6925	19	06037	33.93990915	-118.0714911	Los Angeles County
187919	Fee-for-Service	1427470533	1427470533	1	1	GEORGE, MIRANDA P LMFT	5/24/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
187927	Fee-for-Service	1093757403	1093757403	1	1	GANDHI, SUNIL N MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77733	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
187937	Fee-for-Service	1013787092	1013787092	1	1	GRIZZLY PHARMACY-CLOVIS	3/15/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	255 W HERNDON AVE	101	CLOVIS	CA	93612	0381	10	06019	36.83766353	-119.7141345	Fresno County
187971	Fee-for-Service	1669493375	1669493375	1	1	GELLMAN, MARK P DO	3/19/2008	207P00000X	NA	Other	026	PHYSICIANS	8207	66	Emergency Medicine (Urgent Care)	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	0070	36	06071	34.26577765	-117.1695461	San Bernardino County
188003	Fee-for-Service	1649287004	1649287004	1	1	GUPTA, SATISH MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29545	03	Allergy	0	In state provider	None	2258 FOOTHILL BLVD	STE 100	LA CANADA	CA	91011	1471	19	06037	34.21685503	-118.2270405	Los Angeles County
188010	Fee-for-Service	1619997871	1619997871	1	1	GUERRERO, ALMA D MD	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91517	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	STE 12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
188032	Fee-for-Service	1285472605	1285472605	1	1	GREEN, TERESA BIRTH DOULA	9/4/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
188046	Fee-for-Service	1922632322	1922632322	1	1	G & A CARE INC	7/12/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	16301 NORDHOFF STREET	None	NORTH HILLS	CA	91343	3807	19	06037	34.23567553	-118.4874812	Los Angeles County
188065	Fee-for-Service	1275534745	1275534745	1	1	GOLDEN, STANLEY E MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	42671	01	General Practice	0	In state provider	None	1024 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4762	19	06037	34.083612	-118.1230405	Los Angeles County
188068	Fee-for-Service	1730307729	1730307729	1	1	GREGORY SPEARS	11/24/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
188093	Fee-for-Service	1548298656	1548298656	1	1	GROSS, MITCHELL E MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55762	68	Hematology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
188114	Fee-for-Service	1922249077	1922249077	1	1	GOLDEN VALLEY HEALTH CENTER	6/1/2009	261QF0400X	NA	Federally Qualified Health Center	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1200 W MAIN ST	None	TURLOCK	CA	95380	3411	50	06099	37.4926695	-120.862917	Stanislaus County
188162	Fee-for-Service	1366574386	1366574386	1	2	GARVASI, ERIN M LMFT	12/17/2018	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
188166	Fee-for-Service	1417901463	1417901463	1	1	GAUGER, GRANT E MD	3/21/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	32850	14	Neurological Surgery	0	In state provider	UNIV OF CA	1001 POTRERO AVE	# 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
188187	Fee-for-Service	1215269022	1215269022	1	1	GARFIELD BEACH CVS LLC	5/28/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1302 W MISSION RD	None	SAN MARCOS	CA	92069	3038	37	06073	33.14884032	-117.1896892	San Diego County
188240	Fee-for-Service	1245323674	1245323674	2	1	GOLD SUN YUAN INC	2/27/2007	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	201 W GARVEY AVE	STE 107	MONTEREY PARK	CA	91754	7420	19	06037	34.06256747	-118.1246805	Los Angeles County
188244	Fee-for-Service	1184373748	1184373748	1	1	GEE, SERINA MD	3/14/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189535	08	Family Practice	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
188289	Fee-for-Service	1649287004	1649287004	1	1	GUPTA, SATISH MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29545	41	Internal Medicine	0	In state provider	None	2258 FOOTHILL BLVD	STE 100	LA CANADA	CA	91011	1471	19	06037	34.21685503	-118.2270405	Los Angeles County
188302	Fee-for-Service	1306862040	1306862040	1	1	GRAVES, GRETCHEN D	7/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	46185	None	None	0	In state provider	None	2260 GLADSTONE DR	SUITE 2	PITTSBURG	CA	94565	5125	07	06013	38.00615824	-121.8668668	Contra Costa County
188317	Fee-for-Service	1215341490	1215341490	1	1	GANTER, DEVON E MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140154	40	Pediatrics	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
188353	Fee-for-Service	1275534745	1275534745	1	1	GOLDEN, STANLEY E MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	42671	41	Internal Medicine	0	In state provider	None	1024 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4762	19	06037	34.083612	-118.1230405	Los Angeles County
188368	Fee-for-Service	1851627004	1851627004	1	1	GUARNIERI, MICHAEL J MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112110	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
188381	Fee-for-Service	1548298656	1548298656	1	1	GROSS, MITCHELL E MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55762	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
188406	Fee-for-Service	1922249077	1922249077	1	1	GOLDEN VALLEY HEALTH CENTER	6/1/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1200 W MAIN ST	None	TURLOCK	CA	95380	3411	50	06099	37.4926695	-120.862917	Stanislaus County
188418	Fee-for-Service	1730125899	1730125899	1	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10181 RESEDA BLVD	None	NORTHRIDGE	CA	91324	1454	19	06037	34.255962	-118.536119	Los Angeles County
188424	Fee-for-Service	1356801575	1356801575	1	1	GUEVARA, BERNARDO MD	8/9/2022	390200000X	NA	Other	026	PHYSICIANS	176826	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
188460	Fee-for-Service	1871802629	1871802629	1	1	GOLIAN, ALAN J PSYD	1/23/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	44444 20TH STREET WEST	None	LANCASTER	CA	93534	2714	19	06037	34.69063406	-118.1656452	Los Angeles County
188501	Fee-for-Service	1679071971	1679071971	1	1	GREEN, MERCEDES D LMFT	12/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13261 SPRING VALLEY PRKW	205	VICTORVILLE	CA	92395	0000	36	06071	34.49232827	-117.2686243	San Bernardino County
188514	Fee-for-Service	1821731506	1821731506	1	1	GRANT, HEATHER M NP	7/11/2022	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
188542	Fee-for-Service	1336785252	1336785252	1	1	GOLDEN LIFE MANOR	2/25/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	507 S CITADELL LANE	None	ANAHEIM	CA	92806	4204	30	06059	33.83578408	-117.8847903	Orange County
188543	Fee-for-Service	1346497245	1346497245	1	1	GIRI, PARESH C MD	6/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105163	None	None	0	In state provider	None	1700 CESAR CHAVEZ AVE	# 3900	LOS ANGELES	CA	90033	2414	19	06037	34.05101259	-118.217259	Los Angeles County
188609	Fee-for-Service	1275560286	1275560286	1	1	GANNON, PETER M MD	10/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	25472	14	Neurological Surgery	0	In state provider	None	545 E CLEVELAND ST	STE B	STOCKTON	CA	95204	5535	39	06077	37.97379447	-121.2893338	San Joaquin County
188620	Fee-for-Service	1295700995	1295700995	1	1	GARTLAND, PATRICK F MD	3/31/1989	208600000X	NA	General Surgery	026	PHYSICIANS	65145	02	General Surgery	0	In state provider	None	2100 FOREST AVENUE	STE 103	SAN JOSE	CA	95128	1422	43	06085	37.3270195	-121.9368645	Santa Clara County
188621	Fee-for-Service	1326001298	1326001298	1	1	GEVELBER, MITCHELL MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70083	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
188634	Fee-for-Service	1134673981	1134673981	1	1	GALLARDO, JANELLE LMFT	8/1/2024	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
188729	Fee-for-Service	1497305213	1497305213	1	1	GONZALEZ, MARIA DEL CARMEN	8/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
188742	Fee-for-Service	1710060025	1710060025	2	1	GARFIELD BEACH CVS LLC	4/20/2018	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2220 BRIDGEPOINTE PKWY	None	SAN MATEO	CA	94404	1569	41	06081	37.56030854	-122.2838381	San Mateo County
188768	Fee-for-Service	1497989776	1497989776	1	1	GIMAG CORP	2/25/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4175 FIRST STREET	None	LIVERMORE	CA	94551	4913	01	06001	37.69386995	-121.7477466	Alameda County
188773	Fee-for-Service	1316116890	1316116890	1	1	GEORGIES, RAMI MD	8/22/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	102009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
188787	Fee-for-Service	1891089298	1891089298	1	1	GIBBENS, JACOB MD	10/11/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	155597	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
188789	Fee-for-Service	1487793188	1487793188	1	1	GILBREATH, PATRICIA L MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	57352	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
188799	Fee-for-Service	1770053639	1770053639	1	1	GARFIELD BEACH CVS LLC	3/5/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7030 HOLLISTER AVE	None	GOLETA	CA	93117	2974	42	06083	34.4302156	-119.8730261	Santa Barbara County
188831	Fee-for-Service	1043680978	1043680978	1	1	GELERIS, BETHANY L NP	3/6/2019	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
188838	Fee-for-Service	1457404998	1457404998	1	1	GADDIS, GAIL P MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	31964	08	Family Practice	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
188863	Fee-for-Service	1073629549	1073629549	1	1	GUPTA, ANUJ MD	11/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85939	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
188883	Fee-for-Service	1073947495	1073947495	1	1	GLENN, ERICA N MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126938	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
188887	Fee-for-Service	1285912006	1285912006	1	1	GREEN, GENEVIEVE A LMFT	2/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
188904	Fee-for-Service	1467945493	1467945493	1	1	GARCIA, MIGUEL J LCSW	5/3/2023	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
188926	Fee-for-Service	1588168769	1588168769	1	1	GREENWOOD, LAURA M DO	8/2/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	22564	13	Neurology (M.D. only)	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
188930	Fee-for-Service	1073144531	1073144531	1	1	GARFIELD BEACH CVS LLC	12/11/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3968 MISSOURI FLAT RD	None	PLACERVILLE	CA	95667	5240	09	06017	38.71303206	-120.8418836	El Dorado County
188935	Fee-for-Service	1972864882	1972864882	1	1	GALARIO, JUDITH MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116162	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	ATTN DR A BANUELOS JR CM	SAN JOSE	CA	95150	5280	43	06085	37.313433	-121.9318385	Santa Clara County
188953	Fee-for-Service	1205060308	1205060308	1	1	GRAJEDA, ANA C LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96593	-	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
188955	Fee-for-Service	1306876461	1306876461	1	1	GANESH, SIVATHILAKA MD	1/23/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53266	40	Pediatrics	0	In state provider	None	245 F ST	None	CHULA VISTA	CA	91910	2801	37	06073	32.6419613	-117.0776444	San Diego County
188974	Fee-for-Service	1598129652	1598129652	1	1	GABRIEL MEDICAL CENTER INC	8/31/2018	207R00000X	NA	Other	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	4146 E OLYMPIC BLVD	UNIT B	LOS ANGELES	CA	90023	3347	19	06037	34.01887148	-118.184463	Los Angeles County
188979	Fee-for-Service	1174601942	1174601942	1	1	GETZELL, MICHAEL L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30598	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
188991	Fee-for-Service	1588795694	1588795694	1	1	GOLDBERG, CHERYL L LCSW	6/27/2023	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
188992	Fee-for-Service	1245464882	1245464882	1	1	GREENMAN, NOAM MD	3/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121329	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
189054	Fee-for-Service	1982615696	1982615696	1	1	GREENSTEIN, JAY A MD	9/15/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	25998	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
189057	Fee-for-Service	1790849230	1790849230	1	1	GONZALEZ, ROBERT MD	2/28/1996	207RR0500X	NA	Other	026	PHYSICIANS	38441	41	Internal Medicine	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
189061	Fee-for-Service	1316116890	1316116890	1	1	GEORGIES, RAMI MD	8/22/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	102009	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
189092	Fee-for-Service	1346380748	1346380748	1	1	GILLESPIE, HEATHER J MD	9/30/2022	207RR0500X	NA	Other	026	PHYSICIANS	180234	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
189099	Fee-for-Service	1760588107	1760588107	1	1	GANTAN, JOSEPH D MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71758	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	STE MS	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189101	Fee-for-Service	1780679464	1780679464	1	1	GABRIEL, STEVEN M MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68473	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
189127	Fee-for-Service	1457404998	1457404998	1	1	GADDIS, GAIL P MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	31964	01	General Practice	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
189132	Fee-for-Service	1740874528	1740874528	1	1	GHASSAN KAZMOUZ MD INC	12/2/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	None	1180 N INDIAN CANYON DR	W304	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
189170	Fee-for-Service	1871616763	1871616763	1	1	GOODYEAR, ALLISON A MD	1/5/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	128105	None	None	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
189182	Fee-for-Service	1053757922	1053757922	1	1	GRAFF, JENNIFER L CNP	6/1/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
189184	Fee-for-Service	1134296148	1134296148	1	1	GOMEZ, MARIA F MD	12/1/1997	207R00000X	NA	Other	026	PHYSICIANS	79140	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
189212	Fee-for-Service	1154416139	1154416139	1	1	GANDHI, ARUN P MD INC	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	35115	05	Anesthesiology	0	In state provider	None	2701 W ALAMEDA AVE	STE 203	BURBANK	CA	91505	4406	19	06037	34.15751343	-118.3303715	Los Angeles County
189228	Fee-for-Service	1477966885	1477966885	1	1	GAZARIAN, MARAL C DO	8/20/2021	207R00000X	NA	Other	026	PHYSICIANS	15508	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
189238	Fee-for-Service	1962537407	1962537407	1	1	GENERAL HEALTH SYSTEM	6/6/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3600 FLORIDA BLVD	None	BATON ROUGE	LA	70806	3842	00	None	30.45033794	-91.15315955	East Baton Rouge Parish
189276	Fee-for-Service	1790344638	1790344638	1	1	GODINEZ, JEANNINE KATHLYN C	12/15/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	CCC-SLP	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
189307	Fee-for-Service	1013955186	1013955186	2	1	GOTT, KERRY N MD	11/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	65566	41	Internal Medicine	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
189322	Fee-for-Service	1164511002	1164511002	1	1	GLASER, CAROL A	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48309	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
189344	Fee-for-Service	1790849230	1790849230	1	1	GONZALEZ, ROBERT MD	2/28/1996	207RR0500X	NA	Other	026	PHYSICIANS	38441	83	Rheumatology	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
189348	Fee-for-Service	1891729745	1891729745	1	7	GRAYBILL MEDICAL GROUP INC	3/18/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3142 VISTA WAY	STE 100	OCEANSIDE	CA	92056	3627	37	06073	33.18253858	-117.3252818	San Diego County
189358	Fee-for-Service	1669434619	1669434619	1	1	GAVLICK,KIRK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	445 N SILVERBELL RD	STE 200	TUCSON	AZ	85745	0000	00	None	32.227632	-111.0001545	Pima County
189385	Fee-for-Service	1760588107	1760588107	1	1	GANTAN, JOSEPH D MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71758	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	STE MS	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
189419	Fee-for-Service	1518021963	1518021963	1	1	GENUS HOME CARE OF	8/16/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SAN BERNARDINO	515 N MOUNTAIN VIEW AVE	None	SAN BERNARDINO	CA	92401	1351	36	06071	34.10865	-117.2873745	San Bernardino County
189423	Fee-for-Service	1255405155	1255405155	1	1	GU, HUIYING MD	12/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89633	40	Pediatrics	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
189440	Fee-for-Service	1952626731	1952626731	1	1	GOEL, VEENA V MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117796	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
189456	Fee-for-Service	1235165176	1235165176	1	1	GOLDBERG, ROBERT L MD	4/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	34632	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
189491	Fee-for-Service	1427055045	1427055045	1	1	GHANI, MUHAMMAD S MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	68	Hematology	1	Border provider	None	58 N PECOS RD	None	HENDERSON	NV	89074	7319	00	None	36.03160397	-115.1002424	Clark County
189523	Fee-for-Service	1063079010	1063079010	1	1	GREEN PATH HOME HEALTH	8/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12158 HAMLIN ST	STE 2A	NORTH HOLLYWOOD	CA	91606	1215	19	06037	34.18845983	-118.3984616	Los Angeles County
189526	Fee-for-Service	1962537407	1962537407	1	1	GENERAL HEALTH SYSTEM	6/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3600 FLORIDA BLVD	None	BATON ROUGE	LA	70806	3842	00	None	30.45033794	-91.15315955	East Baton Rouge Parish
189548	Fee-for-Service	1730115601	1730115601	1	1	GIESEMANN, CORINNE H MD	4/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67809	08	Family Practice	0	In state provider	None	20911 EARL ST	STE 440	TORRANCE	CA	90503	4355	19	06037	33.840459	-118.3580985	Los Angeles County
189559	Fee-for-Service	1568557619	1568557619	1	1	GENERATIONS HEALTH CARE	7/3/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOR WOMEN A MED GRP	202 GREEN VALLEY RD	None	FREEDOM	CA	95019	3135	44	06087	36.93777813	-121.7711905	Santa Cruz County
189578	Fee-for-Service	1326534439	1326534439	1	1	GARCIA, MARIBEL PSYD	8/16/2023	103T00000X	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
189581	Fee-for-Service	1790246247	1790246247	1	1	GUERRERO, ALFREDO DO	6/17/2022	207P00000X	NA	Other	026	PHYSICIANS	19704	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	54	06107	36.327888	-119.294919	Tulare County
189594	Fee-for-Service	1992985733	1992985733	1	1	GOOD SHEPHERD AMBULANCE	10/27/2008	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	109 AGOSTINO RD	STE 203	SAN GABRIEL	CA	91776	2550	19	06037	34.0978119	-118.0987737	Los Angeles County
189597	Fee-for-Service	1265885537	1265885537	1	1	GRANILLO, CHRISTINA E LMFT	10/20/2018	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	92260	3613	33	06065	33.72240897	-116.381407	Riverside County
189604	Fee-for-Service	1407511587	1407511587	1	1	GRANDISON, BROOKE LCSW	11/14/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11306 MOUNTAIN VIEW	A	LOMA LINDA	CA	92354	3832	36	06071	34.047513	-117.243647	San Bernardino County
189606	Fee-for-Service	1699796045	1699796045	1	1	GOLDBERG, JAMES D MD	1/30/1997	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	43192	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3700 CALIFORNIA ST	FL 5	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
189609	Fee-for-Service	1255418505	1255418505	1	1	GITTER, JOSHUA M MD	11/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94328	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
189636	Fee-for-Service	1891729745	1891729745	1	7	GRAYBILL MEDICAL GROUP INC	3/18/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3142 VISTA WAY	STE 100	OCEANSIDE	CA	92056	3627	37	06073	33.18253858	-117.3252818	San Diego County
189672	Fee-for-Service	1528184033	1528184033	1	1	GRITTON, LIVA Y MD	12/17/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	76396	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
189681	Fee-for-Service	1356364640	1356364640	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8148 E SANTA ANA CANYON	None	ANAHEIM	CA	92808	1105	30	06059	33.865326	-117.747063	Orange County
189704	Fee-for-Service	1528621596	1528621596	1	1	GIUDICE, CATHARINA MD	9/1/2022	207P00000X	NA	Other	026	PHYSICIANS	179460	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
189708	Fee-for-Service	1245345693	1245345693	1	1	GUATELLI, JOHN MD	9/30/1988	174400000X	NA	Other	026	PHYSICIANS	58874	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
189725	Fee-for-Service	1336198415	1336198415	2	1	GARCIA-MARTINEZ, MARIA S MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63229	None	None	0	In state provider	None	2615 H STREET	None	BAKERSFIELD	CA	93301	2819	15	06029	35.38335768	-119.0211743	Kern County
189743	Fee-for-Service	1235165176	1235165176	1	1	GOLDBERG, ROBERT L MD	4/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	34632	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
189766	Fee-for-Service	1801350392	1801350392	1	1	GRAY, AMY M OT	10/16/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 ROWLAND WAY	220	NOVATO	CA	94945	5008	21	06041	38.09755172	-122.5591766	Marin County
189783	Fee-for-Service	1427055045	1427055045	1	1	GHANI, MUHAMMAD S MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	58 N PECOS RD	None	HENDERSON	NV	89074	7319	00	None	36.03160397	-115.1002424	Clark County
189827	Fee-for-Service	1083956338	1083956338	1	1	GASCHLER, WESLEY N MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134682	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
189844	Fee-for-Service	1568434058	1568434058	1	1	GUARDIAN MEDICAL TRANSPORTAT	4/9/1991	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION INC	12121 BARRINGER ST	None	SOUTH EL MONTE	CA	91733	4137	19	06037	34.04666102	-118.0279862	Los Angeles County
189846	Fee-for-Service	1568557619	1568557619	1	1	GENERATIONS HEALTH CARE	7/3/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOR WOMEN A MED GRP	202 GREEN VALLEY RD	None	FREEDOM	CA	95019	3135	44	06087	36.93777813	-121.7711905	Santa Cruz County
189856	Fee-for-Service	1063440980	1063440980	1	1	GITELMAN, STEPHEN E MD	1/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	42776	01	General Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
189867	Fee-for-Service	1689764003	1689764003	1	1	GIGER, ANTON G DO	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	8376	08	Family Practice	0	In state provider	None	26991 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
189897	Fee-for-Service	1699796045	1699796045	1	1	GOLDBERG, JAMES D MD	1/30/1997	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	43192	47	Miscellaneous	0	In state provider	None	3700 CALIFORNIA ST	FL 5	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
189904	Fee-for-Service	1265692917	1265692917	2	1	GRANT, MICHAEL J MD	7/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	129326	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
189923	Fee-for-Service	1891729745	1891729745	1	7	GRAYBILL MEDICAL GROUP INC	3/18/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3142 VISTA WAY	STE 100	OCEANSIDE	CA	92056	3627	37	06073	33.18253858	-117.3252818	San Diego County
189995	Fee-for-Service	1245345693	1245345693	1	1	GUATELLI, JOHN MD	9/30/1988	174400000X	NA	Other	026	PHYSICIANS	58874	77	Infectious Disease	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
190005	Fee-for-Service	1558627778	1558627778	1	1	GARCHA, JASMINE K MD	11/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133483	01	General Practice	0	In state provider	None	2210 E ILLINOIS AVE	STE 301	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
190018	Fee-for-Service	1750336137	1750336137	1	1	GAIL CLIFFORD	5/8/2018	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
190035	Fee-for-Service	1760459499	1760459499	1	1	GOFF, WALTER B MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	4187	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
190093	Fee-for-Service	1023459260	1023459260	1	1	GIBSON, CARLY R LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
190124	Fee-for-Service	1497076723	1497076723	1	1	GILL, AVNISH K MD	7/15/2021	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	154100	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
190129	Fee-for-Service	1467118786	1467118786	1	1	GEORGE, KIRSTEN CPO	1/5/2022	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	#310	LOS ANGELES	CA	90017	3904	19	06037	34.05270508	-118.2641005	Los Angeles County
190144	Fee-for-Service	1740248566	1740248566	1	1	GHOGALE, SANJIV J MD	12/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55247	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
190154	Fee-for-Service	1134207632	1134207632	1	1	GIBSON, DOUGLAS E MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90553	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
190157	Fee-for-Service	1184685893	1184685893	1	1	GONZALES, RICHARD M MD	10/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72193	41	Internal Medicine	0	In state provider	None	8585 KNOTT AVE	STE 101	BUENA PARK	CA	90620	3896	30	06059	33.838056	-118.0111455	Orange County
190247	Fee-for-Service	1053632091	1053632091	1	1	GILBERT, DANIEL R DO	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15720	34	Urology and Urological Surgery	0	In state provider	None	1100 TRANCAS ST	STE 209	NAPA	CA	94558	2909	28	06055	38.32316569	-122.2981938	Napa County
190272	Fee-for-Service	1023127057	1023127057	1	1	GUPTA, SAMIR MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78715	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
190298	Fee-for-Service	1790129575	1790129575	1	2	GOLD, DONNA M LCSW	11/21/2014	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	500 LA TERRAZA BLVD	SUITE 150	ESCONDIDO	CA	92025	3876	37	06073	33.11238641	-117.096444	San Diego County
190408	Fee-for-Service	1801282017	1801282017	1	1	GRAY, ASHLEY N MD	6/7/2022	2080P0207X	NA	Hematology	026	PHYSICIANS	151488	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
190487	Fee-for-Service	1619486529	1619486529	1	1	GUERRERO, CARLOS R MSW LCSW	1/25/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER 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
190517	Fee-for-Service	1548608854	1548608854	1	1	GILL, SARABJIT S MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151056	36	Psychiatry	0	In state provider	None	1305 TOMMYDON STREET	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
190541	Fee-for-Service	1861666059	1861666059	1	1	GRENINGER, DANIEL A MD	10/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109166	18	Ophthalmology	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
190555	Fee-for-Service	1518594399	1518594399	1	1	GUNANTO, TRACEY J DO	8/4/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19574	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
190569	Fee-for-Service	1962061184	1962061184	1	1	GOOLSBY, BRAD L PA-C	11/11/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	58462	-	NOT APPLICABLE	0	In state provider	None	7545 METROPOLITAN DR	None	SAN DIEGO	CA	92108	4402	37	06073	32.77687129	-117.1585907	San Diego County
190587	Fee-for-Service	1356388961	1356388961	3	1	GLENN MEDICAL CENTER, LLC	7/1/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1133 W SYCAMORE STREET	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
190610	Fee-for-Service	1770097693	1770097693	1	1	GARFIELD BEACH CVS LLC	3/23/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	402 5TH AVENUE	None	SAN DIEGO	CA	92101	6912	37	06073	32.7101457	-117.1601627	San Diego County
190653	Fee-for-Service	1386065274	1386065274	1	1	GEORGE, SHOBHA LCSW	5/1/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
190671	Fee-for-Service	1053457598	1053457598	1	1	GABOR, ERWIN P MD AMC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	21520	41	Internal Medicine	0	In state provider	None	9735 WILSHIRE BLVD	STE 400	BEVERLY HILLS	CA	90212	2103	19	06037	34.06711051	-118.4074605	Los Angeles County
190716	Fee-for-Service	1043372394	1043372394	1	1	GANADJIAN, KRAUZ K MD	1/8/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	94325	36	Psychiatry	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
190741	Fee-for-Service	1194743385	1194743385	2	1	GOULD, RICHARD E MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	73353	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
190765	Fee-for-Service	1346220217	1346220217	1	1	GRIGER, CHRISTINE A MD	1/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	34315	40	Pediatrics	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
190767	Fee-for-Service	1477882587	1477882587	1	1	GARDNER, MARISA A MD	3/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110006	13	Neurology (M.D. only)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
190779	Fee-for-Service	1740316835	1740316835	1	1	GENTLE, CHRISTOPHER	12/10/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
190828	Fee-for-Service	1427032366	1427032366	1	1	GROSS, LAWRENCE	3/31/1995	174400000X	NA	Other	026	PHYSICIANS	44631	36	Psychiatry	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
190829	Fee-for-Service	1861666059	1861666059	1	1	GRENINGER, DANIEL A MD	10/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109166	40	Pediatrics	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
190875	Fee-for-Service	1356388961	1356388961	3	1	GLENN MEDICAL CENTER, LLC	7/1/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1133 W SYCAMORE STREET	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
190897	Fee-for-Service	1740658657	1740658657	1	1	GONDERMAN, KELLY PSYD	4/22/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
190960	Fee-for-Service	1548568421	1548568421	1	2	GOLDEN VALLEY HEALTH CENTERS	1/29/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1801 TULLY RD	SUITE F	MODESTO	CA	95350	3235	50	06099	37.670814	-121.0122795	Stanislaus County
190964	Fee-for-Service	1538639216	1538639216	1	1	GOWAN, TAYLOR A NP	12/10/2018	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
190983	Fee-for-Service	1588614655	1588614655	1	1	GOLD, RICHARD MD	11/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	10393	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
191031	Fee-for-Service	1194743385	1194743385	2	1	GOULD, RICHARD E MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	73353	68	Hematology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
191054	Fee-for-Service	1225140759	1225140759	1	1	GIN, JEFFREY K MD	4/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101609	None	None	0	In state provider	None	120 S MONTEBELLO BLVD	None	MONTEBELLO	CA	90640	4730	19	06037	34.00902509	-118.1084052	Los Angeles County
191057	Fee-for-Service	1770768509	1770768509	1	1	GHC OF UPLAND SNF LLC	1/1/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	275 GARNET WAY	None	UPLAND	CA	91786	5932	36	06071	34.097193	-117.6549365	San Bernardino County
191108	Fee-for-Service	1275180010	1275180010	1	1	GONZALEZ, CYNTHIA LPCC	1/28/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	38780 TRADE CENTER DR	STE 1C	PALMDALE	CA	93551	3641	19	06037	34.58685376	-118.1430494	Los Angeles County
191127	Fee-for-Service	1912348871	1912348871	1	1	GUTTA, NISHKALA MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140001	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
191146	Fee-for-Service	1548568421	1548568421	1	1	GOLDEN VALLEY HEALTH CENTERS	11/28/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	4150 PATTERSON ROAD	None	RIVERBANK	CA	95367	2566	50	06099	37.73262081	-120.9200969	Stanislaus County
191153	Fee-for-Service	1497888622	1497888622	1	1	GARNER, JESSICA D LCSW	8/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6412 LAUREL AVE	None	LAKE ISABELLA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
191181	Fee-for-Service	1619918372	1619918372	1	1	GREWAL, SONIA	10/11/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11550 INDIAN HILLS RD	STE 210	MISSION HILLS	CA	91345	1202	19	06037	34.28024575	-118.4588775	Los Angeles County
191249	Fee-for-Service	1548568421	1548568421	1	2	GOLDEN VALLEY HEALTH CENTERS	7/16/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1801 TULLY RD	SUITE F	MODESTO	CA	95350	3235	50	06099	37.670814	-121.0122795	Stanislaus County
191278	Fee-for-Service	1659556835	1659556835	1	1	GLEN-WHITE UROLOGICAL	3/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	MEDICAL GROUP	1700 E CESAR CHAVEZ AVE	STE 205	LOS ANGELES	CA	90033	2438	19	06037	34.05101259	-118.217259	Los Angeles County
191296	Fee-for-Service	1558708800	1558708800	1	1	GONZALEZ-GIRALDO, ERNESTO M	6/4/2019	2084N0402X	NA	Neurology	026	PHYSICIANS	161064	13	Neurology (M.D. only)	0	In state provider	D	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191316	Fee-for-Service	1194743385	1194743385	2	1	GOULD, RICHARD E MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	73353	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
191360	Fee-for-Service	1891559993	1891559993	1	1	GOMEZ, DANIEL	9/23/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	19367 VICTORY BLVD	SUITE 14	TARZANA	CA	91335	6302	19	06037	34.18658599	-118.5557169	Los Angeles County
191366	Fee-for-Service	1669882189	1669882189	1	1	GONZALEZ, REBECCA L MD	7/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142069	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
191375	Fee-for-Service	1700848835	1700848835	1	1	GLENVIEW PATHOLOGY	9/22/2003	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
191384	Fee-for-Service	1245646231	1245646231	1	2	GREWAL, NAVJOT DO	3/1/2022	207RS0012X	NA	Other	026	PHYSICIANS	17522	None	None	0	In state provider	None	5201 NORRIS CANYON RD	STE 120	SAN RAMON	CA	94583	5411	07	06013	37.77779028	-121.9600626	Contra Costa County
191398	Fee-for-Service	1700383601	1700383601	1	1	GREATER BAKERSFIELD DIALYSIS	10/30/2019	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	5101 WHITE LANE	SUITE A	BAKERSFIELD	CA	93309	8941	15	06029	35.31801234	-119.0591378	Kern County
191407	Fee-for-Service	1811243652	1811243652	1	1	GORDON, JOSEPH A MD	10/4/2018	207R00000X	NA	Other	026	PHYSICIANS	126822	29	Pulmonary Diseases (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
191411	Fee-for-Service	1750624979	1750624979	1	1	GIBBY, CONRAD C MD	12/24/2022	2085R0204X	NA	Other	026	PHYSICIANS	175297	None	None	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
191413	Fee-for-Service	1518997154	1518997154	1	1	GUANCHE, CARLOS A MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	87050	20	Orthopedic Surgery	0	In state provider	None	6815 NOBLE AVE	None	VAN NUYS	CA	91405	3796	19	06037	34.19440435	-118.461871	Los Angeles County
191421	Fee-for-Service	1174973960	1174973960	1	1	GOYAL, SHUBHI MD	7/8/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	168595	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
191434	Fee-for-Service	1548568421	1548568421	1	1	GOLDEN VALLEY HEALTH CENTERS	9/9/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	4150 PATTERSON ROAD	None	RIVERBANK	CA	95367	2566	50	06099	37.73262081	-120.9200969	Stanislaus County
191535	Fee-for-Service	1548568421	1548568421	1	2	GOLDEN VALLEY HEALTH CENTERS	1/29/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1801 TULLY RD	SUITE F	MODESTO	CA	95350	3235	50	06099	37.670814	-121.0122795	Stanislaus County
191539	Fee-for-Service	1396737896	1396737896	1	1	GLINN AND GIORDANO PHYSICAL	1/31/2019	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3700 GOSFORD RD	SUITE G	BAKERSFIELD	CA	93309	7694	15	06029	35.320932	-119.092064	Kern County
191596	Fee-for-Service	1295295384	1295295384	1	1	GALINDO, RAMON G MD	7/30/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	179764	None	None	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
191605	Fee-for-Service	1043412026	1043412026	1	1	GAMBARIN, YELENA MD	1/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100273	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	SUITE 200	CONCORD	CA	94520	2270	07	06013	37.98417931	-122.0361585	Contra Costa County
191684	Fee-for-Service	1083870463	1083870463	1	1	GONZALEZ, MARISA C MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120499	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	655 EUCLID AVE	STE 409	NATIONAL CITY	CA	91950	2981	37	06073	32.68353398	-117.082625	San Diego County
191724	Fee-for-Service	1548568421	1548568421	1	1	GOLDEN VALLEY HEALTH CENTERS	6/22/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	4150 PATTERSON ROAD	None	RIVERBANK	CA	95367	2566	50	06099	37.73262081	-120.9200969	Stanislaus County
191739	Fee-for-Service	1508867839	1508867839	1	1	GAIDICI, ADRIANA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1111 E MCDOWELL RD	None	PHOENIX	AZ	85006	2612	00	None	33.463935	-112.0596975	Maricopa County
191747	Fee-for-Service	1427038504	1427038504	1	1	GALLAGHER, JEANNE M MD	9/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80874	40	Pediatrics	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
191752	Fee-for-Service	1639757891	1639757891	1	1	GARCIA, BRIANA MD	1/3/2025	207N00000X	NA	Dermatology	026	PHYSICIANS	182234	07	Dermatology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
191777	Fee-for-Service	1083962161	1083962161	1	1	GOLD LAB	8/29/2013	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1311 SHOAL DRIVE	None	SAN MATEO	CA	94404	1517	41	06081	37.56344993	-122.2912396	San Mateo County
191821	Fee-for-Service	1508852609	1508852609	1	1	GREGG POLZIN M.D.	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1221 PLEASANT ST	STE 400	DES MOINES	IA	50309	1426	00	None	41.59014972	-93.6356546	Polk County
191822	Fee-for-Service	1376961250	1376961250	1	1	GARCIA, CAMILLE E MFT	12/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	98913	-	NOT APPLICABLE	0	In state provider	None	3315 AIRWAY DR	None	SANTA ROSA	CA	95403	2005	49	06097	38.474307	-122.738571	Sonoma County
191823	Fee-for-Service	1548568421	1548568421	1	2	GOLDEN VALLEY HEALTH CENTERS	4/28/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1801 TULLY RD	SUITE F	MODESTO	CA	95350	3235	50	06099	37.670814	-121.0122795	Stanislaus County
191825	Fee-for-Service	1396737896	1396737896	1	1	GLINN AND GIORDANO PHYSICAL	11/12/2021	261QP2000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3700 GOSFORD RD	SUITE G	BAKERSFIELD	CA	93309	7694	15	06029	35.320932	-119.092064	Kern County
191845	Fee-for-Service	1689061988	1689061988	1	1	GARG, ANISH DO	10/25/2019	390200000X	NA	Other	026	PHYSICIANS	17133	None	None	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
191863	Fee-for-Service	1518144344	1518144344	1	1	GOSHTASBI, SAEID	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89441	10	Gastroenterology (M.D. only)	0	In state provider	None	11480 BROOKSHIRE AVE	STE 308	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
191932	Fee-for-Service	1972731990	1972731990	1	1	GONZALEZ-CALDWELL, SARA N MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108238	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
191956	Fee-for-Service	1700087145	1700087145	1	1	GHOSHAL, ASISH MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42055	13	Neurology (M.D. only)	0	In state provider	None	6601 COYLE AVE	None	CARMICHAEL	CA	95608	6311	34	06067	38.668302	-121.3106535	Sacramento County
192011	Fee-for-Service	1548568421	1548568421	1	1	GOLDEN VALLEY HEALTH CENTERS	11/28/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	4150 PATTERSON ROAD	None	RIVERBANK	CA	95367	2566	50	06099	37.73262081	-120.9200969	Stanislaus County
192030	Fee-for-Service	1134891609	1134891609	1	1	GREAT CHOICE HOME HEALTH	12/12/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14531 HAMLIN ST	SUITE 206	VAN NUYS	CA	91411	4163	19	06037	34.18870941	-118.449902	Los Angeles County
192075	Fee-for-Service	1558473876	1558473876	1	1	GOCK, TERRY S PHD	8/24/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11712 MOORPARK ST	SUITE 111	STUDIO CITY	CA	91604	2163	19	06037	34.1503315	-118.38825	Los Angeles County
192092	Fee-for-Service	1942311386	1942311386	1	1	GALATIN, PETER S MD	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85095	68	Hematology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
192097	Fee-for-Service	1043362627	1043362627	1	1	GREWAL, SWIPEN MD DO	9/23/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	125766	08	Family Practice	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
192112	Fee-for-Service	1871768069	1871768069	1	1	GILL, AMANDEEP S MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110465	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
192153	Fee-for-Service	1609437599	1609437599	1	1	GINTIEN HUANG MD INC	11/9/2019	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1909 N WATERMAN AVE	3	SAN BERNARDINO	CA	92404	4842	36	06071	34.132626	-117.2787445	San Bernardino County
192171	Fee-for-Service	1881730471	1881730471	1	1	GROOTEGOED, ANN M DO	3/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	6850	08	Family Practice	0	In state provider	None	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	19	06037	33.97292523	-118.1475473	Los Angeles County
192174	Fee-for-Service	1417968496	1417968496	1	1	GRUBER, FIROZEH MD	10/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55389	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
192179	Fee-for-Service	1932150257	1932150257	1	1	GLAZE, GARY M DO	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	4983	05	Anesthesiology	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
192196	Fee-for-Service	1619905080	1619905080	1	1	GONZALES, PATRICK D MD	8/27/2008	207R00000X	NA	Other	026	PHYSICIANS	50669	41	Internal Medicine	0	In state provider	GONZALES MEDICAL GRP INC	29798 HAUN ROAD	SUITE 106	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
192257	Fee-for-Service	1659305852	1659305852	1	1	GODOY JR, EDUARDO R MD	2/28/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	74220	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
192298	Fee-for-Service	1245366061	1245366061	1	1	GORAB, LISA C MD	3/8/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	64708	40	Pediatrics	0	In state provider	None	1120 W LA VETA AVE	STE 125	ORANGE	CA	92868	4235	30	06059	33.78029455	-117.864369	Orange County
192310	Fee-for-Service	1477567170	1477567170	1	1	GRAHAM, GARY R MD	10/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51164	08	Family Practice	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
192349	Fee-for-Service	1467815936	1467815936	1	1	GROSSMAN, ALEXANDRA MD	1/1/2020	207P00000X	NA	Other	026	PHYSICIANS	152503	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
192361	Fee-for-Service	1063944270	1063944270	1	1	GAO, SEAN L DO	8/15/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	19358	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
192364	Fee-for-Service	1063434678	1063434678	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	72549 HWY 111	None	PALM DESERT	CA	92260	3306	33	06065	33.723648	-116.403363	Riverside County
192379	Fee-for-Service	1942311386	1942311386	1	1	GALATIN, PETER S MD	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85095	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
192400	Fee-for-Service	1316098866	1316098866	1	1	GOODMAN, SUZAN R MD	7/15/1995	207P00000X	NA	Other	026	PHYSICIANS	82282	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
192402	Fee-for-Service	1871768069	1871768069	1	1	GILL, AMANDEEP S MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110465	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
192409	Fee-for-Service	1548352131	1548352131	1	1	GITTINS, SCOTT E	12/8/1995	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3300 SUNSET BLVD	STE 100	ROCKLIN	CA	95677	3094	31	06061	38.78529353	-121.2492539	Placer County
192413	Fee-for-Service	1093723108	1093723108	1	1	GOURGY, DALIA J MD	1/1/1998	207L00000X	NA	Other	026	PHYSICIANS	81125	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
192414	Fee-for-Service	1639195365	1639195365	1	1	GOCHOCO, JOSE L DO	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
192419	Fee-for-Service	1669540753	1669540753	1	1	GALATI, GREGORY T LMFT	2/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
192441	Fee-for-Service	1609437599	1609437599	1	1	GINTIEN HUANG MD INC	11/9/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1909 N WATERMAN AVE	3	SAN BERNARDINO	CA	92404	4842	36	06071	34.132626	-117.2787445	San Bernardino County
192500	Fee-for-Service	1134165293	1134165293	1	1	GARFIELD BEACH CVS, LLC	5/13/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14503 RAMONA BLVD	None	BALDWIN PARK	CA	91706	3322	19	06037	34.08739058	-117.957714	Los Angeles County
192503	Fee-for-Service	1720583479	1720583479	1	1	GARFINKEL, RACHEL J MD	7/3/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	185164	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
192527	Fee-for-Service	1134617772	1134617772	1	1	GOLESTANY, BARRY B MD	6/21/2021	390200000X	NA	Other	026	PHYSICIANS	165359	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
192558	Fee-for-Service	1912085630	1912085630	1	1	GEISCHEN, BONNIE M MD	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55242	40	Pediatrics	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
192574	Fee-for-Service	1073875746	1073875746	1	1	GILDEA, ELIJAH J LMFT	5/5/2022	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
192592	Fee-for-Service	1740492719	1740492719	1	1	GEWIRTZ, YAFFA R MD	7/26/2022	2080P0204X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
192608	Fee-for-Service	1457553109	1457553109	1	1	GILMORE, 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	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
192668	Fee-for-Service	1942311386	1942311386	1	1	GALATIN, PETER S MD	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85095	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
192695	Fee-for-Service	1093066359	1093066359	1	3	GOMEZ, ELENA N PSYD	2/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1801 BUSH ST	209	SAN FRANCISCO	CA	94109	5204	38	06075	37.78777536	-122.427321	San Francisco County
192712	Fee-for-Service	1962289462	1962289462	1	1	GIBSON, DEYANIRA	3/12/2024	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
192713	Fee-for-Service	1891218673	1891218673	1	1	GETTAS, MARIAM A OD	1/20/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
192718	Fee-for-Service	1942455860	1942455860	1	1	GANGAR, PAMELA MD	2/3/2020	225XP0200X	NA	Other	026	PHYSICIANS	140651	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
192735	Fee-for-Service	1932340502	1932340502	1	1	GAREYS, LYUDMYLA I MD	5/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105642	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
192769	Fee-for-Service	1881616498	1881616498	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1931 N CAMPUS AVE	None	UPLAND	CA	91784	1667	36	06071	34.133643	-117.640674	San Bernardino County
192770	Fee-for-Service	1689610743	1689610743	1	1	GARFIELD BEACH CVS, LLC	8/15/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3575 ATLANTIC AVE	None	LONG BEACH	CA	90807	4515	19	06037	33.821712	-118.185059	Los Angeles County
192777	Fee-for-Service	1609824986	1609824986	1	1	GOMEZ, JOSE L MD	2/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87407	08	Family Practice	0	In state provider	None	1701 CESAR CHAVEZ AVE	STE 230	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
192783	Fee-for-Service	1265467864	1265467864	1	1	GANZ, DAVID A MD	7/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80247	38	Geriatrics	0	In state provider	None	200 MEDICAL PLAZA STE 42	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
192786	Fee-for-Service	1194170290	1194170290	1	1	GHATNEKAR, NIKHIL J DO	8/31/2023	1835C0206X	NA	None	026	PHYSICIANS	15803	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
192798	Fee-for-Service	1972571636	1972571636	1	1	GOLDSTEIN, LARRY MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	61253	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
192813	Fee-for-Service	1124196050	1124196050	1	1	GILL, JERRY H MD	9/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	66397	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
192835	Fee-for-Service	1144212200	1144212200	1	1	GLINN & GIORDANO PHYSICAL TH	5/15/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERAPY INC	1201 23RD ST	None	BAKERSFIELD	CA	93301	2306	15	06029	35.38001554	-119.015649	Kern County
192849	Fee-for-Service	1275004822	1275004822	1	1	GARCIA, MARCO A RCP	2/25/2019	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
192870	Fee-for-Service	1801963772	1801963772	1	1	GRAHEK, STEVEN P MD	8/30/1985	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	55849	None	None	0	In state provider	None	7300 MEDICAL CENTER DR	None	CANOGA PARK	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
192911	Fee-for-Service	1144498023	1144498023	1	1	GAROFALO, SALVATORE A	2/13/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	63	Unknown	0	In state provider	None	351 S PATTERSON AVENUE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
192971	Fee-for-Service	1184716342	1184716342	1	1	GRIFFITH UROLOGY CLINIC PC	12/10/2015	174400000X	NA	Other	026	PHYSICIANS	72967	34	Urology and Urological Surgery	0	In state provider	None	1004 N DOUTY ST	None	HANFORD	CA	93230	3723	16	06031	36.335133	-119.6460765	Kings County
192978	Fee-for-Service	1427455344	1427455344	1	1	GUERRERO, BROOKE L	4/7/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	139947	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
192982	Fee-for-Service	1346283017	1346283017	3	1	GLENN MEDICAL CENTER, LLC	7/1/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	130 NORTH ENRIGHT AVENUE	None	WILLOWS	CA	95988	2601	11	06021	39.521034	-122.2074315	Glenn County
192991	Fee-for-Service	1861542664	1861542664	1	1	GARCIA, LUIS F MD	4/11/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171853	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
193073	Fee-for-Service	1073148854	1073148854	1	1	GREENE, TINA T MSW LCSW	8/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 S GRAND STREET	SUITE 780	LOS ANGELES	CA	90017	8590	19	06037	34.04532806	-118.258462	Los Angeles County
193076	Fee-for-Service	1649814724	1649814724	1	1	GUARDIAN FLIGHT LLC	4/27/2020	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	None	3474 OLD INTL AIRPORT RD	STE A	ANCHORAGE	AK	99502	1003	00	None	61.173306	-149.94864	Municipality of Anchorage
193085	Fee-for-Service	1972571636	1972571636	1	1	GOLDSTEIN, LARRY MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	61253	02	General Surgery	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
193196	Fee-for-Service	1144498023	1144498023	1	1	GAROFALO, SALVATORE A	2/13/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	43	Pediatric Allergy	0	In state provider	None	351 S PATTERSON AVENUE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
193210	Fee-for-Service	1992306583	1992306583	1	1	GALA HOSPICE CARE INC	9/20/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13317 VENTURA BLVD	STE G1	SHERMAN OAKS	CA	91423	6217	19	06037	34.14670639	-118.4231775	Los Angeles County
193214	Fee-for-Service	1427310275	1427310275	1	2	GOSHGARIAN, ANNE M MD	4/8/2022	207P00000X	NA	Other	086	MEDICAL DIRECTORS	135437	-	NOT APPLICABLE	0	In state provider	None	1360 N MAIN ST	None	BISHOP	CA	93514	3013	14	06027	37.37584141	-118.3953422	Inyo County
193221	Fee-for-Service	1922110311	1922110311	1	1	GRAY,DAVID 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	801 SEVENTH AVE	None	FORTWORTH	TX	76104	0000	00	None	32.73710364	-97.3419336	Tarrant County
193224	Fee-for-Service	1851497291	1851497291	1	1	GALLOWAY, LESLE S MD	3/2/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76416	08	Family Practice	0	In state provider	None	4944 SUNRISE BLVD	None	FAIR OAKS	CA	95628	4941	34	06067	38.656107	-121.271931	Sacramento County
193226	Fee-for-Service	1144663741	1144663741	1	1	GADGIL, NISHA MD	8/1/2021	207T00000X	NA	General Surgery	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
193266	Fee-for-Service	1164840856	1164840856	1	1	GARCIA, RAMON RYAN MD	12/9/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158035	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
193270	Fee-for-Service	1346283017	1346283017	3	1	GLENN MEDICAL CENTER, LLC	7/1/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	130 NORTH ENRIGHT AVENUE	None	WILLOWS	CA	95988	2601	11	06021	39.521034	-122.2074315	Glenn County
193272	Fee-for-Service	1770153793	1770153793	1	1	GREATHOUSE, KATHY E LMFT	11/16/2023	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
193275	Fee-for-Service	1285873406	1285873406	1	1	GILL, JASMEET K MD INC	12/22/2008	193400000X	NA	Other	026	PHYSICIANS	99494	40	Pediatrics	0	In state provider	None	612 W DURATE RD	# 206	ARCADIA	CA	91007	7602	19	06037	34.12647805	-118.051994	Los Angeles County
193281	Fee-for-Service	1578121927	1578121927	1	1	GILL, SHARANBIR K DPM	1/17/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	20130 LAKE CHABOT ROAD	SUITE 202	CASTRO VALLEY	CA	94546	5306	01	06001	37.69738066	-122.087041	Alameda County
193332	Fee-for-Service	1104147149	1104147149	1	1	GUPTA, KIRAN MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137867	01	General Practice	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
193333	Fee-for-Service	1699719153	1699719153	1	1	GROSS, ERIC A MD	4/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129701	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
193336	Fee-for-Service	1548464332	1548464332	1	2	GUPTA, AMIT MD MPH	6/8/2022	208800000X	NA	Other	026	PHYSICIANS	142651	None	None	0	In state provider	None	414 N CAMDEN DR	STE 650	BEVERLY HILLS	CA	90210	4513	19	06037	34.06880486	-118.4042308	Los Angeles County
193381	Fee-for-Service	1982702478	1982702478	2	1	GARFIELD BEACH CVS, LLC	5/27/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	915 E ARROW HWY	None	AZUSA	CA	91702	5800	19	06037	34.10683323	-117.8899644	Los Angeles County
193421	Fee-for-Service	1700962206	1700962206	1	1	GILBERT, GREGORY D LAC	8/28/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	733 ZION ST	None	NEVADA CITY	CA	95959	2920	29	06057	39.25342652	-121.0259727	Nevada County
193442	Fee-for-Service	1508564964	1508564964	1	1	GUTIERREZ, MARISOL G NP	3/14/2025	1835P0200X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
193447	Fee-for-Service	1740224013	1740224013	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8008 FIRESTONE BLVD	None	DOWNEY	CA	90241	4229	19	06037	33.9423765	-118.1375373	Los Angeles County
193480	Fee-for-Service	1568654879	1568654879	1	1	GOMES, RICK LMFT	3/16/2024	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
193499	Fee-for-Service	1992306583	1992306583	1	1	GALA HOSPICE CARE INC	9/20/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13317 VENTURA BLVD	STE G1	SHERMAN OAKS	CA	91423	6217	19	06037	34.14670639	-118.4231775	Los Angeles County
193505	Fee-for-Service	1720814486	1720814486	1	1	GIBSON, MADELINE E AU	10/15/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	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
193510	Fee-for-Service	1851497291	1851497291	1	1	GALLOWAY, LESLE S MD	3/2/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76416	41	Internal Medicine	0	In state provider	None	4944 SUNRISE BLVD	None	FAIR OAKS	CA	95628	4941	34	06067	38.656107	-121.271931	Sacramento County
193557	Fee-for-Service	1386651230	1386651230	1	1	GOLDEN, JOEL G MD	2/2/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	26683	41	Internal Medicine	0	In state provider	None	10234 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2602	19	06037	33.90197379	-118.1144208	Los Angeles County
193620	Fee-for-Service	1295042687	1295042687	1	1	GRAY, JONATHAN J MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118751	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
193639	Fee-for-Service	1912018995	1912018995	1	1	GOLDSTONE, HARVEY R OD	4/19/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2280 E CARSON ST	None	LONG BEACH	CA	90807	3044	19	06037	33.83241248	-118.164456	Los Angeles County
193652	Fee-for-Service	1174533855	1174533855	1	1	GAIDARSKI, ALEXANDER 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	3500 W WHEATLAND RD	None	DALLAS	TX	75237	3460	00	None	32.64745255	-96.8764365	Dallas County
193692	Fee-for-Service	1376579227	1376579227	1	1	GENOVA, MICHAEL L MD	8/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	76648	08	Family Practice	0	In state provider	None	1045 W REDONDO BEACH BLV	STE 240	GARDENA	CA	90247	4182	19	06037	33.89247044	-118.2931941	Los Angeles County
193694	Fee-for-Service	1205854833	1205854833	1	1	GREWAL, KANWARDEEP S MD	6/1/1998	207R00000X	NA	Other	026	PHYSICIANS	55986	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
193722	Fee-for-Service	1043224892	1043224892	1	1	GREGORY BRANT MEADOR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	551 HILL COUNTRY DR	None	KERRVILLE	TX	78028	6085	00	None	30.04481871	-99.15170303	Kerr County
193723	Fee-for-Service	1851553572	1851553572	1	1	GAAL, WADE R MD	10/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	2313	00	None	36.135288	-115.1368705	Clark County
193757	Fee-for-Service	1811074875	1811074875	1	1	GREEN, GEORGE ELLIS MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	45441	41	Internal Medicine	0	In state provider	PULMONARY & INTERNAL MED	9460 N NAME UNO	STE 110	GILROY	CA	95020	3536	43	06085	37.037781	-121.570965	Santa Clara County
193800	Fee-for-Service	1912908021	1912908021	1	1	GRAY, CYNTHIA J MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55681	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
193824	Fee-for-Service	1205023249	1205023249	1	1	GONZALO GONZALEZ MARTINEZ MD	11/12/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MD INC	41230 11TH STREET WEST	STE E	PALMDALE	CA	93551	1411	19	06037	34.63215221	-118.1501501	Los Angeles County
193836	Fee-for-Service	1861472318	1861472318	1	6	GENESISCARE USA OF CALIFORNI	2/3/2009	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CALIFORNIA AMC	46-883 MONROE ST	STE 100	INDIO	CA	92201	5547	33	06065	33.70748774	-116.2338705	Riverside County
193890	Fee-for-Service	1750889531	1750889531	1	1	GARFIELD BEACH CVS LLC	10/22/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1204 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3205	19	06037	34.28406538	-118.4431419	Los Angeles County
193896	Fee-for-Service	1700480571	1700480571	1	1	GRANT PALLIATIVE SERVICES	10/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	6320 VAN NUYS BLVD	STE 301	VAN NUYS	CA	91401	6337	19	06037	34.18545203	-118.4487091	Los Angeles County
193902	Fee-for-Service	1144534975	1144534975	1	1	GUPTA, ABHA DO	2/3/2020	2084P0802X	NA	Psychiatry	026	PHYSICIANS	None	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
193908	Fee-for-Service	1992052245	1992052245	1	1	GERARDO OCHOA, FABRICIO MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127194	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
193941	Fee-for-Service	1598019580	1598019580	1	1	GANUPURU, MAYURI MD	1/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123391	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
193978	Fee-for-Service	1316142920	1316142920	1	1	GUTIERREZ JR, EFREN MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125866	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
193980	Fee-for-Service	1649858051	1649858051	1	1	GHYAZ, MOHAMED MD	7/1/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
194010	Fee-for-Service	1407986888	1407986888	1	1	GELDWERT, DARON MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	94424	24	Plastic Surgery	0	In state provider	None	9961 SERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
194034	Fee-for-Service	1114937844	1114937844	1	1	GAITANIS, ALEXANDER DO	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10801	78	Neoplastic Diseases/Oncology	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
194035	Fee-for-Service	1841724416	1841724416	1	1	GARFIELD BEACH CVS LLC	3/21/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	866 EASTLAKE PKWY	None	CHULA VISTA	CA	91914	4541	37	06073	32.65292169	-116.9706476	San Diego County
194043	Fee-for-Service	1811074875	1811074875	1	1	GREEN, GEORGE ELLIS MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	45441	29	Pulmonary Diseases (M.D. only)	0	In state provider	PULMONARY & INTERNAL MED	9460 N NAME UNO	STE 110	GILROY	CA	95020	3536	43	06085	37.037781	-121.570965	Santa Clara County
194105	Fee-for-Service	1588758551	1588758551	1	1	GOODMAN, GARY MD	3/23/1992	2080P0203X	NA	Other	026	PHYSICIANS	45219	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
194122	Fee-for-Service	1861472318	1861472318	1	6	GENESISCARE USA OF CALIFORNI	8/1/2017	2085R0001X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA AMC	46-883 MONROE ST	STE 100	INDIO	CA	92201	5547	33	06065	33.70748774	-116.2338705	Riverside County
194125	Fee-for-Service	1699926881	1699926881	1	1	GROSSMAN, DANIEL B MD	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109203	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
194184	Fee-for-Service	1700480571	1700480571	1	1	GRANT PALLIATIVE SERVICES	10/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	6320 VAN NUYS BLVD	STE 301	VAN NUYS	CA	91401	6337	19	06037	34.18545203	-118.4487091	Los Angeles County
194209	Fee-for-Service	1649204819	1649204819	1	1	GENINAHI,MARILYN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1601 W ST MARY'S RD	None	TUCSON	AZ	85745	2623	00	None	32.228199	-111.0000825	Pima County
194213	Fee-for-Service	1225253933	1225253933	1	1	GARCIA, REGINO L MD	10/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	39590	01	General Practice	0	In state provider	None	HWY 162 & BIGGER	None	COVELO	CA	95428	0000	23	06045	39.809763	-123.2481105	Mendocino County
194223	Fee-for-Service	1659482958	1659482958	1	1	GAMBRILL, STANLEY R MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40434	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
194258	Fee-for-Service	1093772857	1093772857	1	1	GRANDIS, DONALD J MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134090	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
194290	Fee-for-Service	1932125523	1932125523	1	1	GULDNER, GREGORY T MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66619	66	Emergency Medicine (Urgent Care)	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92253	0000	36	06071	34.26577765	-117.1695461	San Bernardino County
194298	Fee-for-Service	1386685204	1386685204	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11428 KENYON WAY	None	RANCHO CUCAMONGA	CA	91701	9234	36	06071	34.13410806	-117.5562787	San Bernardino County
194315	Fee-for-Service	1235365982	1235365982	1	1	GUZIEL, JEANNETTE M MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141660	68	Hematology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
194322	Fee-for-Service	1114937844	1114937844	1	1	GAITANIS, ALEXANDER DO	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10801	41	Internal Medicine	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
194336	Fee-for-Service	1073878922	1073878922	1	1	GIRON, YASSER M MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129153	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
194348	Fee-for-Service	1700090073	1700090073	1	1	GOMEZ, NEPHTALI R MD	7/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95430	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
194354	Fee-for-Service	1922182906	1922182906	1	1	GEIGER, GREER L MD	8/29/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45999	18	Ophthalmology	0	In state provider	None	45 CASTRO ST	STE 315	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
194401	Fee-for-Service	1043715717	1043715717	1	1	GUIROY, ILANG M MD	6/19/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159608	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
194416	Fee-for-Service	1467458273	1467458273	1	1	GROSS, HOWARD M MD	3/31/1992	174400000X	NA	Other	026	PHYSICIANS	61854	24	Plastic Surgery	0	In state provider	None	425 W JUNIPERO ST	STE 1	SANTA BARBARA	CA	93105	4292	42	06083	34.42973253	-119.7249544	Santa Barbara County
194442	Fee-for-Service	1477322378	1477322378	1	1	GARRICK, KRISTIN A NP	3/4/2024	363LA2100X	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
194455	Fee-for-Service	1215066972	1215066972	1	1	GOLD, VIVIAN J PHD	11/24/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3235 KELTON AVENUE	None	LOS ANGELES	CA	90034	3001	19	06037	34.0263612	-118.4200339	Los Angeles County
194464	Fee-for-Service	1366901324	1366901324	1	1	GARDNER, JEFFREY MD	1/10/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	178766	None	None	0	In state provider	None	11370 ANDERSON ST	# 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
194514	Fee-for-Service	1790018455	1790018455	1	1	GOYAL, SHALINI K	6/24/2013	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
194523	Fee-for-Service	1073018891	1073018891	1	1	GILLES, LOUIS DPM	2/17/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	320 SANTA FE DR	305	ENCINITAS	CA	92024	5140	37	06073	33.038847	-117.285579	San Diego County
194524	Fee-for-Service	1184892481	1184892481	1	1	GAILEY, KENNETH E LMFT	12/12/2018	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
194549	Fee-for-Service	1558363671	1558363671	1	1	GANGADHARAN, MEERA MD	4/12/2021	207LP3000X	NA	Other	026	PHYSICIANS	51381	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
194567	Fee-for-Service	1912330952	1912330952	1	1	GOULD, JULIE A MD	6/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	88761	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	20911 EARL STREET	STE 440	TORRANCE	CA	90503	4355	19	06037	33.840459	-118.3580985	Los Angeles County
194588	Fee-for-Service	1215683677	1215683677	1	1	GREVIOUS, CHIOKO LMFT	2/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2417 21ST STREET	None	SACRAMENTO	CA	95818	2409	34	06067	38.560203	-121.485132	Sacramento County
194607	Fee-for-Service	1235365982	1235365982	1	1	GUZIEL, JEANNETTE M MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141660	78	Neoplastic Diseases/Oncology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
194609	Fee-for-Service	1114937844	1114937844	1	1	GAITANIS, ALEXANDER DO	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10801	68	Hematology	0	In state provider	None	8900 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	1958	19	06037	34.06703955	-118.3859235	Los Angeles County
194611	Fee-for-Service	1023331311	1023331311	1	1	GUIDRY, SHANNON P LMFT	8/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	604 REDINGTON ST	None	HANFORD	CA	93230	3835	16	06031	36.33155849	-119.649362	Kings County
194615	Fee-for-Service	1730332024	1730332024	1	1	GONZALEZ-FRANCO, FRANCISCO	5/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135410	36	Psychiatry	0	In state provider	MD	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
194618	Fee-for-Service	1902847817	1902847817	2	1	GARFIELD BEACH CVS, LLC	6/19/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	511 N HOLLYWOOD WAY	None	BURBANK	CA	91505	3406	19	06037	34.15985598	-118.3431272	Los Angeles County
194651	Fee-for-Service	1851544480	1851544480	1	1	GARCIA, DAVID NP	6/9/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.75385831	-117.1628029	San Diego County
194678	Fee-for-Service	1811428147	1811428147	1	1	GARAY, KAREN MD	1/21/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
194695	Fee-for-Service	1295845782	1295845782	1	1	GIACOMELLI, VINCE M	2/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
194701	Fee-for-Service	1336227149	1336227149	1	1	GANGULA, RAVI V MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74219	30	Radiology	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
194757	Fee-for-Service	1003269937	1003269937	1	1	GARLAPATI, PRANAV MD	10/21/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
194779	Fee-for-Service	1902019151	1902019151	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	WOMEN'S HEALTH	797 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
194793	Fee-for-Service	1942509260	1942509260	1	1	GOYAL, RAJAT MD	1/28/2025	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	182734	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	365 HAWTHORNE AVE	SUITE 201	OAKLAND	CA	94609	3107	01	06001	37.82079728	-122.2633226	Alameda County
194808	Fee-for-Service	1235662487	1235662487	1	1	GAVILAN YODU, RONALD MD	2/28/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	164003	08	Family Practice	0	In state provider	None	1332 NATIVIDAD RD	STE C	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
194811	Fee-for-Service	1891729745	1891729745	1	3	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2626 EL CAMINO REAL	SUITE B	CARLSBAD	CA	92008	1214	37	06073	33.1752923	-117.3253782	San Diego County
194833	Fee-for-Service	1710096789	1710096789	1	1	GOLDIN, ALICE L MD	10/3/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	15283	40	Pediatrics	0	In state provider	None	20911 EARL ST	STE 100	TORRANCE	CA	90503	4354	19	06037	33.840459	-118.3580985	Los Angeles County
194847	Fee-for-Service	1033410444	1033410444	1	2	GONZALEZ, DOLORES	10/27/2023	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
194853	Fee-for-Service	1023062171	1023062171	1	1	GRASS VALLEY CARD MED GR	12/15/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	150 CATHERINE LN	STE D	GRASS VALLEY	CA	95945	5719	29	06057	39.22894557	-121.0489578	Nevada County
194904	Fee-for-Service	1205074804	1205074804	1	1	GARCIA, DANIEL J LCSW	3/21/2022	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
194951	Fee-for-Service	1700808318	1700808318	2	1	GARFIELD BEACH CVS LLC	12/21/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17751 COLIMA RD	None	CITY OF INDUSTRY	CA	91748	1714	19	06037	33.992145	-117.918549	Los Angeles County
195027	Fee-for-Service	1013018050	1013018050	1	1	GARCIA, MARIBEL PSYD	3/1/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	S	115 PINE AVE	440	LONG BEACH	CA	90802	4457	19	06037	33.76840039	-118.1924299	Los Angeles County
195036	Fee-for-Service	1164637443	1164637443	1	1	GANESA HEALTH CARE	8/8/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	331 MAIN STREET	STE B	SALINAS	CA	93901	2705	27	06053	36.67295657	-121.6546689	Monterey County
195082	Fee-for-Service	1942509260	1942509260	1	1	GOYAL, RAJAT MD	1/28/2025	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	182734	70	Clinic (mixed specialty)	0	In state provider	None	365 HAWTHORNE AVE	SUITE 201	OAKLAND	CA	94609	3107	01	06001	37.82079728	-122.2633226	Alameda County
195098	Fee-for-Service	1891729745	1891729745	1	3	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2626 EL CAMINO REAL	SUITE B	CARLSBAD	CA	92008	1214	37	06073	33.1752923	-117.3253782	San Diego County
195113	Fee-for-Service	1649228917	1649228917	1	1	GLATT, DANIEL J MD	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79524	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
195168	Fee-for-Service	1043715444	1043715444	1	1	GIALLANZO, PATTI S NP	8/16/2018	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
195179	Fee-for-Service	1003272592	1003272592	1	1	GRAVIET, HEATHER LCSW	3/19/2025	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
195190	Fee-for-Service	1417352691	1417352691	1	1	GALINDO, GUADALUPE NP	7/21/2023	363LF0000X	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
195203	Fee-for-Service	1376860809	1376860809	1	1	GARCIA, DAIRON MD	10/18/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191192	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
195214	Fee-for-Service	1023635562	1023635562	1	1	GRISTAN, YANA D MD	6/27/2023	207R00000X	NA	Other	026	PHYSICIANS	186841	None	None	0	In state provider	None	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	42	06083	34.42887662	-119.7237878	Santa Barbara County
195240	Fee-for-Service	1982033353	1982033353	1	1	GOLDEN MEADOWS HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	640 S SUNSET AVE	SUITE 201	WEST COVINA	CA	91790	2808	19	06037	34.06977627	-117.9371391	Los Angeles County
195277	Fee-for-Service	1447207402	1447207402	1	1	GONZALES, JOHN M MD	1/31/1992	246Q00000X	NA	Other	026	PHYSICIANS	56012	22	Pathology (M.D. only)	0	In state provider	None	2505 SAMARITAN DR	STE 609	SAN JOSE	CA	95124	4006	43	06085	37.25111447	-121.9483395	Santa Clara County
195355	Fee-for-Service	1427150879	1427150879	1	1	GOLDMAN, MARCIE I PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4452 PARK BLVD	STE 101	SAN DIEGO	CA	92116	4039	37	06073	32.758281	-117.1462795	San Diego County
195385	Fee-for-Service	1891729745	1891729745	1	3	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2626 EL CAMINO REAL	SUITE B	CARLSBAD	CA	92008	1214	37	06073	33.1752923	-117.3253782	San Diego County
195403	Fee-for-Service	1093828816	1093828816	1	1	GAINES, LARRY E PHD	3/9/1989	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4833 RUBIO AVE	None	ENCINO	CA	91436	1118	19	06037	34.158915	-118.4945795	Los Angeles County
195408	Fee-for-Service	1174842439	1174842439	1	1	GELORMINO, SHAWNA	7/23/2024	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
195431	Fee-for-Service	1184642647	1184642647	1	1	GABOREK, JANET P LCSW	7/3/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DR	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
195458	Fee-for-Service	1063448371	1063448371	1	1	GOLDING, ILYSSA B MD	10/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	78242	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
195468	Fee-for-Service	1134255698	1134255698	1	1	GOLDSTEIN, JEFFREY A MD	1/1/1982	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	39151	10	Gastroenterology (M.D. only)	0	In state provider	None	3939 J ST	STE 360	SACRAMENTO	CA	95819	3671	34	06067	38.570211	-121.45374	Sacramento County
195486	Fee-for-Service	1366418071	1366418071	1	1	GOTTLIEB, GARY 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	7140 E ROSEWOOD ST	None	TUCSON	AZ	85710	1346	00	None	32.232501	-110.84004	Pima County
195492	Fee-for-Service	1841691565	1841691565	1	1	GASKINS, KARI A CNM	5/22/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
195513	Fee-for-Service	1205870557	1205870557	1	1	GARFIELD BEACH CVS LLC	1/14/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5985 W PICO BLVD	None	LOS ANGELES	CA	90035	2652	19	06037	34.05229947	-118.3706073	Los Angeles County
195522	Fee-for-Service	1336315894	1336315894	1	1	GHAUSI, OMAR A MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95679	13	Neurology (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
195528	Fee-for-Service	1982033353	1982033353	1	1	GOLDEN MEADOWS HOSPICE LLC	9/21/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	640 S SUNSET AVE	SUITE 201	WEST COVINA	CA	91790	2808	19	06037	34.06977627	-117.9371391	Los Angeles County
195547	Fee-for-Service	1831395557	1831395557	1	2	GOLDSTEIN, RACHEL Y MD	10/1/2014	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	308 WEYMOUTH AVE	None	SAN PEDRO	CA	90732	3426	19	06037	33.739515	-118.309653	Los Angeles County
195565	Fee-for-Service	1548217573	1548217573	1	1	GIURGIUS, MOATAZ K MD	3/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53359	36	Psychiatry	0	In state provider	None	12675 LAMIRADA BLVD	None	LA MIRADA	CA	90639	0001	19	06037	33.91589551	-118.0119734	Los Angeles County
195578	Fee-for-Service	1871881003	1871881003	1	1	GUY, MOLTU J MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135737	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
195589	Fee-for-Service	1912232059	1912232059	1	1	GALLEGOS, LISA R LCSW	10/23/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	19	06037	34.100523	-118.3324855	Los Angeles County
195606	Fee-for-Service	1790041804	1790041804	1	1	GOMEZ, JESSICA MD	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154766	18	Ophthalmology	0	In state provider	None	7695 CARDINAL COURT	STE 100	SAN DIEGO	CA	92123	3357	37	06073	32.79146985	-117.1578472	San Diego County
195620	Fee-for-Service	1831775444	1831775444	1	1	GROSSAINT, CAMERON DO	12/13/2024	390200000X	NA	Other	026	PHYSICIANS	22790	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
195648	Fee-for-Service	1972694610	1972694610	1	1	GOTTLIEB, ROBERT J PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9663 TIERRA GRANDE ST	STE 104	SAN DIEGO	CA	92126	4569	37	06073	32.89501952	-117.1213425	San Diego County
195715	Fee-for-Service	1467538447	1467538447	1	1	GLENN BARBER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	WILLIS CHIRO MED	7171 TWO NOTCH RD	None	COLUMBIA	SC	29223	0000	00	None	34.06411454	-80.95802291	Richland County
195722	Fee-for-Service	1093710345	1093710345	1	1	GELLER, MARK LAWRENCE MD	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60287	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18370 BURBANK BLVD	STE 601	TARZANA	CA	91356	2831	19	06037	34.17173059	-118.5331881	Los Angeles County
195736	Fee-for-Service	1033405592	1033405592	1	1	GOEL, ANURAG MD	1/21/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	148442	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
195739	Fee-for-Service	1275527657	1275527657	1	1	GOLDKLANG, ROBERT H MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69237	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
195752	Fee-for-Service	1629538194	1629538194	1	1	GLENN P. MATNEY, M.D., INC.	4/22/2019	193400000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	12402 INDUSTRIAL BLVD	B1	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
195775	Fee-for-Service	1861426561	1861426561	1	1	GALES, JASON V CRNA	11/17/2022	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
195776	Fee-for-Service	1760878607	1760878607	1	1	GAMBHIR, SAHIL MD	5/9/2022	390200000X	NA	Other	026	PHYSICIANS	145370	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
195862	Fee-for-Service	1215970165	1215970165	1	1	GLENN, ORIT A MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54884	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
195878	Fee-for-Service	1740729763	1740729763	1	1	GIRIRAJ CORPORATION	4/21/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	24825 ALESSANDRO BLVD	STE 2	MORENO VALLEY	CA	92553	5851	33	06065	33.91717548	-117.2299139	Riverside County
195896	Fee-for-Service	1386871473	1386871473	1	1	GELLER, DREW D MD	11/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14771	01	General Practice	0	In state provider	None	1000 NUT TREE ROAD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
195917	Fee-for-Service	1215515598	1215515598	1	1	GURLEY, AMELIA L MD	8/8/2024	163WE0003X	NA	Other	026	PHYSICIANS	191694	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
195971	Fee-for-Service	1043379639	1043379639	1	1	GAVIN-HEADEN, VANESSA MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61486	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
195996	Fee-for-Service	1629044706	1629044706	1	1	GIMELLI, GIORGIO MD	1/2/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	600 HIGHLAND AVE	None	MADISON	WI	53792	0001	00	None	43.07868393	-89.4316606	Dane County
196019	Fee-for-Service	1467498956	1467498956	1	1	GJEDSTED, VIRGINIA S 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
196026	Fee-for-Service	1275527657	1275527657	1	1	GOLDKLANG, ROBERT H MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69237	10	Gastroenterology (M.D. only)	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
196058	Fee-for-Service	1972674919	1972674919	1	1	GEORGE, SAJINI S MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75762	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
196079	Fee-for-Service	1326243833	1326243833	1	1	GRANT, REBEKAH I MD	5/15/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	159737	15	Obstetrics (D.O. only)	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
196142	Fee-for-Service	1710425012	1710425012	1	1	GOMEZ-ALVAREZ, MARIA G LCSW	12/9/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
196201	Fee-for-Service	1225524507	1225524507	1	1	GREENBLAT, ROBIN LMFT	12/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	177 BOVET RD	SUITE 300	SAN MATEO	CA	94402	3140	41	06081	37.5502646	-122.3169875	San Mateo County
196262	Fee-for-Service	1053477836	1053477836	1	1	GHAZZAGH, LAYLA LCSW	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
196274	Fee-for-Service	1588308340	1588308340	1	1	GOSNELL, EMILY M PSYD	5/6/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
196303	Fee-for-Service	1003956798	1003956798	1	1	GRIEGER, NANCY N PT	2/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	20701 CEREAL ST	SKYDIVE ELSINORE, TEAM R	LAKE ELSINORE	CA	92530	9650	33	06065	33.6314242	-117.2959818	Riverside County
196313	Fee-for-Service	1275527657	1275527657	1	1	GOLDKLANG, ROBERT H MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69237	01	General Practice	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
196342	Fee-for-Service	1699157826	1699157826	1	1	GORIPARTHI, SARITHA N MD	11/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152019	08	Family Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
196356	Fee-for-Service	1255078531	1255078531	1	1	GLOBAL HEALTH PLUS INC.	8/11/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	714 S HARBOR BLVD	None	SANTA ANA	CA	92704	2337	30	06059	33.73777075	-117.9201704	Orange County
196373	Fee-for-Service	1073879847	1073879847	1	1	GABRIEL, RODNEY A MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134856	05	Anesthesiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
196379	Fee-for-Service	1952459885	1952459885	1	1	GENIBLAZO, COLLEEN MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79303	40	Pediatrics	0	In state provider	None	3838 SHERMAN DR	STE 3	RIVERSIDE	CA	92503	4001	33	06065	33.92678822	-117.4368632	Riverside County
196394	Fee-for-Service	1356417851	1356417851	1	1	GALVAN, CRYSTAL DC	7/13/2007	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	310 PINE AVE	SUITE B	GOLETA	CA	93117	3736	42	06083	34.43451781	-119.8266063	Santa Barbara County
196399	Fee-for-Service	1922114131	1922114131	1	1	GROSSMONT OB GYN MED GRP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8851 CENTER DR	STE 500	LA MESA	CA	91942	3033	37	06073	32.78189749	-117.0075062	San Diego County
196487	Fee-for-Service	1396043329	1396043329	1	1	GOMEZ, RODOLFO M LMFT	6/30/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	E AND FAMILY THERAPY INC	23461 S POINTE DRIVE	190	LAGUNA HILLS	CA	92653	1547	30	06059	33.62535142	-117.7206568	Orange County
196512	Fee-for-Service	1215221148	1215221148	1	1	GONZALEZ, JAMIE M MD	9/13/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	137912	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
196516	Fee-for-Service	1255379939	1255379939	1	1	GRAVORI, TOORAJ MD	9/25/2008	207T00000X	NA	General Surgery	026	PHYSICIANS	75506	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
196544	Fee-for-Service	1790484475	1790484475	1	1	GENETIC EYE THERAPIES PC	8/23/2023	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	2895 LOMA VISTA RD	STE C	VENTURA	CA	93003	1572	56	06111	34.27543868	-119.2574459	Ventura County
196551	Fee-for-Service	1316162829	1316162829	1	1	GOLDEN VALLEY HEALTH CTR	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	0000	24	06047	37.28825369	-120.4963159	Merced County
196587	Fee-for-Service	1255436242	1255436242	1	1	GOLDMAN, MATTHEW D MD	12/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142553	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
196632	Fee-for-Service	1417292657	1417292657	1	1	GAEDT-SMITH, HEATHER PSYD	5/3/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	73730 HIGHWAY 111	STE 8	PALM DESERT	CA	92260	4018	33	06065	33.72156112	-116.3787188	Riverside County
196637	Fee-for-Service	1649272766	1649272766	1	1	GINKEL, MARK L MD	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	71322	None	None	0	In state provider	None	393 E WALNUT ST	None	PASADENA	CA	91188	0001	19	06037	34.14955087	-118.1422348	Los Angeles County
196647	Fee-for-Service	1811127558	1811127558	1	1	GRIFFIN, MICHAEL O MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129429	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
196670	Fee-for-Service	1417247842	1417247842	1	1	GIUROIU, IULIA MD	9/4/2018	1835X0200X	NA	Other	026	PHYSICIANS	155292	41	Internal Medicine	0	In state provider	None	2850 TELEGRAPH AVE	110	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
196683	Fee-for-Service	1861518458	1861518458	1	1	GARCIA, ALICIA E DC	2/25/2022	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	500 OLD RIVER RD	250	BAKERSFIELD	CA	93311	9515	15	06029	35.35127492	-119.1142991	Kern County
196688	Fee-for-Service	1518609635	1518609635	1	1	GIORGI, KENNETH NP	6/27/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95020616	-	NOT APPLICABLE	0	In state provider	None	2810 CAMINO DEL RIO S	STE 106	SAN DIEGO	CA	92108	3819	37	06073	32.77081335	-117.1316557	San Diego County
196726	Fee-for-Service	1568919983	1568919983	1	1	GRACE COUNSELING & PSYCHOTHE	11/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RAPY INC.	5575 LAKE PARK WAY	100-6	LA MESA	CA	91942	1664	37	06073	32.78203256	-117.0342041	San Diego County
196756	Fee-for-Service	1598844516	1598844516	1	1	GAYLE, SHANTI M P MD	1/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	82390	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
196772	Fee-for-Service	1710943543	1710943543	1	1	GAAL, KARL K MD	5/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60183	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
196774	Fee-for-Service	1699324392	1699324392	1	1	GAMMA HOME HEALTH INC	1/22/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7590 N GLENOAKS BLVD	STE 12	BURBANK	CA	91504	1003	19	06037	34.20858506	-118.3436243	Los Angeles County
196833	Fee-for-Service	1245315910	1245315910	1	1	GUDUR, KARUNA MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71108	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
196850	Fee-for-Service	1922020551	1922020551	2	1	GARFIELD BEACH CVS LLC	3/27/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1153 BUTTE HOUSE RD	None	YUBA CITY	CA	95991	3102	51	06101	39.14538701	-121.6321785	Sutter County
196864	Fee-for-Service	1467497362	1467497362	1	1	GARFIELD BEACH CVS, LLC	4/7/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11940 GARVEY AVE	None	EL MONTE	CA	91732	3514	19	06037	34.06274553	-118.020735	Los Angeles County
196892	Fee-for-Service	1164263869	1164263869	1	1	GARCIA ORTIZ, AYMIE-LEE LCS	9/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
196915	Fee-for-Service	1922041102	1922041102	1	1	GRANT, VALERIE MD	10/17/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64361	01	General Practice	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
196965	Fee-for-Service	1952323800	1952323800	1	1	GOODFAITH FAMILY MEDICAL	8/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, A MEDICAL CORP	7770 GARVEY AVE	None	ROSEMEAD	CA	91770	3061	19	06037	34.0625953	-118.0999043	Los Angeles County
197069	Fee-for-Service	1215340674	1215340674	1	1	GUBATAN, JOHN MARK B MD	6/14/2021	207R00000X	NA	Other	026	PHYSICIANS	154629	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
197092	Fee-for-Service	1336126663	1336126663	1	1	GROVE,DENISE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2222 PHILADELPHIA DRIVE	None	DAYTON	OH	45406	0000	00	None	39.78749248	-84.23490647	Montgomery County
197191	Fee-for-Service	1962880039	1962880039	1	1	GARRISON, DAVID J MD	6/30/2020	207RC0200X	NA	Other	026	PHYSICIANS	167925	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
197204	Fee-for-Service	1205157658	1205157658	1	1	GILSTRAP, JAROM N MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141650	24	Plastic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
197205	Fee-for-Service	1922041102	1922041102	1	1	GRANT, VALERIE MD	10/17/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64361	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
197231	Fee-for-Service	1316162043	1316162043	1	1	GARLAND, GLORIA J	1/21/2015	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	49722 ROAD 426	SUITE 101	OAKHURST	CA	93644	9703	20	06039	37.32574953	-119.6410791	Madera County
197248	Fee-for-Service	1992381206	1992381206	1	1	GIVEN, JANA PSYD	1/15/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
197252	Fee-for-Service	1952323800	1952323800	1	1	GOODFAITH FAMILY MEDICAL	8/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP, A MEDICAL CORP	7770 GARVEY AVE	None	ROSEMEAD	CA	91770	3061	19	06037	34.0625953	-118.0999043	Los Angeles County
197268	Fee-for-Service	1588240683	1588240683	1	1	GIMELLI, ALEX MD	9/25/2024	207P00000X	NA	Other	026	PHYSICIANS	190178	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
197349	Fee-for-Service	1740511492	1740511492	1	1	GOMEZ, LISSETTE LMFT	8/25/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 W MAIN ST	SUITE 101	TUSTIN	CA	92780	7717	30	06059	33.74204833	-117.8258263	Orange County
197364	Fee-for-Service	1811951148	1811951148	1	1	GRISE, MURLAN E. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	24461 E WELCHES RD	None	WELCHES	OR	97067	7067	00	None	45.346482	-121.963347	Clackamas County
197373	Fee-for-Service	1467410829	1467410829	1	1	GIBB, GREGORY N MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45184	18	Ophthalmology	0	In state provider	None	2840 ONEIL LN	None	EUREKA	CA	95503	4870	12	06023	40.78229635	-124.1356362	Humboldt County
197388	Fee-for-Service	1508269606	1508269606	1	1	GLOBAL CARE SOLUTIONS, INC	4/20/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	22411 MARTHA ST	None	WOODLAND HILLS	CA	91367	4470	19	06037	34.17366748	-118.615248	Los Angeles County
197418	Fee-for-Service	1649662131	1649662131	1	1	GOLDMAN, DAVID DO	9/16/2020	207L00000X	NA	Other	026	PHYSICIANS	17176	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
197443	Fee-for-Service	1477641173	1477641173	1	1	GOULD, JEFFREY MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19398	13	Neurology (M.D. only)	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
197465	Fee-for-Service	1679046775	1679046775	2	1	GROVE RX INC	10/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	655 N FAIR OAKS AVE	None	PASADENA	CA	91103	3383	19	06037	34.15684941	-118.1506023	Los Angeles County
197466	Fee-for-Service	1427586825	1427586825	1	1	GUTIERREZ COLIN, GUSTAVO J M	1/29/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164913	None	None	0	In state provider	D	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
197479	Fee-for-Service	1770895724	1770895724	1	1	GUZMAN, IGNACIO MD	3/16/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	113019	None	None	0	In state provider	None	18 FOURTH STREET	None	GONZALES	CA	93926	0808	27	06053	36.50698522	-121.4443339	Monterey County
197501	Fee-for-Service	1780215244	1780215244	1	1	GARFIELD BEACH CVS LLC	3/30/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	31874 DEL OBISPO ST	None	SAN JUAN CAPISTRA	CA	92675	3204	30	06059	33.49896407	-117.6602423	Orange County
197548	Fee-for-Service	1457447898	1457447898	1	1	GRACER, ERIK M MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67244	01	General Practice	0	In state provider	None	11030 BOLLINGER CANYON R	STE 200	SAN RAMON	CA	94582	4874	07	06013	37.77383963	-121.9239786	Contra Costa County
197571	Fee-for-Service	1861460925	1861460925	1	1	GOLDBERGER, LAWRENCE MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20333	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
197579	Fee-for-Service	1366419004	1366419004	1	1	GREENWAY, HUBERT T JR MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39104	07	Dermatology	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
197608	Fee-for-Service	1821157033	1821157033	1	1	GRIMALDI, JOHN A MD	5/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	11355	34	Urology and Urological Surgery	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
197612	Fee-for-Service	1114085065	1114085065	1	1	GARCIA, EDUARDO A MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	53121	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11441 HEACOCK ST	STE E	MORENO VALLEY	CA	92557	7907	33	06065	33.954858	-117.243978	Riverside County
197622	Fee-for-Service	1700119369	1700119369	1	1	GALINDO, TERESA Z LCSW	1/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
197627	Fee-for-Service	1063513737	1063513737	2	1	GARBUTT, GLENN D MD	6/13/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	13844	None	None	0	In state provider	None	3736 N 1ST ST	None	FRESNO	CA	93726	5601	10	06019	36.785925	-119.7723515	Fresno County
197631	Fee-for-Service	1881625465	1881625465	1	1	GUSSENHOVEN, JULIE L OD	9/1/2001	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3416 BECHELLI LN	None	REDDING	CA	96002	2432	45	06089	40.557294	-122.3626695	Shasta County
197644	Fee-for-Service	1184982191	1184982191	1	1	GODOY, ANA B LMFT	11/22/2021	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
197666	Fee-for-Service	1003887456	1003887456	1	1	GHOSH, SUTAPA MD	3/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114166	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	955 BOARDWALK STREET	SUITE 100	SAN MARCOS	CA	92078	2659	37	06073	33.13639585	-117.1868403	San Diego County
197672	Fee-for-Service	1174813588	1174813588	1	1	GOYAL, AMIT MD	4/17/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	183924	13	Neurology (M.D. only)	0	In state provider	None	1745 BROADWAY	101	SANTA MARIA	CA	93454	1929	42	06083	34.971759	-120.4356175	Santa Barbara County
197703	Fee-for-Service	1245658988	1245658988	1	1	GLENDALE VEIN CLINIC PC	8/21/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PC	800 S CENTRAL AVE	STE 305A	GLENDALE	CA	91204	4644	19	06037	34.13654729	-118.2578243	Los Angeles County
197723	Fee-for-Service	1477555464	1477555464	1	1	GALIN, AMY J MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67765	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
197733	Fee-for-Service	1619147071	1619147071	2	1	GASPARD, SCOTT F MD	2/4/2023	2086S0127X	NA	General Surgery	026	PHYSICIANS	98442	None	None	0	In state provider	None	1401 SOUTH GRAND AVE	None	LOS ANGELES	CA	90015	3071	19	06037	34.03719097	-118.2654105	Los Angeles County
197746	Fee-for-Service	1326061599	1326061599	1	1	GIANG, VERNON MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77968	01	General Practice	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
197782	Fee-for-Service	1134258148	1134258148	1	1	GERBATSCHBORNEMISZA, ILDIKO	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63645	01	General Practice	0	In state provider	None	3490 PALM AVE	None	SAN DIEGO	CA	92154	1664	37	06073	32.58391748	-117.0594012	San Diego County
197784	Fee-for-Service	1508904657	1508904657	1	1	GHAHREMANI, SIMIN M MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51110	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
197793	Fee-for-Service	1851656771	1851656771	1	1	GIVENS, MICHAEL J MD	5/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130057	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
197797	Fee-for-Service	1588109375	1588109375	1	1	GRAJO, ANA MARIE NP	10/16/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
197814	Fee-for-Service	1063869444	1063869444	1	1	GORDAN, PATRICIA LMFT	8/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 N MACLAY AVE	114	SAN FERNANDO	CA	91340	2989	19	06037	34.28449525	-118.4396137	Los Angeles County
197830	Fee-for-Service	1619221447	1619221447	1	1	GRIFFIN, TARINA L MFT	3/6/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1651 EAST MAIN ST	STE 101	EL CAJON	CA	92021	5206	37	06073	32.81056562	-116.9197497	San Diego County
197833	Fee-for-Service	1760677348	1760677348	1	1	GILLIS, AMY M MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90168	78	Neoplastic Diseases/Oncology	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
197854	Fee-for-Service	1447647268	1447647268	1	1	GU, PHILLIP MD	7/27/2022	207R00000X	NA	Other	026	PHYSICIANS	148851	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
197883	Fee-for-Service	1245272764	1245272764	1	1	GARFIELD BEACH CVS, LLC	11/6/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2505 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2011	19	06037	34.03287856	-118.4748782	Los Angeles County
197896	Fee-for-Service	1649442575	1649442575	1	1	GHASSEMI, AZAD MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102123	30	Radiology	0	In state provider	None	2800 L STREET	STE 610	SACRAMENTO	CA	95816	5126	34	06067	38.571237	-121.469958	Sacramento County
197902	Fee-for-Service	1114085065	1114085065	1	1	GARCIA, EDUARDO A MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	53121	08	Family Practice	0	In state provider	None	11441 HEACOCK ST	STE E	MORENO VALLEY	CA	92557	7907	33	06065	33.954858	-117.243978	Riverside County
197904	Fee-for-Service	1356371421	1356371421	1	1	GORTON, NICOLE H MD	12/31/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78197	40	Pediatrics	0	In state provider	None	550 WASHINGTON ST	STE 111	SAN DIEGO	CA	92103	2213	37	06073	32.75003652	-117.1603431	San Diego County
197922	Fee-for-Service	1417654914	1417654914	1	1	GUTHRIE, TIFFANY N NP	5/22/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	19	06037	34.05260995	-118.3015825	Los Angeles County
197923	Fee-for-Service	1962726109	1962726109	1	1	GAGE PEDIATRIC MEDICAL	2/2/2011	193400000X	NA	Other	026	PHYSICIANS	86864	40	Pediatrics	0	In state provider	CORPORATION	1560 W LACEY BLVD	STE 101	HANFORD	CA	93230	3581	16	06031	36.32816502	-119.6700447	Kings County
197953	Fee-for-Service	1295300028	1295300028	1	1	GODBY, MICHAEL P	10/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	220 HAMES RD	None	WATSONVILLE	CA	95076	0200	44	06087	36.98997588	-121.8106485	Santa Cruz County
197959	Fee-for-Service	1003330572	1003330572	1	1	GABBY, LAURYN C MD	7/13/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151539	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
197981	Fee-for-Service	1710909601	1710909601	1	1	GORSKI, JEFFREY P LCSW	9/20/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	46485 RIVER VIEW DR	None	OAKHURST	CA	93644	9028	20	06039	37.33603332	-119.7000689	Madera County
197991	Fee-for-Service	1477873099	1477873099	1	1	GASPERI, SIMONE K DO	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12690	01	General Practice	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
197996	Fee-for-Service	1245658988	1245658988	1	1	GLENDALE VEIN CLINIC PC	8/21/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	PC	800 S CENTRAL AVE	STE 305A	GLENDALE	CA	91204	4644	19	06037	34.13654729	-118.2578243	Los Angeles County
198017	Fee-for-Service	1720328131	1720328131	1	1	GONZALEZ, YVETTE D LCSW	4/25/2024	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
198048	Fee-for-Service	1760418016	1760418016	1	1	GEISELER, PETER JAN MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42608	None	None	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
198063	Fee-for-Service	1578684544	1578684544	1	1	GALINDO, ROGER M MD	6/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117794	02	General Surgery	0	In state provider	None	2800 L ST	SUITE 200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
198065	Fee-for-Service	1891066221	1891066221	1	1	GORDON, MARVIN I MD APC	2/21/2012	207W00000X	NA	Ophthalmology	026	PHYSICIANS	83747	18	Ophthalmology	0	In state provider	None	321 N LARCHMONT BLVD	STE 506	LOS ANGELES	CA	90004	6405	19	06037	34.0769016	-118.323663	Los Angeles County
198075	Fee-for-Service	1366553687	1366553687	1	1	GOODMAN, HARRIS MD	12/1/1997	207ZP0102X	NA	Other	026	PHYSICIANS	75777	22	Pathology (M.D. only)	0	In state provider	None	126 S FLORAL ST	None	VISALIA	CA	93291	6259	54	06107	36.329472	-119.295558	Tulare County
198086	Fee-for-Service	1306946215	1306946215	1	1	GOMPERTS, EDWARD MD	11/1/1995	2080P0207X	NA	Hematology	026	PHYSICIANS	34311	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
198088	Fee-for-Service	1003081951	1003081951	1	1	GARCES, CARLOS M CPO	8/29/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	GARCES, CARLOS M CPO	2300 KNOLL DR	#D	VENTURA	CA	93003	8058	56	06111	34.25197867	-119.2196596	Ventura County
198100	Fee-for-Service	1215691951	1215691951	1	1	GINSBERG DERMATOLOGY	11/14/2022	261QM2500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	6719 ALVARADO RD	207	SAN DIEGO	CA	92120	5252	37	06073	32.77684978	-117.055137	San Diego County
198104	Fee-for-Service	1417530338	1417530338	1	1	GENOA HEALTHCARE LLC	8/4/2021	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2550 W CLINTON AVENUE	123	FRESNO	CA	93705	4227	10	06019	36.77202022	-119.8415276	Fresno County
198142	Fee-for-Service	1619313566	1619313566	1	1	GOLDMAN, ROGER MD	10/2/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	132374	30	Radiology	0	In state provider	None	1245 WILSHIRE BLVD	STE 205	LOS ANGELES	CA	90017	4812	19	06037	34.05362775	-118.2661889	Los Angeles County
198153	Fee-for-Service	1053879932	1053879932	1	1	GEORGE, ANITHA C CNP	9/18/2019	363LC0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
198200	Fee-for-Service	1053305458	1053305458	1	1	GUPTA, JIWAN P MD	5/13/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	37323	None	None	0	In state provider	None	14795 JEFFREY RD	SUITE 204	IRVINE	CA	92618	0414	30	06059	33.68748311	-117.7710103	Orange County
198210	Fee-for-Service	1568403913	1568403913	1	1	GOLDMAN, TRACY B MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82208	40	Pediatrics	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
198253	Fee-for-Service	1427311133	1427311133	1	1	GOODMAN, LAURA F MD	8/12/2021	2086S0120X	NA	General Surgery	026	PHYSICIANS	126862	None	None	0	In state provider	None	505 S MAIN ST	STE 225	ORANGE	CA	92868	4516	30	06059	33.78004808	-117.8672472	Orange County
198260	Fee-for-Service	1386805877	1386805877	1	1	GARCIA, MARY A MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89980	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
198277	Fee-for-Service	1245658988	1245658988	1	1	GLENDALE VEIN CLINIC PC	8/21/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	PC	800 S CENTRAL AVE	STE 305A	GLENDALE	CA	91204	4644	19	06037	34.13654729	-118.2578243	Los Angeles County
198278	Fee-for-Service	1477873099	1477873099	1	1	GASPERI, SIMONE K DO	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12690	08	Family Practice	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
198293	Fee-for-Service	1033113816	1033113816	1	1	GOVEA, CHRISTOPHER J MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	86995	30	Radiology	0	In state provider	None	2300 CLAYTON RD	None	CONCORD	CA	94520	2100	07	06013	37.97577223	-122.0298863	Contra Costa County
198351	Fee-for-Service	1528068442	1528068442	1	1	GROMIS, MICHAEL W	5/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	29729	None	None	0	In state provider	None	110 N VALERIA ST	STE 501	FRESNO	CA	93701	2168	10	06019	36.74388938	-119.7847725	Fresno County
198373	Fee-for-Service	1306946215	1306946215	1	1	GOMPERTS, EDWARD MD	11/1/1995	2080P0207X	NA	Hematology	026	PHYSICIANS	34311	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
198376	Fee-for-Service	1033735931	1033735931	1	1	GAURAV DATTA MD INC	11/6/2020	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	585 NUT TREE CT	None	VACAVILLE	CA	95687	3353	48	06095	38.36167248	-121.9482153	Solano County
198404	Fee-for-Service	1518386416	1518386416	1	1	GRUBB, SCOTT C MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140924	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
198409	Fee-for-Service	1184074668	1184074668	1	1	GROSS, TERESA S MD	10/24/2022	208600000X	NA	General Surgery	026	PHYSICIANS	177678	None	None	0	In state provider	None	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	39	06077	37.97165921	-121.2895813	San Joaquin County
198456	Fee-for-Service	1659442549	1659442549	1	1	GEOGHEGAN, ROBERT JR MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36692	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
198485	Fee-for-Service	1962550806	1962550806	1	1	GOLDSTEIN, REBECCA S MD	7/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55204	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
198514	Fee-for-Service	1972545499	1972545499	2	1	GARFIELD BEACH CVS, LLC	2/24/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13021 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	2925	19	06037	34.18670747	-118.416474	Los Angeles County
198515	Fee-for-Service	1780606921	1780606921	1	1	GILPEN, RENEE S MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75939	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	8533	09	06017	38.72453536	-120.7921649	El Dorado County
198526	Fee-for-Service	1134697212	1134697212	1	1	GONZALES, LINDSAY LMFT	7/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
198546	Fee-for-Service	1386805877	1386805877	1	1	GARCIA, MARY A MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89980	10	Gastroenterology (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
198558	Fee-for-Service	1114229069	1114229069	1	1	GENESIS MANOR I	4/15/2011	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OWNER/ADMINSTRATOR	6354 SACRAMENTO AVE	None	ALTA LOMA	CA	91701	3325	36	06071	34.13902651	-117.6128635	San Bernardino County
198581	Fee-for-Service	1518161629	1518161629	1	2	GONZALEZ, ANITA E MD	10/19/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	100277	None	None	0	In state provider	None	14649 VICTORY BLVD	STE 20	VAN NUYS	CA	91411	4101	19	06037	34.18669152	-118.452393	Los Angeles County
198629	Fee-for-Service	1629473988	1629473988	1	1	GARFIELD BEACH CVS LLC	4/14/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4949 SANTA MONICA AVE	None	SAN DIEGO	CA	92107	2812	37	06073	32.74719283	-117.2495347	San Diego County
198687	Fee-for-Service	1285682161	1285682161	1	1	GOGIA, NAVNEET K MD	5/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82968	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
198707	Fee-for-Service	1659490944	1659490944	1	1	GAO, XING MD	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123096	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
198720	Fee-for-Service	1245651017	1245651017	1	1	GAUTHIER, DAFNA LPCC	10/29/2021	102L00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
198731	Fee-for-Service	1902926587	1902926587	1	1	GARZA-RODRIGUEZ, MICHELLE I	2/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MSW LCSW	9089 BASELINE RD	200	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
198786	Fee-for-Service	1992021554	1992021554	1	1	GLASS, ALLISON S MD	5/12/2021	208800000X	NA	Other	026	PHYSICIANS	118062	None	None	0	In state provider	None	1321 COTTONWOOD ST	STE 205	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
198801	Fee-for-Service	1174824635	1174824635	1	1	GILILLAND, DEBORAH Y DO	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11412	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
198802	Fee-for-Service	1194838441	1194838441	1	1	GROSSMONT DERMATOLOGY	1/1/1979	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	MEDICAL CLINIC INC	8860 CENTER DR	STE 300	LA MESA	CA	91942	3068	37	06073	32.78189749	-117.0075062	San Diego County
198805	Fee-for-Service	1114008612	1114008612	1	1	GOLDFINE, VALERIE S PSY	1/2/2019	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	530 WILSHIRE BLVD	STE 306	SANTA MONICA	CA	90401	1426	19	06037	34.02043392	-118.496647	Los Angeles County
198822	Fee-for-Service	1659469500	1659469500	1	1	GAYLE, RICHARD E MD	6/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84809	20	Orthopedic Surgery	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6367	43	06085	37.36777579	-122.0276404	Santa Clara County
198840	Fee-for-Service	1184467870	1184467870	1	1	GUDINO, ALEX PT	10/2/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
198844	Fee-for-Service	1134489164	1134489164	1	1	GLOBAL CANCER RESEARCH INSTI	10/29/2014	207RH0003X	NA	Oncology	026	PHYSICIANS	66600	78	Neoplastic Diseases/Oncology	0	In state provider	TUTE, INC	9460 NO NAME UNO	230	GILROY	CA	95020	3537	43	06085	37.037781	-121.570965	Santa Clara County
198887	Fee-for-Service	1902108145	1902108145	1	1	GANDARA, MARLA M MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115486	None	None	0	In state provider	None	12401 E WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
198923	Fee-for-Service	1679790661	1679790661	1	1	GOLDSTEIN, ESTELLE T MD	11/10/2014	174400000X	NA	Other	026	PHYSICIANS	50226	36	Psychiatry	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 190	RIDGECREST	CA	93555	3131	15	06029	35.64171	-117.669847	Kern County
198994	Fee-for-Service	1497982920	1497982920	1	1	GARFIELD BEACH CVS LLC	12/24/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	44075 JEFFERSON ST	None	LA QUINTA	CA	92253	4871	33	06065	33.72868763	-116.268947	Riverside County
198998	Fee-for-Service	1609818780	1609818780	1	1	GARNER, AMANDA J MD	3/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79080	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
199019	Fee-for-Service	1710083159	1710083159	1	1	GAIO-HANSBERGER, KAREN L MD	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	74945	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	165 W HOSPITALITY LANE	SUITE 1	SAN BERNARDINO	CA	92408	3320	36	06071	34.0658125	-117.2867985	San Bernardino County
199020	Fee-for-Service	1902435670	1902435670	1	1	GAO, JASON MD	10/24/2023	207R00000X	NA	Other	026	PHYSICIANS	185420	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
199045	Fee-for-Service	1992947261	1992947261	1	1	GOLD COAST DIABETES	2/23/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	RESOURCE LLC	5030 KATELLA AVENUE	SUITE 204	LOS ALAMITOS	CA	90720	2819	30	06059	33.80289721	-118.0450714	Orange County
199071	Fee-for-Service	1871598706	1871598706	1	1	GENEVIEVE, MARY S	10/7/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	84937	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
199078	Fee-for-Service	1306092564	1306092564	1	1	GOLDFARB, MELANIE R MD	9/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117052	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
199091	Fee-for-Service	1194838441	1194838441	1	1	GROSSMONT DERMATOLOGY	6/2/1998	207N00000X	NA	Dermatology	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CLINIC INC	8860 CENTER DR	STE 300	LA MESA	CA	91942	3068	37	06073	32.78189749	-117.0075062	San Diego County
199097	Fee-for-Service	1659437358	1659437358	1	1	GABBAI, MICHELLE MD	1/19/2022	207R00000X	NA	Other	026	PHYSICIANS	82579	None	None	0	In state provider	None	140 NORTH ORANGE AVE	STE 100	WEST COVINA	CA	91790	2032	19	06037	34.07369406	-117.9431173	Los Angeles County
199108	Fee-for-Service	1447232988	1447232988	1	1	GIL, LISA M	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74592	08	Family Practice	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
199110	Fee-for-Service	1679849251	1679849251	1	1	GOPATH LABORATORIES, LLC	10/20/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	1351 BARCLAY BLVD	None	BUFFALO GROVE	IL	60089	4501	00	None	42.17553	-87.9317685	Lake County
199129	Fee-for-Service	1316253487	1316253487	1	1	GILLETT, JOHN B MD	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130207	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
199134	Fee-for-Service	1134489164	1134489164	1	1	GLOBAL CANCER RESEARCH INSTI	10/29/2014	207RH0003X	NA	Oncology	026	PHYSICIANS	66600	41	Internal Medicine	0	In state provider	TUTE, INC	9460 NO NAME UNO	230	GILROY	CA	95020	3537	43	06085	37.037781	-121.570965	Santa Clara County
199139	Fee-for-Service	1720157142	1720157142	1	1	GOLDBAUM, MICHAEL MD	11/5/1981	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32010	18	Ophthalmology	0	In state provider	None	225 DICKINSON ST	# H225	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
199156	Fee-for-Service	1679033880	1679033880	1	1	GATES, GINA G AU	4/15/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
199182	Fee-for-Service	1922508324	1922508324	1	1	GARCIA, ERICA LMFT	3/19/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1909 KEHOE AVE	None	SAN MATEO	CA	94401	3448	41	06081	37.56552672	-122.297321	San Mateo County
199200	Fee-for-Service	1679749873	1679749873	1	1	GALVAN, TERESA LMFT	5/26/2022	171M00000X	NA	Other	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
199259	Fee-for-Service	1710012281	1710012281	1	1	GREGORY, MARIANNA LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	42768	-	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
199264	Fee-for-Service	1811967748	1811967748	1	1	GUEVARA, PABLO I MD	9/17/2020	207R00000X	NA	Other	026	PHYSICIANS	162697	41	Internal Medicine	0	In state provider	None	2160 APPIAN WAY	SUITE 200	PINOLE	CA	94564	2565	07	06013	37.99585174	-122.3021549	Contra Costa County
199275	Fee-for-Service	1164485751	1164485751	1	1	GOYAL, ANOOP 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	34653 US HIGHWAY 19 N	None	PALM HARBOR	FL	34684	2152	00	None	28.08695904	-82.73928993	Pinellas County
199306	Fee-for-Service	1053835801	1053835801	1	1	GOODEN, GREGORY F LMFT	7/2/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	160 N EL MOLINO AVE	None	PASADENA	CA	91101	1805	19	06037	34.14884154	-118.1368812	Los Angeles County
199344	Fee-for-Service	1811906753	1811906753	1	1	GARBAR, LARISA MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	71864	41	Internal Medicine	0	In state provider	None	3851 KATELLA AVENUE	SUITE 155	LOS ALAMITOS	CA	90720	3353	30	06059	33.80319053	-118.0657305	Orange County
199345	Fee-for-Service	1063989820	1063989820	1	1	GARFIELD BEACH CVS LLC	1/29/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	701 VAN NESS AVE	None	SAN FRANCISCO	CA	94102	3229	38	06075	37.78218473	-122.4208156	San Francisco County
199360	Fee-for-Service	1306092564	1306092564	1	1	GOLDFARB, MELANIE R MD	9/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117052	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
199370	Fee-for-Service	1851305882	1851305882	1	1	GILL, GURDARSHAN MD	7/6/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48442	40	Pediatrics	0	In state provider	None	500 S MAIN ST	STE 1210	ORANGE	CA	92868	4556	30	06059	33.77991974	-117.8674745	Orange County
199409	Fee-for-Service	1821072653	1821072653	1	1	GOLDBERG, SAMUEL S MD	2/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43140	40	Pediatrics	0	In state provider	None	6991 NO STATE ST	None	UKIAH	CA	95482	0000	23	06045	39.2438212	-123.207113	Mendocino County
199422	Fee-for-Service	1134489164	1134489164	1	1	GLOBAL CANCER RESEARCH INSTI	10/29/2014	207RH0003X	NA	Oncology	026	PHYSICIANS	66600	68	Hematology	0	In state provider	TUTE, INC	9460 NO NAME UNO	230	GILROY	CA	95020	3537	43	06085	37.037781	-121.570965	Santa Clara County
199447	Fee-for-Service	1972764009	1972764009	1	1	GREEN, LAUREN DO	1/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11231	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
199450	Fee-for-Service	1427310275	1427310275	1	1	GOSHGARIAN, ANNE M MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135437	66	Emergency Medicine (Urgent Care)	0	In state provider	None	150 PIONEER LANE	None	BISHOP	CA	93514	2599	14	06027	37.36193834	-118.4073304	Inyo County
199452	Fee-for-Service	1841074598	1841074598	1	1	GOLDBERG, ANNA	12/11/2023	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
199505	Fee-for-Service	1457462764	1457462764	1	1	GENERAO, SUZANNE E MD	6/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74881	34	Urology and Urological Surgery	0	In state provider	None	2801 K ST	STE 205	SACRAMENTO	CA	95816	5118	34	06067	38.572947	-121.46904	Sacramento County
199513	Fee-for-Service	1306208517	1306208517	1	1	GANDHI, KUMAR R MD	9/16/2021	207P00000X	NA	Other	026	PHYSICIANS	172325	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
199516	Fee-for-Service	1669496899	1669496899	1	1	GOVER, FREDRICA J PSYD	10/20/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	13880	-	NOT APPLICABLE	0	In state provider	None	1695 N SUNRISE WAY	102	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
199537	Fee-for-Service	1871264796	1871264796	1	1	GO, ADRIAN V PT	3/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
199539	Fee-for-Service	1285298489	1285298489	1	1	GRAHAM, ASHLEIGH MD	7/5/2024	207ZP0102X	NA	Other	026	PHYSICIANS	None	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
199540	Fee-for-Service	1194745885	1194745885	1	1	GIBSON III, GEORGE R DO	7/16/2010	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
199551	Fee-for-Service	1821095134	1821095134	1	1	GERSHONY, GARY MD	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47523	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
199652	Fee-for-Service	1851305882	1851305882	1	1	GILL, GURDARSHAN MD	7/6/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48442	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
199687	Fee-for-Service	1316095201	1316095201	1	1	GUZMAN, ANNA M CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
199701	Fee-for-Service	1447238043	1447238043	1	1	GUERDAN, BRUCE R MD	4/5/2023	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
199720	Fee-for-Service	1881608057	1881608057	1	1	GELEHRTER,SARAH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 E MEDICAL CENTER DR	None	ANN ARBOR	MI	48109	5204	00	None	42.28391347	-83.72716554	Washtenaw County
199765	Fee-for-Service	1548313232	1548313232	1	1	GARRISON, ROBERT K MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	40594	08	Family Practice	0	In state provider	None	168 N BRENT ST	STE 502	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
199800	Fee-for-Service	1528373172	1528373172	1	1	GARUKYAN, NAREK DPM	10/7/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	7640 TAMPA AVE	106	RESEDA	CA	91335	1700	19	06037	34.20951144	-118.5534786	Los Angeles County
199829	Fee-for-Service	1386160331	1386160331	1	1	GODOY, ANDREW J LCSW	2/8/2021	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
199836	Fee-for-Service	1053960849	1053960849	1	1	GOMEZ, CARRIE	9/25/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 203	GLENDALE	CA	91203	2657	19	06037	34.14652066	-118.2549229	Los Angeles County
199866	Fee-for-Service	1699034868	1699034868	1	1	GREEN, GARRETT B MD	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
199888	Fee-for-Service	1346635802	1346635802	1	1	GAGE, CHRISTIAN MD	8/6/2024	208600000X	NA	General Surgery	026	PHYSICIANS	188902	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
199909	Fee-for-Service	1851745152	1851745152	1	1	GUPTA, RAHUL MD	5/23/2023	207R00000X	NA	Other	026	PHYSICIANS	160602	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
199926	Fee-for-Service	1811933971	1811933971	1	1	GARFIELD BEACH CVS, LLC	12/19/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	921 PACIFIC COAST HWY	None	SEAL BEACH	CA	90740	6245	30	06059	33.74418902	-118.1018883	Orange County
200011	Fee-for-Service	1013582055	1013582055	1	1	GALASSI, MIA G CRNA	10/15/2024	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
200015	Fee-for-Service	1972786853	1972786853	1	1	GUERRA, OLGA I CCC-SLP	2/17/2011	No Taxonomy Provided	NA	None	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
200037	Fee-for-Service	1760679591	1760679591	1	1	GALLO, AMY E MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97147	02	General Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
200069	Fee-for-Service	1063075331	1063075331	1	1	GALLOWAY, MARGARET MD	8/27/2023	207L00000X	NA	Other	026	PHYSICIANS	186197	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
200070	Fee-for-Service	1033123203	1033123203	1	1	GOLDBERG, ROBERT A MD	3/31/1989	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52591	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
200077	Fee-for-Service	1538540315	1538540315	1	1	GREGORY, JEREMY W LCSW	4/14/2025	No Taxonomy Provided	NA	None	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
200083	Fee-for-Service	1588845986	1588845986	1	1	GONZALEZ, MARIA LCSW	5/13/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 REDLANDS BLVD	None	REDLANDS	CA	92373	4775	36	06071	34.05731952	-117.181197	San Bernardino County
200139	Fee-for-Service	1699324988	1699324988	1	1	GARCIA, GABRIELA OT	8/3/2021	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
200154	Fee-for-Service	1699034868	1699034868	1	1	GREEN, GARRETT B MD	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
200158	Fee-for-Service	1396780284	1396780284	1	1	GARFIELD BEACH CVS LLC	12/13/2006	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	33205 TEMECULA PARKWAY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
200175	Fee-for-Service	1972586097	1972586097	1	1	GALANG, JACQUELINE M MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69426	41	Internal Medicine	0	In state provider	None	165 ST DOMINICS	STE 201	MANTECA	CA	95337	7802	39	06077	37.79882972	-121.2447835	San Joaquin County
200208	Fee-for-Service	1568510436	1568510436	1	1	GURALNICK, MARK P MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80927	07	Dermatology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
200263	Fee-for-Service	1548630890	1548630890	1	1	GREENFIELD, RACHEL J LCSW	6/23/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
200273	Fee-for-Service	1134682255	1134682255	1	1	GUNZ, EMILY F MD	9/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178407	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
200275	Fee-for-Service	1720009269	1720009269	1	1	GRIFFITH, CAROLYN S MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71324	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5333 HOLLISTER AVE	STE 239	SANTA BARBARA	CA	93111	3327	42	06083	34.43491982	-119.8105484	Santa Barbara County
200279	Fee-for-Service	1811082712	1811082712	1	1	GRACIANO, ESTER A MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81495	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	None	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
200341	Fee-for-Service	1548568421	1548568421	1	10	GOLDEN VALLEY HEALTH CENTERS	10/27/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1524 MCHENRY AVE	SUITE 550	MODESTO	CA	95350	4573	50	06099	37.666233	-120.993933	Stanislaus County
200349	Fee-for-Service	1629295217	1629295217	1	1	GUEVARA, ALICIA A MD	11/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95110	None	None	0	In state provider	None	215 PESETAS LANE	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
200379	Fee-for-Service	1548245582	1548245582	1	1	GAMP, PATRICK D MD	6/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93017	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
200391	Fee-for-Service	1356418172	1356418172	1	1	GYI, BO MD	8/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66674	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
200400	Fee-for-Service	1861616799	1861616799	1	1	GIEM, ANDREW D MD	9/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109261	34	Urology and Urological Surgery	0	In state provider	None	534 EAST MAPLE STREET	None	STOCKTON	CA	95204	6112	39	06077	37.96948196	-121.28765	San Joaquin County
200425	Fee-for-Service	1740441542	1740441542	1	1	GEE, MELISSA L MD	2/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107530	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
200477	Fee-for-Service	1851945901	1851945901	1	1	GO, ZSANELL PT	5/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
200488	Fee-for-Service	1740305986	1740305986	1	2	GUPTA, ASHWINI LMFT	10/7/2024	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
200519	Fee-for-Service	1538601349	1538601349	1	1	GONZALEZ, ELIZABETH LCSW	10/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
200539	Fee-for-Service	1134321383	1134321383	1	1	GIUSTI, REBECCA E DO	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9276	47	Miscellaneous	0	In state provider	None	887 E SECOND ST	STE C	POMONA	CA	91766	2009	19	06037	34.05810644	-117.7395016	Los Angeles County
200566	Fee-for-Service	1205871191	1205871191	1	1	GARFIELD BEACH CVS, LLC	4/23/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	313 S. GARFIELD AVE	None	MONTEREY PARK	CA	91754	3326	19	06037	34.05918168	-118.122898	Los Angeles County
200598	Fee-for-Service	1851199004	1851199004	1	1	GOLDEN GRACE BIRTH AND FITNE	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	43	06085	0	0	None
200603	Fee-for-Service	1316940828	1316940828	1	1	GOOD LIFE MEDICAL GROUP	7/5/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	3650 SOUTH ST	STE 204	LAKEWOOD	CA	90712	1521	19	06037	33.86019847	-118.149255	Los Angeles County
200621	Fee-for-Service	1780022327	1780022327	1	1	GALBREATH, GREGORY J MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139469	01	General Practice	0	In state provider	None	15725 WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
200668	Fee-for-Service	1164510855	1164510855	1	1	GORING, CHRISTOPHER G MD	8/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	55914	20	Orthopedic Surgery	0	In state provider	None	3628 E IMPERIAL HWY	SUITE 300	LYNWOOD	CA	90262	2646	19	06037	33.93070837	-118.2044557	Los Angeles County
200682	Fee-for-Service	1356418172	1356418172	1	1	GYI, BO MD	8/14/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66674	30	Radiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
200703	Fee-for-Service	1144746348	1144746348	1	1	GOOSE PHARMA LLC	9/11/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18049 MAGNOLIA STREET	None	FOUNTAIN VALLEY	CA	92708	5638	30	06059	33.70052432	-117.9718109	Orange County
200762	Fee-for-Service	1689386815	1689386815	1	2	GEM MEDICAL GROUP CORPORATIO	3/31/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
200788	Fee-for-Service	1013914142	1013914142	1	1	GARCIA, FRANCISCO 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	343 W HOUSTON, SUITE 211	None	SAN ANTONIO	TX	78205	0000	00	None	29.42641735	-98.49739328	Bexar County
200842	Fee-for-Service	1174914410	1174914410	1	1	GELLER, ANNA G NP	10/29/2018	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
200862	Fee-for-Service	1669528766	1669528766	1	1	GARRY, JOHN R PSYD	7/7/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
200889	Fee-for-Service	1174018535	1174018535	1	1	GASA HOME HEALTH CARE INC	1/22/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13758 VICTORY BLVD	STE 204	VAN NUYS	CA	91401	6733	19	06037	34.18664549	-118.4332815	Los Angeles County
200890	Fee-for-Service	1447303227	1447303227	1	1	GULF HEALTH HOSPITALS, INC	8/5/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	750 MORPHY AVE	None	FAIRHOPE	AL	36532	1812	00	None	30.51996152	-87.889554	Baldwin County
200912	Fee-for-Service	1265166045	1265166045	1	1	GEMINI PROFESSIONAL CLINICAL	11/7/2024	163WP0807X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	NG	6310 SAN VICENTE BLVD	410	LOS ANGELES	CA	90048	5426	19	06037	34.06093425	-118.3673115	Los Angeles County
200963	Fee-for-Service	1336381177	1336381177	1	1	GOLDBERG, SETH PSYD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
200972	Fee-for-Service	1306050075	1306050075	1	1	GOLDEN VALLEY HEALTH CTR	7/31/1991	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	PATTERSON MEDICAL CTR	200 C ST	None	PATTERSON	CA	95363	2701	50	06099	37.46733509	-121.1258615	Stanislaus County
200987	Fee-for-Service	1033430764	1033430764	1	1	GREEN, JAMISON M MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135735	20	Orthopedic Surgery	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
200993	Fee-for-Service	1417299595	1417299595	1	1	GHADJAR, KIUMARS G MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133673	02	General Surgery	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
201038	Fee-for-Service	1700858859	1700858859	1	1	GANDHI, SHEETAL N MD	12/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	81898	40	Pediatrics	0	In state provider	None	4520 EXECUTIVE DR	STE 350	SAN DIEGO	CA	92121	3020	37	06073	32.87608747	-117.2097763	San Diego County
201042	Fee-for-Service	1821146770	1821146770	1	1	GABRIEL, ALLEN G MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82206	24	Plastic Surgery	0	In state provider	None	11370 ANDERSON STREET	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
201048	Fee-for-Service	1700932332	1700932332	1	1	GRAHAM, CHARLES S DO	2/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	700 SOUTH J STREET	None	LAKEVIEW	OR	97630	1623	00	None	42.181335	-120.351489	Lake County
201113	Fee-for-Service	1063481893	1063481893	1	1	GRANLUND, KIRK F MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65440	20	Orthopedic Surgery	0	In state provider	None	1600 ESPLANADE	STE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
201122	Fee-for-Service	1487782702	1487782702	1	1	GALFFY, LASZLO Z MD INC	3/3/2009	207LP2900X	NA	Other	026	PHYSICIANS	53830	05	Anesthesiology	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
201124	Fee-for-Service	1649424995	1649424995	1	1	GUTIERREZ, PATRICIA CNP	5/26/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16119 VANOWEN STREET	None	VAN NUYS	CA	94106	4822	19	06037	34.19394152	-118.484424	Los Angeles County
201142	Fee-for-Service	1871904953	1871904953	1	1	GILL, MANASA MD	6/7/2021	207L00000X	NA	Other	026	PHYSICIANS	172570	None	None	0	In state provider	None	23625 WR HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
201159	Fee-for-Service	1114229069	1114229069	1	6	GENESIS MANOR I	9/7/2012	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6936 AMETHYST AVE	None	ALTA LOMA	CA	91701	5006	36	06071	34.12830751	-117.5982684	San Bernardino County
201163	Fee-for-Service	1245422310	1245422310	1	1	GILBREATH AND PARK OPTOM	2/28/1991	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	102 SCOTT ST	None	UKIAH	CA	95482	4316	23	06045	39.15364636	-123.2089629	Mendocino County
201174	Fee-for-Service	1952807901	1952807901	1	1	GREEN LIGHT HOME HEALTH INC	1/23/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	SUITE 311	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
201179	Fee-for-Service	1447303227	1447303227	1	1	GULF HEALTH HOSPITALS, INC	8/5/2011	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	750 MORPHY AVE	None	FAIRHOPE	AL	36532	1812	00	None	30.51996152	-87.889554	Baldwin County
201198	Fee-for-Service	1265166045	1265166045	1	1	GEMINI PROFESSIONAL CLINICAL	11/7/2024	163WP0807X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NG	6310 SAN VICENTE BLVD	410	LOS ANGELES	CA	90048	5426	19	06037	34.06093425	-118.3673115	Los Angeles County
201207	Fee-for-Service	1558302463	1558302463	1	1	GARFIELD BEACH CVS, LLC	1/10/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23357 MULHOLLAND DR	None	WOODLAND HILLS	CA	91364	2734	19	06037	34.15788221	-118.6355139	Los Angeles County
201219	Fee-for-Service	1922550169	1922550169	1	1	GALLO, ELIZABETH LMFT	5/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3815 ATLANTIC AVE	6	LONG BEACH	CA	90807	3500	19	06037	33.827346	-118.1851085	Los Angeles County
201227	Fee-for-Service	1669546339	1669546339	1	1	GRELLA, ANNE E LCSW	3/10/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD ROAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
201273	Fee-for-Service	1033495411	1033495411	1	1	GATES, ROXANA LCSW	9/1/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
201332	Fee-for-Service	1215546510	1215546510	1	1	GASPARI, MICHAEL A	10/19/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
201351	Fee-for-Service	1396076279	1396076279	1	1	GUEZMIR, HINA MD	8/31/2021	208M00000X	NA	Other	026	PHYSICIANS	171396	None	None	0	In state provider	None	70077 RANCHO RD	None	RANCHO MIRAGE	CA	92270	5201	33	06065	33.73387132	-116.4032696	Riverside County
201373	Fee-for-Service	1073599544	1073599544	1	1	GARMA, SYLVIA I PHD	3/11/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
201418	Fee-for-Service	1104229012	1104229012	1	1	GRANITE HILLS SENIOR LIVING	5/21/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	768 DOROTHY STREET	None	EL CAJON	CA	92019	3101	37	06073	32.786388	-116.933676	San Diego County
201444	Fee-for-Service	1699797209	1699797209	2	1	GARFIELD BEACH CVS LLC	11/28/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	24425 MAGIC MOUNTAIN PKW	None	VALENCIA	CA	91355	3403	19	06037	34.41970496	-118.562197	Los Angeles County
201500	Fee-for-Service	1033175187	1033175187	1	2	GHERINI, SCOTT T MD	9/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51159	20	Orthopedic Surgery	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4533	23	06045	39.15305697	-123.2037774	Mendocino County
201529	Fee-for-Service	1083077408	1083077408	1	1	GIESEN, ZACHARY P DO	9/4/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	520 SW RAMSEY AVE	STE 101	GRANTS PASS	OR	97527	5573	00	None	42.41988251	-123.3431404	Josephine County
201533	Fee-for-Service	1851463699	1851463699	1	1	GANNAWAY, LAURA E MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64747	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
201537	Fee-for-Service	1295062552	1295062552	1	1	GANDHI, BIMAL P MD	6/10/2019	207L00000X	NA	Other	026	PHYSICIANS	158645	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
201540	Fee-for-Service	1689834418	1689834418	1	1	GUPTA, CHARU MD	6/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128823	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
201542	Fee-for-Service	1982059168	1982059168	1	1	GREAS, MICHAEL MD	7/1/2022	207ZP0101X	NA	Other	026	PHYSICIANS	157365	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
201547	Fee-for-Service	1053765727	1053765727	1	1	GUEVORKIAN, MARK MD DO	7/9/2020	207P00000X	NA	Other	026	PHYSICIANS	166409	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
201567	Fee-for-Service	1710999222	1710999222	1	1	GREIG, LLOYD B MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	26440	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9210 W SUNSET BLVD	STE 906	LOS ANGELES	CA	90069	3112	19	06037	34.09005172	-118.3929408	Los Angeles
201600	Fee-for-Service	1700032216	1700032216	1	1	GEBREEGZIABHER,YOHANNES A MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106570	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2124 COLORADO AVENUE	None	TURLOCK	CA	95382	2011	50	06099	37.51218898	-120.8352103	Stanislaus County
201622	Fee-for-Service	1770676793	1770676793	1	1	GREGORY L WATSON	9/10/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1490 E FOREMASTER DR	STE 200	ST GEORGE	UT	84790	4496	00	None	37.09513991	-113.5502324	Washington County
201623	Fee-for-Service	1790240372	1790240372	1	1	GERSKE, LORI CNP	4/13/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	201 E NOBLE AVE	None	VISALIA	CA	93277	2857	54	06107	36.326259	-119.2909725	Tulare County
201644	Fee-for-Service	1548217821	1548217821	1	1	GUIANG, RAINIER E MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84296	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	STE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
201648	Fee-for-Service	1235868258	1235868258	1	1	GAURANO, JARED LMFT	12/20/2024	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
201682	Fee-for-Service	1639182223	1639182223	1	1	GIACONI, JO ANN A MD	6/12/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69916	None	None	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
201698	Fee-for-Service	1023701786	1023701786	1	1	GADE LLC	7/27/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10600 MAGNOLIA AVE	STE B	RIVERSIDE	CA	92505	1819	33	06065	33.90819148	-117.4676613	Riverside County
201735	Fee-for-Service	1538555792	1538555792	1	1	GANDHI, KRUPA A MD	7/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156026	41	Internal Medicine	0	In state provider	None	1680 E 120TH ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
201752	Fee-for-Service	1992862668	1992862668	1	1	GANT, LORI S LCSW	12/18/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVENUE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
201755	Fee-for-Service	1558961789	1558961789	1	1	GRATON TRANSPORTATION SERVIC	11/13/2020	344600000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6071 DONNA CT	None	ROHNERT PARK	CA	94928	9998	49	06097	38.35303342	-122.6993653	Sonoma County
201766	Fee-for-Service	1306963756	1306963756	1	1	GARCIA, FERNANDO D MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	37360	01	General Practice	0	In state provider	None	345 N VALENCIA BLVD	None	WOODLAKE	CA	93286	1243	54	06107	36.418293	-119.0989165	Tulare County
201779	Fee-for-Service	1104848738	1104848738	2	1	GARFIELD BEACH CVS LLC	11/8/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	209 W VENTURA BLVD	None	CAMARILLO	CA	93010	8359	56	06111	34.21596831	-119.0729223	Ventura County
201787	Fee-for-Service	1851493373	1851493373	1	1	GONG, I-YEH MD	4/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69062	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
201797	Fee-for-Service	1396545927	1396545927	1	1	GOMEZ, ALEXANDRA-GRISSELL	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	19	06037	0	0	None
201807	Fee-for-Service	1467798843	1467798843	1	1	GREWAL, AJANAMJOT K MD INC	3/12/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	103791	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4231 US HIGHWAY 86	STE 6	BRAWLEY	CA	92227	9648	13	06025	32.95825939	-115.551562	Imperial County
201855	Fee-for-Service	1588728786	1588728786	1	1	GILMARTIN, CHARLES K	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
201889	Fee-for-Service	1700032216	1700032216	1	1	GEBREEGZIABHER,YOHANNES A MD	8/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106570	41	Internal Medicine	0	In state provider	None	2124 COLORADO AVENUE	None	TURLOCK	CA	95382	2011	50	06099	37.51218898	-120.8352103	Stanislaus County
201914	Fee-for-Service	1053404970	1053404970	1	1	GAGE, CHARLES E MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	41200	04	Otology, Laryngology, Rhinology	0	In state provider	None	3100 DOUGLAS BLVD	STE 200	ROSEVILLE	CA	95661	3868	31	06061	38.74399612	-121.2349547	Placer County
201925	Fee-for-Service	1326077033	1326077033	1	1	GILBERTSON, RUSSELL M MD	7/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	47691	05	Anesthesiology	0	In state provider	None	5900 W OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
201962	Fee-for-Service	1467730556	1467730556	1	1	GARFIELD BEACH CVS, LLC	10/11/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14220 SCHLEISMAN RD	None	EASTVALE	CA	92880	4020	33	06065	33.96068153	-117.5938972	Riverside County
201963	Fee-for-Service	1437490679	1437490679	1	1	GARFIELD BEACH CVS LLC	7/29/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2655 TELEGRAPH AVE	None	BERKELEY	CA	94704	3323	01	06001	37.86208581	-122.2588331	Alameda County
201986	Fee-for-Service	1235534033	1235534033	1	1	GREEN, NADINE VICTORIA	10/28/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14421 PEAR STREET	None	RIVERSIDE	CA	92508	8974	33	06065	33.91024777	-117.3345631	Riverside County
201989	Fee-for-Service	1376632596	1376632596	1	1	GREER, JAMES M DPM	9/19/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	STE 225	BRENTWOOD	CA	94513	5193	07	06013	37.91980577	-121.734715	Contra Costa County
202025	Fee-for-Service	1477286185	1477286185	1	2	GOLDEN H LLC	6/25/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	574 WILLIAMS RD	None	PALM SPRINGS	CA	92264	1551	33	06065	33.81463353	-116.4951047	Riverside County
202054	Fee-for-Service	1104926500	1104926500	1	1	GORMAN, STEVEN P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	83973	41	Internal Medicine	0	In state provider	None	78150 CALLE TAMPICO	STE 100	LA QUINTA	CA	92253	2907	33	06065	33.67817382	-116.30003	Riverside County
202057	Fee-for-Service	1932316718	1932316718	2	1	GARFIELD BEACH CVS LLC	10/30/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20288 US HWY 18	None	APPLE VALLEY	CA	92307	2937	36	06071	34.528014	-117.217152	San Bernardino County
202060	Fee-for-Service	1457594244	1457594244	2	1	GOLDTHWAITE, LISA M MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136020	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
202074	Fee-for-Service	1851493373	1851493373	1	1	GONG, I-YEH MD	4/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69062	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
202078	Fee-for-Service	1952451767	1952451767	1	1	GREENWALD, GEORGE I MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41818	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
202101	Fee-for-Service	1063629962	1063629962	1	1	GULATI, ISH K MD	2/18/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	170054	None	None	0	In state provider	None	300 HILLMONT AVENUE	None	VENTURA	CA	93003	1651	56	06111	34.27771547	-119.2540344	Ventura County
202146	Fee-for-Service	1548206600	1548206600	1	1	GARFIELD BEACH CVS LLC	4/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11011 ALONDRA BLVD	None	NORWALK	CA	90650	6202	19	06037	33.88766277	-118.0996515	Los Angeles County
202160	Fee-for-Service	1720584311	1720584311	1	1	GARZA, JOHNNY R CRNA	11/20/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 GREENFIELD AVENUE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
202174	Fee-for-Service	1952345316	1952345316	1	1	GARFIELD BEACH CVS, LLC	3/20/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14589 CAMINO DEL NORTE	None	SAN DIEGO	CA	92128	5801	37	06073	32.99046834	-117.0712532	San Diego County
202211	Fee-for-Service	1053035592	1053035592	1	1	GILL, HARJEET NP	2/10/2025	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3656 W SHAW AVE	None	FRESNO	CA	93711	3231	10	06019	36.80840238	-119.8594473	Fresno County
202244	Fee-for-Service	1144731795	1144731795	1	1	GREGORY ALAN KUBO OD APC	11/9/2017	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1319 S HARBOR BLVD	None	FULLERTON	CA	92832	3001	30	06059	33.858954	-117.924409	Orange County
202255	Fee-for-Service	1871868968	1871868968	1	1	GROCK, SHIRA M MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136419	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
202274	Fee-for-Service	1235534033	1235534033	1	1	GREEN, NADINE VICTORIA	10/28/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14421 PEAR STREET	None	RIVERSIDE	CA	92508	8974	33	06065	33.91024777	-117.3345631	Riverside County
202310	Fee-for-Service	1356671762	1356671762	1	1	GLOBAL ONCOLOGY INC	3/15/2010	261QX0200X	NA	Other	026	PHYSICIANS	63882	78	Neoplastic Diseases/Oncology	0	In state provider	None	1411 S GARFIELD AVE	SUITE 306, 308	ALHAMBRA	CA	91801	5045	19	06037	34.07787	-118.1230385	Los Angeles County
202320	Fee-for-Service	1043746449	1043746449	1	1	GOPINATH, PREIYAA B MD	9/1/2020	207R00000X	NA	Other	026	PHYSICIANS	169313	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
202344	Fee-for-Service	1538426101	1538426101	1	1	GONG, JUN MD	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129164	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
202462	Fee-for-Service	1710055850	1710055850	1	1	GEORGE, GIHAN G MD	10/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88052	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
202468	Fee-for-Service	1285799635	1285799635	1	1	GANDEK, PATRICE M LCSW	3/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
202484	Fee-for-Service	1538466800	1538466800	1	1	GHEYTANCHI, ANAHITA PHD	10/6/2014	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
202506	Fee-for-Service	1750844536	1750844536	1	1	GUO, DENGHUI MD	7/7/2022	207R00000X	NA	Other	026	PHYSICIANS	179402	None	None	0	In state provider	None	1020 29TH ST	#550	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
202525	Fee-for-Service	1619913779	1619913779	1	1	GRESHAM, ANDREW CRNA	7/14/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1015 WEST YOSEMITE AVE	None	MADERA	CA	93737	4581	20	06039	36.95442695	-120.0708623	Madera County
202535	Fee-for-Service	1275946568	1275946568	1	1	GHC OF KEARNY MESA LLC	6/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7675 FAMILY CIRCLE DRIVE	None	SAN DIEGO	CA	92111	5304	37	06073	32.79926954	-117.1572795	San Diego County
202545	Fee-for-Service	1871868968	1871868968	1	1	GROCK, SHIRA M MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136419	67	Endocrinology	0	In state provider	None	200 MED PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
202562	Fee-for-Service	1710286166	1710286166	1	1	GLOZER, SARA S MFT	1/4/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	84614	-	NOT APPLICABLE	0	In state provider	None	214 HAIGHT ST	None	SAN FRANCISCO	CA	94102	6127	38	06075	37.77268396	-122.4261582	San Francisco County
202576	Fee-for-Service	1265722623	1265722623	1	1	GANDSE HOME HEALTH CARE INC	10/15/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	26302 WESTERN AVE	STE 4	LOMITA	CA	90717	3537	19	06037	33.78354374	-118.3098035	Los Angeles County
202609	Fee-for-Service	1609863190	1609863190	1	1	GARG, RAJESH K MD	11/1/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	175615	None	None	0	In state provider	None	21840 S NORMANDIE AVE	STE 100A	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
202624	Fee-for-Service	1992727523	1992727523	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8999 BALBOA BLVD	None	NORTHRIDGE	CA	91325	2608	19	06037	34.23447	-118.5025585	Los Angeles County
202636	Fee-for-Service	1942358833	1942358833	1	1	GUO, VERNA MD	11/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81134	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
202671	Fee-for-Service	1639350366	1639350366	1	1	GROTSKY, THOMAS S MD	3/12/2008	207P00000X	NA	Other	026	PHYSICIANS	98690	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
202695	Fee-for-Service	1770653974	1770653974	1	1	GOLD, MARINA MD	4/18/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	41684	01	General Practice	0	In state provider	None	1219 S CENTRAL AVE	None	GLENDALE	CA	91204	2503	19	06037	34.131501	-118.257846	Los Angeles County
202704	Fee-for-Service	1770655110	1770655110	1	1	GRANT,STEVEN W MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81596	02	General Surgery	0	In state provider	None	2865 ATLANTIC AVE	STE 223	LONG BEACH	CA	90806	7429	19	06037	33.809418	-118.185058	Los Angeles County
202728	Fee-for-Service	1992012553	1992012553	1	1	GONZALES, GERALD G PHD	11/18/2013	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
202760	Fee-for-Service	1467517557	1467517557	1	2	GONZALEZ-DIAZ, JOSE M MD	9/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	13500 VAN NUYS BLVD	None	PACOIMA	CA	91331	3028	19	06037	34.26224593	-118.4273324	Los Angeles County
202761	Fee-for-Service	1750510566	1750510566	1	1	GOMEZ, EMMA A LCSW	5/20/2016	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
202792	Fee-for-Service	1932123742	1932123742	1	1	GEE, CHRISTOPHER R OD	2/21/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1171 MURRIETA BLVD	STE 100	LIVERMORE	CA	94550	4143	01	06001	37.67592941	-121.7802007	Alameda County
202802	Fee-for-Service	1619084423	1619084423	1	1	GARCIA, MARTIN J MD	5/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83183	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
202812	Fee-for-Service	1174817415	1174817415	1	1	GONZALEZ, LILIANA N LMFT	10/13/2021	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
202847	Fee-for-Service	1114066073	1114066073	1	1	GORMAN, MELISSA A MD	7/1/2018	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
202852	Fee-for-Service	1134747223	1134747223	1	1	GREEN WAY HOSPICE INC	12/21/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7630 VINELAND AVE	SUITE 210A	SUN VALLEY	CA	91352	4535	19	06037	34.209189	-118.3703025	Los Angeles County
202886	Fee-for-Service	1215976840	1215976840	1	1	GUTIERREZ, MELISSA E MD	11/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81438	08	Family Practice	0	In state provider	None	1300 E COOLEY DR	None	COLTON	CA	92324	3905	36	06071	34.0544745	-117.306315	San Bernardino County
202896	Fee-for-Service	1194112789	1194112789	1	1	GRAY, BRITTANY L DO	2/24/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17350	15	Obstetrics (D.O. 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
202983	Fee-for-Service	1003812348	1003812348	1	1	GHARAI, FARIBA MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55954	33	Thoracic Surgery	0	In state provider	None	1310 W STEWART DR	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
202999	Fee-for-Service	1851320709	1851320709	1	1	GIRON, SARAH E	6/7/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
203006	Fee-for-Service	1780696518	1780696518	1	1	GREEN PINE HOME HEALTHCARE	10/5/2007	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	1740 NEW AVE	STE 101	SAN GABRIEL	CA	91776	3735	19	06037	34.07699051	-118.1082163	Los Angeles County
203008	Fee-for-Service	1003896366	1003896366	1	1	GODES, IRINA MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72287	40	Pediatrics	0	In state provider	None	12157 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3204	19	06037	34.18669745	-118.3985415	Los Angeles County
203017	Fee-for-Service	1801893995	1801893995	1	1	GREISS, HANI B MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	48330	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
203025	Fee-for-Service	1205101227	1205101227	1	1	GONZALES Y TUCKER, RICHARD D	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124072	66	Emergency Medicine (Urgent Care)	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
203034	Fee-for-Service	1629315791	1629315791	1	1	GRIFFIN, PHOEBE G MD	3/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128251	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
203101	Fee-for-Service	1427218254	1427218254	1	1	GORDON, WENDY A MD	8/26/2019	390200000X	NA	Other	026	PHYSICIANS	156429	08	Family Practice	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
203132	Fee-for-Service	1215668157	1215668157	1	1	GARCIA-MARSHALL, JULIA	12/18/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
203140	Fee-for-Service	1134747223	1134747223	1	1	GREEN WAY HOSPICE INC	12/21/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7630 VINELAND AVE	SUITE 210A	SUN VALLEY	CA	91352	4535	19	06037	34.209189	-118.3703025	Los Angeles County
203158	Fee-for-Service	1447095195	1447095195	1	1	GROTKOWSKI REED, KAROLINA P	10/15/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HD	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
203172	Fee-for-Service	1649301367	1649301367	1	1	GODEL, ERICK LMFT	4/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4425 JAMBOREE RD	263	NEWPORT BEACH	CA	92660	3024	30	06059	33.66279574	-117.8576757	Orange County
203199	Fee-for-Service	1356303812	1356303812	1	1	GO,STEVEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	0000	00	None	39.08455286	-94.57578107	Jackson County
203257	Fee-for-Service	1942234208	1942234208	1	1	GEORGE SABY	1/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	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
203265	Fee-for-Service	1245504851	1245504851	1	1	GILBERT, MARZENA K OD	6/29/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1280 S VICTORIA AVE	STE 100	VENTURA	CA	93003	6550	56	06111	34.26344767	-119.2119344	Ventura County
203269	Fee-for-Service	1003812348	1003812348	1	1	GHARAI, FARIBA MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55954	01	General Practice	0	In state provider	None	1310 W STEWART DR	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
203272	Fee-for-Service	1124098850	1124098850	1	1	GEE, RENEE C NP	7/13/2004	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
203273	Fee-for-Service	1609437599	1609437599	1	2	GINTIEN HUANG MD INC	6/21/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	8275 SIERRA AVE.	SUITE 103	FONTANA	CA	92335	3557	36	06071	34.103448	-117.435754	San Bernardino County
203282	Fee-for-Service	1841037850	1841037850	1	1	GALEN INPATIENT PHYSICIANS P	9/17/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	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
203334	Fee-for-Service	1851310825	1851310825	1	1	GUSTAFSON, GEORGE A MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	24086	20	Orthopedic Surgery	0	In state provider	None	10459 MT VIEW AVE	STE #B	LOMA LINDA	CA	92354	1056	36	06071	34.063722	-117.2436545	San Bernardino County
203352	Fee-for-Service	1417961020	1417961020	1	1	GREENWOOD, MURRAY A MD	11/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52611	25	Physical Medicine and Rehabilitation	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
203390	Fee-for-Service	1033192232	1033192232	1	2	GROVER, CHRISTOPHER M MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76484	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
203412	Fee-for-Service	1942390877	1942390877	1	1	GOLDBERG, JULIE LCSW	9/1/2010	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	6630 HWY 9	STE 205	FELTON	CA	95018	9711	44	06087	37.05726381	-122.0760563	Santa Cruz County
203414	Fee-for-Service	1346322757	1346322757	2	1	GUL, AMBREEN MD	4/15/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7677 CENTER AVE	STE 214	HUNTINGTON BEACH	CA	92647	9102	30	06059	33.736257	-117.995535	Orange County
203432	Fee-for-Service	1871768077	1871768077	1	1	GUMAN, BEBASTIAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	934 CENTER ST	None	ELGIN	IL	60120	2125	00	None	42.05379012	-88.28105438	Kane County
203441	Fee-for-Service	1740575331	1740575331	1	1	GOLDEN ARCHES PODIATRY INC	12/11/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1000 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4139	19	06037	34.01777923	-118.1085898	Los Angeles County
203473	Fee-for-Service	1245434000	1245434000	1	1	GILBERT, THOMAS E	12/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	31493 RANCHO PUEBLO RD	STE 203	TEMECULA	CA	92592	4833	33	06065	33.47938964	-117.1100864	Riverside County
203487	Fee-for-Service	1053943175	1053943175	1	1	GULLEDGE, KELSEY R PT	3/9/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
203496	Fee-for-Service	1417950163	1417950163	1	1	GRANCELL VILLAGE OF THE LOS	8/1/1978	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ANGELES JEWISH HOME FOR	7150 TAMPA AVE	None	RESEDA	CA	91335	3700	19	06037	34.2001266	-118.5534932	Los Angeles County
203502	Fee-for-Service	1144872052	1144872052	1	4	GOLDEN STATE IMAGING ASSOCIA	3/13/2020	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	TES INC	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
203507	Fee-for-Service	1710910401	1710910401	1	1	GOLAN, LAYNE	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	70609	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
203521	Fee-for-Service	1780212506	1780212506	1	1	GIDANIAN, SAMUEL MD	9/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2732 NAVAJO RD	202A	EL CAJON	CA	92020	2149	37	06073	32.80217534	-117.0025853	San Diego County
203562	Fee-for-Service	1609437599	1609437599	1	2	GINTIEN HUANG MD INC	6/21/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8275 SIERRA AVE.	SUITE 103	FONTANA	CA	92335	3557	36	06071	34.103448	-117.435754	San Bernardino County
203564	Fee-for-Service	1770677569	1770677569	1	1	GUY, KRISTEN L MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66620	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
203566	Fee-for-Service	1841037850	1841037850	1	1	GALEN INPATIENT PHYSICIANS P	9/17/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
203570	Fee-for-Service	1437175189	1437175189	1	1	GRANESE, RICHARD MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	83535	36	Psychiatry	0	In state provider	None	1090 THIRD STREET	SUITE 1	SOUTH LAKE TAHOE	CA	96150	3485	09	06017	38.91492536	-119.9966528	El Dorado County
203583	Fee-for-Service	1700977188	1700977188	1	1	GREENBERG, ARNOLD MD INC	1/5/1998	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MANZANITA MEDICAL CLINIC	5810 JAMESON CT	STE 1	CARMICHAEL	CA	95608	0881	34	06067	38.650878	-121.329036	Sacramento County
203636	Fee-for-Service	1720274921	1720274921	1	1	GUNAWARDANA, GIMHA S MD	8/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101531	38	Geriatrics	0	In state provider	None	8330 RED OAK	SUITE 201	RANCHO CUCAMONGA	CA	91730	6030	36	06071	34.10217525	-117.5693231	San Bernardino County
203654	Fee-for-Service	1114371283	1114371283	1	1	GUSLIKOV, ELENA NP	1/23/2018	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
203668	Fee-for-Service	1225032774	1225032774	1	1	GLEISCHMAN, STEWART H MD	10/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42402	02	General Surgery	0	In state provider	None	44902 NORTH 10TH ST WEST	None	LANCASTER	CA	93534	2314	19	06037	34.699158	-118.148051	Los Angeles County
203678	Fee-for-Service	1033192232	1033192232	1	2	GROVER, CHRISTOPHER M MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76484	01	General Practice	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
203690	Fee-for-Service	1205914330	1205914330	1	1	GUERRERO, EMMANUEL MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60177	38	Geriatrics	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
203702	Fee-for-Service	1346322757	1346322757	2	1	GUL, AMBREEN MD	4/15/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	7677 CENTER AVE	STE 214	HUNTINGTON BEACH	CA	92647	9102	30	06059	33.736257	-117.995535	Orange County
203703	Fee-for-Service	1528081460	1528081460	1	1	GOEL, NIRMIT MD	10/18/2010	2085N0700X	NA	MRI Provider	026	PHYSICIANS	53397	30	Radiology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
203768	Fee-for-Service	1972573103	1972573103	1	1	GREWAL, SANJEEV MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136854	18	Ophthalmology	0	In state provider	None	800 FAIRMOUNT AVE	STE 312	PASADENA	CA	91105	3153	19	06037	34.13193177	-118.1517805	Los Angeles County
203772	Fee-for-Service	1184684227	1184684227	1	1	GIBB, KENNETH A MD	1/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	235 WEST 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
203778	Fee-for-Service	1114798030	1114798030	1	1	GENOBLE, JESSICA CNP	9/25/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	683 LOMAS SANTA FE DR	None	SOLANA BEACH	CA	92075	1412	37	06073	32.99596006	-117.2594441	San Diego County
203790	Fee-for-Service	1477630309	1477630309	1	1	GARG, ASHIMA MD	6/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86738	20	Orthopedic Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
203875	Fee-for-Service	1114491545	1114491545	1	1	GERAGHTY, MICHAEL E PHD	2/6/2019	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
203876	Fee-for-Service	1225116023	1225116023	1	1	GARCIA, NORA V MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	70692	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
203879	Fee-for-Service	1144331703	1144331703	1	1	GOODWIN, SCOTT C MD	7/31/1985	2085R0204X	NA	Other	026	PHYSICIANS	56437	41	Internal Medicine	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
203898	Fee-for-Service	1407273345	1407273345	1	1	GUGLIELMO, ROBERT D MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140362	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
203904	Fee-for-Service	1952910960	1952910960	1	1	GREEN ROAD HOSPICE INC	10/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6257 VAN NUYS BLVD	SUITE E	VAN NUYS	CA	91401	2733	19	06037	34.183899	-118.4487895	Los Angeles County
203924	Fee-for-Service	1720274921	1720274921	1	1	GUNAWARDANA, GIMHA S MD	8/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101531	41	Internal Medicine	0	In state provider	None	8330 RED OAK	SUITE 201	RANCHO CUCAMONGA	CA	91730	6030	36	06071	34.10217525	-117.5693231	San Bernardino County
203979	Fee-for-Service	1205914330	1205914330	1	1	GUERRERO, EMMANUEL MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60177	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
204013	Fee-for-Service	1043338734	1043338734	1	1	GUEVARA, PEDRO R MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86351	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	STE 506	SAN FRANCISCO	CA	94110	4418	38	06075	37.74746923	-122.4202583	San Francisco County
204022	Fee-for-Service	1407862154	1407862154	1	1	GRAY B CLARKE 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
204031	Fee-for-Service	1073686127	1073686127	1	1	GELBART, JERRY H MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	48955	36	Psychiatry	0	In state provider	None	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
204051	Fee-for-Service	1154363679	1154363679	2	1	GARFIELD BEACH CVS, LLC	12/19/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19424 SOLEDAD CANYON	None	CANYON COUNTRY	CA	91351	2631	19	06037	34.41558954	-118.474614	Los Angeles County
204077	Fee-for-Service	1659837912	1659837912	1	1	GRONLEY, ERIC W LMFT	12/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	865 9TH ST	204	ARCATA	CA	95521	6242	12	06023	40.86918509	-124.08743	Humboldt County
204085	Fee-for-Service	1386052967	1386052967	1	1	GOULD, DANIEL J MD	5/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135579	02	General Surgery	0	In state provider	None	4333 TORRANCE BLVD	None	TORRANCE	CA	90503	4401	19	06037	33.83759353	-118.360089	Los Angeles County
204109	Fee-for-Service	1619123338	1619123338	1	1	GARCIA, ESMERALDA LCSW	3/28/2018	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
204112	Fee-for-Service	1861435661	1861435661	1	1	GHILARDUCCI, DAVID P MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83897	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
204194	Fee-for-Service	1952910960	1952910960	1	1	GREEN ROAD HOSPICE INC	10/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6257 VAN NUYS BLVD	SUITE E	VAN NUYS	CA	91401	2733	19	06037	34.183899	-118.4487895	Los Angeles County
204197	Fee-for-Service	1497796213	1497796213	1	1	GELB, ALAN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39516	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
204201	Fee-for-Service	1548245103	1548245103	1	1	GULL, AMY K DO	11/16/2007	207L00000X	NA	Other	026	PHYSICIANS	8978	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	0000	34	06067	38.626056	-121.3834455	Sacramento County
204208	Fee-for-Service	1871606251	1871606251	1	1	GALLERY, CHRISTIAN A MD	11/29/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2644 M ST	STE H	MERCED	CA	95340	2826	24	06047	37.31137227	-120.4794155	Merced County
204211	Fee-for-Service	1154366953	1154366953	1	1	GARFIELD BEACH CVS LLC	1/19/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3332 SANDROCK ROAD	None	SAN DIEGO	CA	92123	0000	37	06073	32.80334969	-117.1394307	San Diego County
204215	Fee-for-Service	1821166992	1821166992	1	1	GRIGLAK, MARTIN J MD	1/1/1995	207P00000X	NA	Other	026	PHYSICIANS	45747	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
204216	Fee-for-Service	1548655913	1548655913	1	1	GOUGH, ARIEL N	12/27/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
204222	Fee-for-Service	1235668906	1235668906	1	2	GLORY PHARMACY INC	6/23/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9675 MONTE VISTA AVE	STE. A	MONTCLAIR	CA	91763	2213	36	06071	34.079004	-117.6982135	San Bernardino County
204229	Fee-for-Service	1609992171	1609992171	1	2	GHEYSAR, KENNETH K MD	3/29/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	71924	-	NOT APPLICABLE	0	In state provider	None	21505 NORWALK BLVD	None	HAWAIIAN GARDENS	CA	90716	1121	19	06037	33.834015	-118.0720655	Los Angeles County
204243	Fee-for-Service	1023185956	1023185956	1	1	GIERUT, DEBRA R MD	12/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87373	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
204373	Fee-for-Service	1497384226	1497384226	1	1	GLEN-IVY HOSPICE INC	8/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	169 S ALVARADO ST	SUITE 101-A	LOS ANGELES	CA	90057	2224	19	06037	34.06497318	-118.2714544	Los Angeles County
204412	Fee-for-Service	1619920287	1619920287	2	1	GARFIELD BEACH CVS, L.L.C.	1/30/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2975 EAST ST	None	ANDERSON	CA	96007	3481	45	06089	40.45195672	-122.2992635	Shasta County
204458	Fee-for-Service	1376711325	1376711325	1	1	GARG, SHAILA MD	9/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89801	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
204476	Fee-for-Service	1497236673	1497236673	1	1	GRAHAM, MERI	10/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
204483	Fee-for-Service	1962424754	1962424754	2	1	GARFIELD BEACH CVS LLC	5/26/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 VINTAGE WAY	None	NOVATO	CA	94945	5005	21	06041	38.089818	-122.552622	Marin County
204502	Fee-for-Service	1629036413	1629036413	1	1	GRADY, JAMES J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	26041	08	Family Practice	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
204507	Fee-for-Service	1942413786	1942413786	1	1	GOLDEN VALLEY HEALTH CTR	11/18/2005	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1717 LAS VEGAS ST	None	MODESTO	CA	95358	5500	50	06099	37.6052798	-121.0027523	Stanislaus County
204522	Fee-for-Service	1679100614	1679100614	1	1	GUZDAR, AMY MD	9/25/2023	207R00000X	NA	Other	026	PHYSICIANS	185363	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
204553	Fee-for-Service	1528754603	1528754603	1	1	GENOME-BASED DIAGNOSTICS	8/9/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	6064 CORTE DEL CEDRO	STE B	CARLSBAD	CA	92011	1514	37	06073	33.12527857	-117.2725977	San Diego County
204563	Fee-for-Service	1255328670	1255328670	1	1	GOLDMAN, RONALD A MD	12/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	24329	40	Pediatrics	0	In state provider	None	4120 PRESCOTT ROAD	None	MODESTO	CA	95356	8418	50	06099	37.69891977	-121.0317078	Stanislaus County
204567	Fee-for-Service	1013483197	1013483197	1	1	GRISOLIA, BROOKE A CRNA	5/14/2020	207L00000X	NA	Other	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
204606	Fee-for-Service	1023837812	1023837812	1	1	GALEN INPATIENT PHYSICIANS P	11/22/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
204607	Fee-for-Service	1346329331	1346329331	1	1	GUEVARRA, LOIDA V MD INC	1/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53408	08	Family Practice	0	In state provider	None	12760 HESPERIA RD	STE A	VICTORVILLE	CA	92395	5806	36	06071	34.48276227	-117.2905134	San Bernardino County
204639	Fee-for-Service	1902862196	1902862196	1	1	GUARINO, CECILLE NP	10/14/2019	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
204650	Fee-for-Service	1437609047	1437609047	1	1	GREEN, DOMONICK K LMFT	12/29/2022	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
204661	Fee-for-Service	1497384226	1497384226	1	1	GLEN-IVY HOSPICE INC	8/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	169 S ALVARADO ST	SUITE 101-A	LOS ANGELES	CA	90057	2224	19	06037	34.06497318	-118.2714544	Los Angeles County
204675	Fee-for-Service	1497902308	1497902308	1	1	GOODWIN, KAREN M DO	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13431	02	General Surgery	0	In state provider	None	3300 WEBSTER STREET	SUITE 212	OAKLAND	CA	94609	3120	01	06001	37.82132826	-122.2621843	Alameda County
204693	Fee-for-Service	1033397583	1033397583	1	1	GARCIA, ULISES J MD	5/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102617	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
204720	Fee-for-Service	1831327626	1831327626	1	1	GRANT-ACQUAH, KWEKU W MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126202	18	Ophthalmology	0	In state provider	None	2240 N HARBOR BLVD	STE 210	FULLERTON	CA	92835	2633	30	06059	33.89764434	-117.929218	Orange County
204756	Fee-for-Service	1356363964	1356363964	2	1	GARFIELD BEACH CVS LLC	6/15/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2610 BISHOP DR	None	SAN RAMON	CA	94583	2338	07	06013	37.76306737	-121.9635882	Contra Costa County
204765	Fee-for-Service	1679005854	1679005854	1	1	GIANCATERINO, SHAUN MD	3/1/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	159239	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
204827	Fee-for-Service	1821009952	1821009952	1	1	GRAY, RICHARD J MD	7/18/2006	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	22037	41	Internal Medicine	0	In state provider	None	3490 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1891	38	06075	37.78668333	-122.4514243	San Francisco County
204836	Fee-for-Service	1174572390	1174572390	1	1	GRENERT, JAMES P MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78348	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
204845	Fee-for-Service	1548218522	1548218522	1	1	GALLEGOS, EDUARDO T MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86270	79	Neurology-Child	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
204875	Fee-for-Service	1417919929	1417919929	1	1	GONZALEZ, IRMA Y MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	62810	40	Pediatrics	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
204894	Fee-for-Service	1720602790	1720602790	1	1	GRACE PALLIATIVE AND HOSPICE	8/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE	8119 FOOTHILL BLVD	STE 5	SUNLAND	CA	91040	3600	19	06037	34.2596885	-118.3099545	Los Angeles County
204895	Fee-for-Service	1023837812	1023837812	1	1	GALEN INPATIENT PHYSICIANS P	11/22/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
204947	Fee-for-Service	1972789188	1972789188	1	1	GODOY, IGNATIUS P MD INC	11/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	16660 PARAMOUNT BLVD	STE 206	PARAMOUNT	CA	90723	5458	19	06037	33.882723	-118.1599535	Los Angeles County
204962	Fee-for-Service	1568092443	1568092443	1	1	GONZALEZ, ALINA LMFT	9/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27451 TOURNEY ROAD	SUITE 120	VALENCIA	CA	91355	6304	19	06037	34.42210981	-118.5795785	Los Angeles County
204964	Fee-for-Service	1366470932	1366470932	1	1	GIRALDO, ALVARO M. MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	707 SAVANNAH AVE	None	MCALLEN	TX	78503	3006	00	None	26.1864051	-98.22995168	Hidalgo County
204984	Fee-for-Service	1154429645	1154429645	1	1	GARFIELD BEACH CVS LLC	8/18/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11574 LOWER AZUSA RD	None	EL MONTE	CA	91732	1333	19	06037	34.09101885	-118.0155156	Los Angeles County
205027	Fee-for-Service	1841253531	1841253531	1	1	GOLLIN, JULIE MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58388	41	Internal Medicine	0	In state provider	None	12395 EL CAMINO REAL	STE 317	SAN DIEGO	CA	92130	3085	37	06073	32.94324259	-117.2396525	San Diego County
205034	Fee-for-Service	1679070098	1679070098	1	1	GANDHI, NEHAL N MD	10/27/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173594	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
205085	Fee-for-Service	1558500256	1558500256	1	1	GOYAL, NEELAM MD	9/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106343	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
205109	Fee-for-Service	1225727258	1225727258	1	1	GATDULA, J. PAUL	6/22/2023	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
205110	Fee-for-Service	1205873197	1205873197	1	2	GILBOA, RUTH MD	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	46557	07	Dermatology	0	In state provider	None	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.1814285	-117.3093613	San Diego County
205112	Fee-for-Service	1821009952	1821009952	1	1	GRAY, RICHARD J MD	7/18/2006	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	22037	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3490 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1891	38	06075	37.78668333	-122.4514243	San Francisco County
205115	Fee-for-Service	1386814838	1386814838	1	1	GORODETSKI, SVETLANA A	3/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99376	40	Pediatrics	0	In state provider	MD	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
205119	Fee-for-Service	1205367661	1205367661	1	1	GLASS, MELISSA C MD	3/31/2023	390200000X	NA	Other	026	PHYSICIANS	165055	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
205124	Fee-for-Service	1235795881	1235795881	1	1	GILL, HARMINDER	2/26/2024	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	176540	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
205126	Fee-for-Service	1174572390	1174572390	1	1	GRENERT, JAMES P MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78348	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
205132	Fee-for-Service	1821333691	1821333691	1	1	GHATTAS, CHRISTIAN S MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123616	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
205144	Fee-for-Service	1881875169	1881875169	1	1	GONZALEZ, GABRIEL MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100551	30	Radiology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
205165	Fee-for-Service	1417919929	1417919929	1	1	GONZALEZ, IRMA Y MD	10/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	62810	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
205170	Fee-for-Service	1619056173	1619056173	1	1	GIESEN, 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	2700 NW STEWART PKWY	None	ROSEBURG	OR	97471	1281	00	None	43.2399838	-123.3665048	Douglas County
205171	Fee-for-Service	1124565130	1124565130	1	1	GHAZARIAN, TINA NP	2/10/2020	363LG0600X	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
205178	Fee-for-Service	1952937203	1952937203	1	1	GOLDEN LIFE ADULT DAY CARE	2/20/2025	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	SERVICES	14361 BEACH BLVD	STE 108	WESTMINSTER	CA	92683	8100	30	06059	33.75337421	-117.9897243	Orange County
205179	Fee-for-Service	1720602790	1720602790	1	1	GRACE PALLIATIVE AND HOSPICE	8/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE	8119 FOOTHILL BLVD	STE 5	SUNLAND	CA	91040	3600	19	06037	34.2596885	-118.3099545	Los Angeles County
205200	Fee-for-Service	1164522199	1164522199	1	1	GRUDKO, KENNETH MD	12/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80633	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
205208	Fee-for-Service	1104147008	1104147008	1	1	GARVEY, TIMOTHY J MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111266	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
205226	Fee-for-Service	1851613483	1851613483	1	1	GREWAL, AJANAMJOT K MD	2/16/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	103791	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 WEST LEGION ROAD	SUITE 204	BRAWLEY	CA	92227	7755	13	06025	32.95996012	-115.5538196	Imperial County
205283	Fee-for-Service	1437173085	1437173085	1	1	GANPULE, SANJAY R MD	7/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41572	78	Neoplastic Diseases/Oncology	0	In state provider	None	262 POSADA LN	STE A	TEMPLETON	CA	93465	4057	40	06079	35.5535294	-120.7214694	San Luis Obispo County
205302	Fee-for-Service	1164518056	1164518056	1	1	GREEN, RAQUEL NP	11/21/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15379	-	NOT APPLICABLE	0	In state provider	None	45335 SIERRA HWY	None	LANCASTER	CA	93534	1611	19	06037	34.7068568	-118.1383834	Los Angeles County
205311	Fee-for-Service	1588023469	1588023469	1	1	GIDFAR, SANAZ MD	3/6/2025	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
205334	Fee-for-Service	1356429062	1356429062	1	1	GAMBETTA, DARIO A MD	1/25/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68026	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
205391	Fee-for-Service	1295351427	1295351427	1	1	GAFFANEY, LAUREN MD	7/7/2023	207R00000X	NA	Other	026	PHYSICIANS	185969	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
205400	Fee-for-Service	1689875668	1689875668	1	1	GUALBERTO, GARY C MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138319	13	Neurology (M.D. only)	0	In state provider	None	6010 HIDDEN VALLEY ROAD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
205432	Fee-for-Service	1376795468	1376795468	1	1	GHUMAN, SUDEEP K MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117886	78	Neoplastic Diseases/Oncology	0	In state provider	None	2809 OLIVE HWY	STE 150	OROVILLE	CA	95966	6133	04	06007	39.50386798	-121.5410203	Butte County
205447	Fee-for-Service	1770020034	1770020034	1	1	GARFIELD BEACH CVS LLC	2/20/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	505 BEAR MOUNTAIN BLVD	STE B	ARVIN	CA	93203	1454	15	06029	35.20899347	-118.830078	Kern County
205451	Fee-for-Service	1700807393	1700807393	1	1	GREWAL, KULJINDER S MD	3/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	34108	18	Ophthalmology	0	In state provider	PROFESSIONAL CORPORATION	8881 FLETCHER PKWY	STE 104	LA MESA	CA	91942	3131	37	06073	32.78442148	-117.0073814	San Diego County
205487	Fee-for-Service	1164522199	1164522199	1	1	GRUDKO, KENNETH MD	12/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80633	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
205505	Fee-for-Service	1295004711	1295004711	1	1	GEHRINGER, DANE L MD	2/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116580	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
205512	Fee-for-Service	1861280612	1861280612	1	1	GARCIA, ROXANA E	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	19	06037	0	0	None
205552	Fee-for-Service	1255788469	1255788469	1	1	GOLD, ERICA PT	10/26/2021	225100000X	NA	Physical Therapist	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
205566	Fee-for-Service	1164489159	1164489159	1	1	GARG, BIMLESH MD INC	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	41524	36	Psychiatry	0	In state provider	None	1535 W MERCED AVE	STE 300	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
205570	Fee-for-Service	1437173085	1437173085	1	1	GANPULE, SANJAY R MD	7/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41572	66	Emergency Medicine (Urgent Care)	0	In state provider	None	262 POSADA LN	STE A	TEMPLETON	CA	93465	4057	40	06079	35.5535294	-120.7214694	San Luis Obispo County
205579	Fee-for-Service	1578660346	1578660346	1	1	GONZALEZ, RENE MD	1/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96013	40	Pediatrics	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
205590	Fee-for-Service	1447978721	1447978721	1	1	GEGHAMYAN, ANI NP	3/22/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	425 EAST COLORADO STREET	SUITE 420	GLENDALE	CA	91205	5123	19	06037	34.14266036	-118.2504208	Los Angeles County
205604	Fee-for-Service	1235165796	1235165796	2	1	GRODY, WAYNE W MD	2/18/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	40899	22	Pathology (M.D. only)	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
205606	Fee-for-Service	1255346797	1255346797	1	1	GOVASHIRI, REZA MD	7/18/2019	207R00000X	NA	Other	026	PHYSICIANS	50068	41	Internal Medicine	0	In state provider	None	27800 MEDICAL CENTER RD	STE 461	MISSION VIEJO	CA	92691	6424	30	06059	33.55952733	-117.6645199	Orange County
205607	Fee-for-Service	1851822563	1851822563	1	1	GORDEN, ZACHARY N DO	11/22/2021	207L00000X	NA	Other	026	PHYSICIANS	18988	None	None	0	In state provider	None	18321 CLARK STREET	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
205645	Fee-for-Service	1104926773	1104926773	1	1	GEE, DEREK J MD	4/14/2014	207L00000X	NA	Other	026	PHYSICIANS	92328	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
205695	Fee-for-Service	1821769969	1821769969	1	1	GRADY, GABRIELLE PT	10/14/2022	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
205714	Fee-for-Service	1619529948	1619529948	1	1	GEORGE, KENDALL S OD	10/20/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	931 ANZA AVE	B	VISTA	CA	92084	4531	37	06073	33.21215886	-117.2318869	San Diego County
205715	Fee-for-Service	1467540120	1467540120	1	1	GOLDBERG, STANLEY MD INC	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	29263	02	General Surgery	0	In state provider	None	1045 ATLANTIC AVE	STE 1002	LONG BEACH	CA	90813	3409	19	06037	33.780267	-118.1850795	Los Angeles County
205720	Fee-for-Service	1376795468	1376795468	1	1	GHUMAN, SUDEEP K MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117886	41	Internal Medicine	0	In state provider	None	2809 OLIVE HWY	STE 150	OROVILLE	CA	95966	6133	04	06007	39.50386798	-121.5410203	Butte County
205740	Fee-for-Service	1700807393	1700807393	1	1	GREWAL, KULJINDER S MD	3/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	34108	66	Emergency Medicine (Urgent Care)	0	In state provider	PROFESSIONAL CORPORATION	8881 FLETCHER PKWY	STE 104	LA MESA	CA	91942	3131	37	06073	32.78442148	-117.0073814	San Diego County
205753	Fee-for-Service	1073323689	1073323689	1	1	GOLDSWORTHY, CATHERINE 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
205764	Fee-for-Service	1245053693	1245053693	1	1	GRAVES, JULIA C TOLABOR CERT	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	19	06037	0	0	None
205786	Fee-for-Service	1952732620	1952732620	1	1	GARFIELD BEACH CVS LLC	6/30/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4030 S WESTERN AVE	None	LOS ANGELES	CA	90062	1634	19	06037	34.010532	-118.3089015	Los Angeles County
205793	Fee-for-Service	1811993389	1811993389	1	1	GILEWSKI, MICHAEL J PHD	5/5/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
205794	Fee-for-Service	1710369715	1710369715	1	1	GRINNELL, BRETT LCSW	11/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	964 5TH AVENUE	SUITE 535	SAN DIEGO	CA	92101	6102	37	06073	32.71539477	-117.1601872	San Diego County
205807	Fee-for-Service	1306961016	1306961016	1	1	GARCIA, JOSH L LCSW	5/31/2017	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
205824	Fee-for-Service	1578530291	1578530291	1	1	GEVORKIAN, ARTIN MD	10/17/2008	207P00000X	NA	Other	026	PHYSICIANS	94838	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
205839	Fee-for-Service	1346877784	1346877784	1	1	GOLDRICH, ALISA MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	189412	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
205858	Fee-for-Service	1437173085	1437173085	1	1	GANPULE, SANJAY R MD	7/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41572	68	Hematology	0	In state provider	None	262 POSADA LN	STE A	TEMPLETON	CA	93465	4057	40	06079	35.5535294	-120.7214694	San Luis Obispo County
205890	Fee-for-Service	1528041811	1528041811	1	4	GROSSMONT HOSPITAL CORPORATI	10/2/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	8860 CENTER DRIVE	STE 250	LA MESA	CA	91942	3068	37	06073	32.78189749	-117.0075062	San Diego County
205905	Fee-for-Service	1457379638	1457379638	1	1	GOLLENDER, PAUL R OD INC	9/5/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1263 PLEASANT GROVE BLVD	STE 100	ROSEVILLE	CA	95747	5858	31	06061	38.77233838	-121.3143437	Placer County
205913	Fee-for-Service	1376762013	1376762013	1	1	G T NONE EMERG MEDICAL	9/16/2005	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION INC	2500 E FOOTHILL BLVD	STE 404	PASADENA	CA	91107	3464	19	06037	34.14979547	-118.097982	Los Angeles County
205914	Fee-for-Service	1063465235	1063465235	1	1	GRANT, EDWARD G MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61910	30	Radiology	0	In state provider	None	333 S HOPE ST	STE C145	LOS ANGELES	CA	90071	3019	19	06037	34.05335946	-118.2526978	Los Angeles County
205962	Fee-for-Service	1962830687	1962830687	1	1	GARZA-HALSTEAD, CELIA M NP	4/17/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
205991	Fee-for-Service	1922297746	1922297746	1	1	GRIFFITHS, AMY J PSYD	1/29/2014	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
205996	Fee-for-Service	1356451264	1356451264	1	1	GOGIA, HARINDER S MD INC	4/14/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	801 N TUSTIN AVE	STE 706	SANTA ANA	CA	92705	3611	30	06059	33.752286	-117.8341735	Orange County
206002	Fee-for-Service	1851613079	1851613079	1	1	GHADERI, LIDA	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63230	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
206017	Fee-for-Service	1891912911	1891912911	1	1	GUERRERO, JACQUELINE M	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94381	None	None	0	In state provider	MD	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
206064	Fee-for-Service	1447492517	1447492517	1	1	GACHIMA, PATRICK M	9/14/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1845 BUSINESS CENTER DR	SUITE 127	SAN BERNARDINO	CA	92408	3434	36	06071	34.06865027	-117.2832038	San Bernardino County
206086	Fee-for-Service	1801968615	1801968615	1	1	GARFINKEL, KIMBERLY G MD	1/23/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	86938	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
206093	Fee-for-Service	1699823609	1699823609	1	1	GHELANI, JIGAR P MD	1/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93280	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
206109	Fee-for-Service	1710910872	1710910872	1	1	GASKINS, ROLAND A DPM	11/30/1991	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	27300 IRIS AVE	FL 3	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
206245	Fee-for-Service	1174698534	1174698534	1	1	GIVELBER, ANNA I MD	3/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37606	40	Pediatrics	0	In state provider	#201	7531 SANTA MONICA BLVD	None	LOS ANGELES	CA	90046	6401	19	06037	34.09081315	-118.3541261	Los Angeles County
206287	Fee-for-Service	1245275049	1245275049	1	1	GARFIELD BEACH CVS, LLC	4/23/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26861 SIERRA HWY	None	SANTA CLARITA	CA	91321	2274	19	06037	34.40463115	-118.4665058	Los Angeles County
206288	Fee-for-Service	1619081528	1619081528	2	1	GHALY, ASHRAF I MD	8/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	50209	08	Family Practice	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
206297	Fee-for-Service	1366884033	1366884033	1	1	GIL, JESENIA J LCSW	6/10/2022	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
206303	Fee-for-Service	1043856263	1043856263	1	2	GAURAV GANDOTRA INC	4/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	5900 BROCKTON AVE	None	RIVERSIDE	CA	92506	1862	33	06065	33.96263615	-117.395639	Riverside County
206370	Fee-for-Service	1124476296	1124476296	1	1	GIVEN, KATHERINE M MD	7/8/2022	207ND0101X	NA	Dermatology	026	PHYSICIANS	167878	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
206378	Fee-for-Service	1023646361	1023646361	1	1	GERARDO, JULIETTE MD	8/15/2023	2279E0002X	NA	Other	026	PHYSICIANS	186657	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
206466	Fee-for-Service	1750329660	1750329660	1	1	GANATRA, KOSHA	4/26/2005	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	11550 INDIAN HILLS RD	STE 210	MISSION HILLS	CA	91345	1202	19	06037	34.28024575	-118.4588775	Los Angeles County
206471	Fee-for-Service	1972552990	1972552990	1	1	GOLDEN STATE ORTHOPEDICS & S	9/3/2024	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	PINE	4140 JADE STREET	SUITE 100	CAPITOLA	CA	95010	3956	44	06087	36.97026148	-121.9638195	Santa Cruz County
206514	Fee-for-Service	1548568421	1548568421	1	3	GOLDEN VALLEY HEALTH CENTERS	2/10/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1130 6TH STREET	None	MODESTO	CA	95354	2203	50	06099	37.63941918	-121.0062006	Stanislaus County
206543	Fee-for-Service	1063578458	1063578458	1	1	GOLDEN, THOMAS F MD	4/27/2006	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	32034	20	Orthopedic Surgery	0	In state provider	A PROFESS CORP	168 N BRENT ST	STE 505	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
206560	Fee-for-Service	1548604853	1548604853	1	1	GANESAN, CALYANI MD	6/10/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	135865	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
206695	Fee-for-Service	1295249639	1295249639	1	1	GASS, JESSICA PT	1/27/2020	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
206698	Fee-for-Service	1538127568	1538127568	1	1	GABAEFF, DINA R MD	6/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	#100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
206702	Fee-for-Service	1063510063	1063510063	1	1	GONZALEZ, OLGA L MD	8/31/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77811	40	Pediatrics	0	In state provider	None	4941 OLIVEHURST AVE	None	OLIVEHURST	CA	95961	4225	58	06115	39.09746115	-121.5514942	Yuba County
206718	Fee-for-Service	1154393262	1154393262	1	1	GANDHI, SONIYA S MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116230	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
206749	Fee-for-Service	1679610174	1679610174	1	1	GIUSTINO, MARJORY J LMFT	9/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2551 SAN RAMON VALLEY BL	STE 202	SAN RAMON	CA	94583	1661	07	06013	37.77143928	-121.9737192	Contra Costa County
206754	Fee-for-Service	1285853697	1285853697	1	1	GRASSER, ANGELA N	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93433	08	Family Practice	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
206774	Fee-for-Service	1891729745	1891729745	1	2	GRAYBILL MEDICAL GROUP INC	6/24/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	840 TOWNSITE DR	None	VISTA	CA	92084	5566	37	06073	33.20923325	-117.2343859	San Diego County
206795	Fee-for-Service	1841494366	1841494366	1	1	GRADY, IAN MD	6/27/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1335 BUENAVENTURA BLVD	STE 204	REDDING	CA	96001	6009	45	06089	40.58222519	-122.4261823	Shasta County
206800	Fee-for-Service	1548568421	1548568421	1	3	GOLDEN VALLEY HEALTH CENTERS	2/10/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1130 6TH STREET	None	MODESTO	CA	95354	2203	50	06099	37.63941918	-121.0062006	Stanislaus County
206840	Fee-for-Service	1831126689	1831126689	1	1	GUPTA, RAJ MD	4/13/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	93854	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
206861	Fee-for-Service	1215972120	1215972120	1	1	GARFIELD BEACH CVS, LLC	2/1/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30842 S PACIFIC COAST	None	LAGUNA BEACH	CA	92651	8136	30	06059	33.51550468	-117.7565449	Orange County
206871	Fee-for-Service	1184023947	1184023947	1	1	GILLESPIE, NICOLETTE F LMFT	12/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	365 CAPAY AVE	None	HAMILTON CITY	CA	95951	0777	11	06021	39.74136593	-122.0164349	Glenn County
206876	Fee-for-Service	1689977076	1689977076	1	1	GRUTBO, ANITA C LMFT	7/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG	330 E. LAMBERT ROAD	None	BREA	CA	92821	4100	30	06059	33.92494139	-117.8918336	Orange County
206883	Fee-for-Service	1700148707	1700148707	1	1	GARFIELD BEACH CVS LLC	3/27/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5176 E WHITTIER BLVD	None	LOS ANGELES	CA	90022	3932	19	06037	34.02047202	-118.1576777	Los Angeles County
206893	Fee-for-Service	1104035468	1104035468	1	1	GREWAL, KANWARDEEP S MD	8/20/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	109028	13	Neurology (M.D. only)	0	In state provider	None	11795 EDUCATION ST	#213	AUBURN	CA	95602	2454	31	06061	38.94433757	-121.098912	Placer County
206989	Fee-for-Service	1235858671	1235858671	1	1	GARFIELD BEACH CVS, L.L.C.	8/21/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12121 W VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3204	19	06037	34.18670256	-118.397477	Los Angeles County
207004	Fee-for-Service	1154393262	1154393262	1	1	GANDHI, SONIYA S MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116230	77	Infectious Disease	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
207022	Fee-for-Service	1811484223	1811484223	1	1	GUZMAN, ARNEL P NP	7/22/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
207061	Fee-for-Service	1891729745	1891729745	1	2	GRAYBILL MEDICAL GROUP INC	6/24/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	840 TOWNSITE DR	None	VISTA	CA	92084	5566	37	06073	33.20923325	-117.2343859	San Diego County
207066	Fee-for-Service	1659476323	1659476323	1	1	GARRETT, BENEDICT L MD	7/31/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81780	41	Internal Medicine	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
207090	Fee-for-Service	1578946182	1578946182	1	1	GREENE, TIMOTHY DPM	6/2/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	28078 BAXTER RD	SUITE 320	MURRIETA	CA	92563	1404	33	06065	33.615	-117.1670265	Riverside County
207107	Fee-for-Service	1144914060	1144914060	2	1	GREENFIELD, TAURA LCSW	9/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	409 TAYLOR AVE	None	ALAMEDA	CA	94501	3718	01	06001	37.77265645	-122.2854825	Alameda County
207153	Fee-for-Service	1205938420	1205938420	1	1	GOULD, STEPHEN H MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	17215	36	Psychiatry	0	In state provider	None	4180 LA JOLLA VILLAGE DR	STE 550	LA JOLLA	CA	92037	9158	37	06073	32.87213142	-117.2166424	San Diego County
207161	Fee-for-Service	1568568152	1568568152	1	1	GIORDANI, MAURO MD	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	57052	01	General Practice	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
207244	Fee-for-Service	1831132034	1831132034	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11623 E ROSECRANS BLVD	None	NORWALK	CA	90650	3819	19	06037	33.90226233	-118.0853517	Los Angeles County
207246	Fee-for-Service	1649381641	1649381641	1	1	GOLDSTONE, ALAN M OD	4/19/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2280 E CARSON ST	None	LONG BEACH	CA	90807	3044	19	06037	33.83241248	-118.164456	Los Angeles County
207271	Fee-for-Service	1093756918	1093756918	1	1	GARFIELD BEACH CVS, LLC	9/3/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	711 PIER AVE.	None	HERMOSA BEACH	CA	90254	3941	19	06037	33.86485772	-118.3942384	Los Angeles County
207330	Fee-for-Service	1871860510	1871860510	1	1	GRAY, SHAUNTE M MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118824	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
207350	Fee-for-Service	1891729745	1891729745	1	2	GRAYBILL MEDICAL GROUP INC	6/24/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	840 TOWNSITE DR	None	VISTA	CA	92084	5566	37	06073	33.20923325	-117.2343859	San Diego County
207354	Fee-for-Service	1659476323	1659476323	1	1	GARRETT, BENEDICT L MD	7/31/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81780	66	Emergency Medicine (Urgent Care)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
207381	Fee-for-Service	1861472318	1861472318	1	8	GENESISCARE USA OF CALIFORNI	2/25/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	58295 29 PALMS HIGHWAY	None	YUCCA VALLEY	CA	92284	5803	36	06071	34.13046086	-116.3920956	San Bernardino County
207433	Fee-for-Service	1295740884	1295740884	1	1	GRAD, MICHELE A MD	4/30/1991	207P00000X	NA	Other	026	PHYSICIANS	73903	66	Emergency Medicine (Urgent Care)	0	In state provider	ASSOC EMERGENCY PHYSICIA	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
207464	Fee-for-Service	1609303999	1609303999	1	1	GEORGE, JOYCE S MD	1/9/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166515	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
207512	Fee-for-Service	1811440142	1811440142	1	1	GARCIA, SARA R PSYD	10/2/2023	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
207534	Fee-for-Service	1982782017	1982782017	1	1	GARZA, RICHARD MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52953	02	General Surgery	0	In state provider	None	2 UPPER RAGSDALE	STE B230	MONTEREY	CA	93940	7821	27	06053	36.57940327	-121.8142876	Monterey County
207562	Fee-for-Service	1144914375	1144914375	1	1	GUYTON, COURTNEY CNP	12/19/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10200 SEPULVEDA BLVD	STE 200	MISSION HILLS	CA	91345	2657	19	06037	34.25572562	-118.4673156	Los Angeles County
207575	Fee-for-Service	1669054243	1669054243	1	1	GIOVANNIELLO, ERIKA CRNA	5/26/2022	367500000X	NA	Other	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
207583	Fee-for-Service	1275147746	1275147746	1	1	GHUSHCHYAN-TIGRANYAN, GOHAR	4/20/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	3607	30	06059	33.66719598	-117.7642461	Orange County
207633	Fee-for-Service	1689437121	1689437121	1	1	GARFIELD BEACH CVS, L.L.C.	9/6/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2130 PACIFIC COAST HWY	None	LOMITA	CA	90717	2503	19	06037	33.78949154	-118.318113	Los Angeles County
207635	Fee-for-Service	1396297156	1396297156	1	1	GUENDELMAN, MAYA D PHD	12/17/2023	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
207671	Fee-for-Service	1861472318	1861472318	1	8	GENESISCARE USA OF CALIFORNI	2/25/2020	2085R0001X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CORPORATION	58295 29 PALMS HIGHWAY	None	YUCCA VALLEY	CA	92284	5803	36	06071	34.13046086	-116.3920956	San Bernardino County
207718	Fee-for-Service	1205254224	1205254224	1	1	GOMEZ VILLALOBOS, LUIS D MD	1/8/2019	207R00000X	NA	Other	026	PHYSICIANS	140668	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
207746	Fee-for-Service	1700432770	1700432770	1	1	GARCIA, KYLE C OT	10/19/2023	225X00000X	NA	Other	019	OCCUPATIONAL 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
207775	Fee-for-Service	1366458077	1366458077	1	1	GRAEBER, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
207826	Fee-for-Service	1437267697	1437267697	1	1	GITTLEMANDAVIES, SUSAN LCSW	6/21/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24050 MADISON ST	100-N	TORRANCE	CA	90505	6015	19	06037	33.80594851	-118.348558	Los Angeles County
207832	Fee-for-Service	1225290752	1225290752	1	1	GAY, ANDRE N MD	11/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126102	20	Orthopedic Surgery	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
207840	Fee-for-Service	1124477898	1124477898	1	1	GUERRERO-HALL, KARLA D MD	12/4/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167822	None	None	0	In state provider	None	447 W EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74338833	-121.432305	San Joaquin County
207847	Fee-for-Service	1386760825	1386760825	1	1	GHOFRANI, MOHSEN MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103875	30	Radiology	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
207876	Fee-for-Service	1902016892	1902016892	1	1	GRABER, STARLENE M LMFT	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24924	-	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
207890	Fee-for-Service	1831639988	1831639988	1	1	GALLAGHER, JAMES F LMFT	5/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
207903	Fee-for-Service	1841324860	1841324860	1	1	GIBSON, KELLY A	12/19/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
207954	Fee-for-Service	1699082768	1699082768	1	1	GEISZLER, MELISSA M LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
207976	Fee-for-Service	1902989536	1902989536	2	1	GARFIELD BEACH CVS LLC	5/30/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19661 HESPERIAN BLVD	None	HAYWARD	CA	94541	4200	01	06001	37.66710479	-122.119094	Alameda County
208033	Fee-for-Service	1922408848	1922408848	1	1	GIANELLI, JEFFREY L LCSW	7/29/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	409 13TH	STE 1900	OAKLAND	CA	94612	2605	01	06001	37.80326679	-122.2707988	Alameda County
208098	Fee-for-Service	1740578236	1740578236	1	1	GUZMAN, GRACE M LMFT	4/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
208128	Fee-for-Service	1225112212	1225112212	1	1	GLOVER, CORINA M MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64706	40	Pediatrics	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
208130	Fee-for-Service	1861717704	1861717704	1	1	GHOMRI, YASHAR M DO	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11892	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
208144	Fee-for-Service	1679018238	1679018238	1	1	GATES, BLAIR R PT	1/30/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1902 ROYALTY DR	SUITE 220	POMONA	CA	91767	3056	19	06037	34.07791925	-117.746146	Los Angeles County
208185	Fee-for-Service	1588670673	1588670673	1	1	GOH, ROBERT K MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84650	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
208200	Fee-for-Service	1396206082	1396206082	1	1	GOMES, SALLY LCSW	1/10/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
208227	Fee-for-Service	1851165880	1851165880	1	1	GILL, JAGJEET PT	12/26/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13019 STOCKDALE HWY	500	BAKERSFIELD	CA	93314	9570	15	06029	35.35418947	-119.147103	Kern County
208239	Fee-for-Service	1114292406	1114292406	1	1	GIPSON, SHIH Y MD	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155011	36	Psychiatry	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
208330	Fee-for-Service	1497370340	1497370340	1	1	GMM HOME HEALTH CARE INC	1/29/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6005 VINELAND AVE	SUITE 209	NORTH HOLLYWOOD	CA	91606	4982	19	06037	34.179921	-118.3703275	Los Angeles County
208396	Fee-for-Service	1265401368	1265401368	1	1	GREENE, EDWARD W MD	1/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82156	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
208434	Fee-for-Service	1124220397	1124220397	1	1	GUNSBERGER, TANJA L DO	3/14/2022	208600000X	NA	General Surgery	026	PHYSICIANS	8532	None	None	0	In state provider	None	1095 MARSHALL WAY	STE 202	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
208437	Fee-for-Service	1831171735	1831171735	1	1	GUPTA, ARIKA MD	5/26/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	None	None	1	Border provider	None	670 SIERRA ROSE DR	None	RENO	NV	89511	2072	00	None	39.4735137	-119.7995156	Washoe County
208493	Fee-for-Service	1124552732	1124552732	1	1	GRANT PAHIS MD	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
208535	Fee-for-Service	1588714406	1588714406	1	1	GANGOPADHYAY, ADITYA N MD	3/24/2010	207R00000X	NA	Other	026	PHYSICIANS	94759	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
208541	Fee-for-Service	1861472318	1861472318	1	10	GENESISCARE USA OF CALIFORNI	2/25/2020	2085R0001X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CORPORATION	77-840 FLORA ROAD	None	PALM DESERT	CA	92211	4109	33	06065	33.76856549	-116.3075194	Riverside County
208542	Fee-for-Service	1013487057	1013487057	1	1	GOLDEN HEALTH HOME CARE INC	8/31/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5311 TOPANGA CANYON BLVD	304	WOODLAND HILLS	CA	91364	1754	19	06037	34.166313	-118.6059365	Los Angeles County
208547	Fee-for-Service	1497731665	1497731665	1	1	GEE, LANCE A MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74894	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
208550	Fee-for-Service	1356790786	1356790786	1	1	GENMAR HOMES INC	9/22/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1948 THOREAU STREET	None	LOS ANGELES	CA	90047	4725	19	06037	33.93556541	-118.3127242	Los Angeles County
208672	Fee-for-Service	1760590699	1760590699	1	1	GORDON, BRUCE L MD	2/23/1982	207P00000X	NA	Other	026	PHYSICIANS	34270	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
208774	Fee-for-Service	1962665711	1962665711	1	1	GHOSH, INDUSHREE MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114935	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
208783	Fee-for-Service	1972514461	1972514461	1	1	GORDON, VICTORIA 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	610 STRICKLAND DR	STE 340	ORANGE	TX	77630	4788	00	None	30.09918175	-93.76742785	Orange County
208798	Fee-for-Service	1134462500	1134462500	1	1	GATES, KERRIE J	4/11/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11105 KNOTT AVENUE	SUITE A	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
208802	Fee-for-Service	1013015593	1013015593	1	1	GARFIELD BEACH CVS LLC	7/9/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25622 CROWN VALLEY PKWY	None	LADERA RANCH	CA	92694	0464	30	06059	33.56538968	-117.6294949	Orange County
208818	Fee-for-Service	1386814382	1386814382	1	1	GONZALEZ, EDWARD A	7/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1605 W OLYMPIC BLVD	STE 9063	LOS ANGELES	CA	90015	3830	19	06037	34.04937663	-118.2745348	Los Angeles County
208826	Fee-for-Service	1861472318	1861472318	1	10	GENESISCARE USA OF CALIFORNI	2/25/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	77-840 FLORA ROAD	None	PALM DESERT	CA	92211	4109	33	06065	33.76856549	-116.3075194	Riverside County
208830	Fee-for-Service	1407805310	1407805310	1	1	GENERAL ANESTHESIA SPEC	12/1/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IALIST, RONALD H WENDER	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
208892	Fee-for-Service	1073974911	1073974911	1	1	GENEZEN HOME HEALTH CARE	7/25/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	25910 ACERO	STE 110	MISSION VIEJO	CA	92691	7938	30	06059	33.61712389	-117.6780482	Orange County
208901	Fee-for-Service	1588282792	1588282792	1	1	GRIPPO, AMANDA	5/21/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
208904	Fee-for-Service	1447587126	1447587126	1	1	GREATER LONG BEACH VASCULAR	3/16/2010	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	ACCESS A MEDICAL CORP	16506 LAKEWOOD BLVD	STE 200	BELLFLOWER	CA	90706	5123	19	06037	33.88470916	-118.1424401	Los Angeles County
208912	Fee-for-Service	1710065396	1710065396	1	1	GORI, PAULETTE M MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95579	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
208947	Fee-for-Service	1871965178	1871965178	1	1	GANNON, ALYSSA LMFT	5/1/2024	101Y00000X	NA	Other	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
208963	Fee-for-Service	1306974126	1306974126	1	1	GRAHAM, REGINA R	8/31/2010	2084P0804X	NA	Psychiatry	026	PHYSICIANS	92709	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
208983	Fee-for-Service	1841556701	1841556701	1	1	GEORGIA PATIKOGLOU MD	6/15/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
209009	Fee-for-Service	1659305969	1659305969	1	1	GREATER HEALTH MEDICAL S	2/14/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2204 TORRANCE BLVD	STE 101B	TORRANCE	CA	90501	0501	19	06037	33.83638629	-118.3217142	Los Angeles County
209032	Fee-for-Service	1609422252	1609422252	1	1	GK HOSPICE CARE INC	7/27/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6440 BELLINGHAM AVE	UNIT 1	NORTH HOLLYWOOD	CA	91606	1402	19	06037	34.187742	-118.398713	Los Angeles County
209094	Fee-for-Service	1215711585	1215711585	1	1	GREENBERG, BENJAMIN D PSYD	9/18/2023	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
209103	Fee-for-Service	1942893755	1942893755	1	1	GICHOMO, GLADYS	3/16/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3171 HIGHGATE TER LP	None	FOLSOM	CA	95630	7053	34	06067	38.635641	-121.0935285	Sacramento County
209134	Fee-for-Service	1013572387	1013572387	1	1	GULATI, VIVEK MD	7/3/2023	207L00000X	NA	Other	026	PHYSICIANS	179226	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
209142	Fee-for-Service	1629344825	1629344825	1	1	GLICK, WESLEY A MD	3/26/2020	207L00000X	NA	Other	026	PHYSICIANS	166883	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
209230	Fee-for-Service	1770015505	1770015505	1	1	GUTIERREZ, RICARDO D MD	4/28/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160483	None	None	0	In state provider	None	15141 WHITTIER BLVD	STE 350	WHITTIER	CA	90603	2169	19	06037	33.94810044	-118.0039419	Los Angeles County
209301	Fee-for-Service	1912915448	1912915448	1	1	GEM COUNTY AMBULANCE	3/24/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	415 E MAIN ST	RM 202	EMMETT	ID	83617	0000	00	None	43.87560688	-116.4949796	Gem County
209320	Fee-for-Service	1609422252	1609422252	1	1	GK HOSPICE CARE INC	7/27/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6440 BELLINGHAM AVE	UNIT 1	NORTH HOLLYWOOD	CA	91606	1402	19	06037	34.187742	-118.398713	Los Angeles County
209328	Fee-for-Service	1770256885	1770256885	1	1	GAUSMAN, CASSIDY L OT	8/2/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1225 EUREKA WAY	SUITE B	REDDING	CA	96001	0815	45	06089	40.58819524	-122.3900343	Shasta County
209341	Fee-for-Service	1508291022	1508291022	1	1	GLEN PARK AT MONROVIA	9/6/2013	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	110 N MOUNTAIN AVE	None	MONROVIA	CA	91016	2435	19	06037	34.15184963	-117.9863406	Los Angeles County
209392	Fee-for-Service	1942893755	1942893755	1	1	GICHOMO, GLADYS	3/16/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3171 HIGHGATE TER LP	None	FOLSOM	CA	95630	7053	34	06067	38.635641	-121.0935285	Sacramento County
209416	Fee-for-Service	1902865355	1902865355	1	1	GOOD SAMARITAN HOSPITAL	5/24/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	1000 MONTAUK HWY	None	WEST ISLIP	NY	11795	4927	00	None	40.694094	-73.2944655	Suffolk County
209463	Fee-for-Service	1679560502	1679560502	1	1	GOLD CROSS SEVICES INC	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	2	Out of state provider	GOLD CROSS AMBULANCE	1717 S REDWOOD RD	None	SALT LAKE CTY	UT	84104	5110	00	None	40.732749	-111.9390125	Salt Lake County
209482	Fee-for-Service	1164004107	1164004107	1	1	GLENDALE CARE HOME HEALTH	4/19/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	SUITE 304C	GLENDALE	CA	91205	4099	19	06037	34.14633765	-118.2529554	Los Angeles County
209484	Fee-for-Service	1326355546	1326355546	1	1	GARCIA, IRAN O PHD	8/8/2022	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
209534	Fee-for-Service	1447578604	1447578604	1	1	GOLDSTEIN, ELLEN H MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	125501	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
209543	Fee-for-Service	1447577507	1447577507	1	1	GOEL, RITU MD	9/9/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	119405	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
209544	Fee-for-Service	1811488265	1811488265	1	1	GARFIELD BEACH CVS LLC	11/15/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2121 W BASELINE RD	None	UPLAND	CA	91784	1738	36	06071	34.12173161	-117.6903839	San Bernardino County
209548	Fee-for-Service	1598778136	1598778136	2	1	GRAMYK, KENNETH J MD	11/14/2022	207P00000X	NA	Other	026	PHYSICIANS	61368	None	None	0	In state provider	None	3967 E THOUSAND OAKS BLV	None	THOUSAND OAKS	CA	91362	3628	56	06111	34.16162541	-118.823888	Ventura County
209582	Fee-for-Service	1205033990	1205033990	1	1	GREENFELD, ANDREA H MD	1/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130800	40	Pediatrics	0	In state provider	None	2182 HWY 4	STE A-100	ARNOLD	CA	95223	9908	05	06009	38.23858651	-120.3630901	Calaveras County
209590	Fee-for-Service	1124625652	1124625652	1	1	G AND P HOSPICE INC	12/16/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	350 10TH AVE	SUITE 1000	SAN DIEGO	CA	92101	8706	37	06073	32.708898	-117.1555415	San Diego County
209608	Fee-for-Service	1295827830	1295827830	1	1	GROSSMONT SURGICAL ASSO	1/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	5565 GROSSMONT CENTER DR	# 1-221	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
209613	Fee-for-Service	1669415105	1669415105	1	1	GOMEZ, RUBEN O MD	6/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80959	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
209621	Fee-for-Service	1710641550	1710641550	1	1	GREG WARNER MD INCORPORATED	7/26/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	None	None	0	In state provider	None	1303 HERNDON	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
209663	Fee-for-Service	1659342624	1659342624	1	1	GRASSI, FRANK T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52598	29	Pulmonary Diseases (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
209669	Fee-for-Service	1134621741	1134621741	1	1	GIANG, NHAT LCSW	3/3/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
209703	Fee-for-Service	1902865355	1902865355	1	1	GOOD SAMARITAN HOSPITAL	6/1/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MEDICAL CENTER	1000 MONTAUK HWY	None	WEST ISLIP	NY	11795	4927	00	None	40.694094	-73.2944655	Suffolk County
209736	Fee-for-Service	1790110831	1790110831	1	1	GALUSTANIAN, GAYANE MD	2/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126937	41	Internal Medicine	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
209751	Fee-for-Service	1821173063	1821173063	1	1	GOMEZ, JULIETA C	9/10/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	145 N SIERRA MADRE BLVD	STE 8	PASADENA	CA	91107	3379	19	06037	34.14869475	-118.1011646	Los Angeles County
209753	Fee-for-Service	1639243769	1639243769	1	1	GAMBOA, JOSE C MD INC	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45291	26	Psychiatry (child)	0	In state provider	None	1020 S ANAHEIM BLVD	STE 214	ANAHEIM	CA	92805	5808	30	06059	33.82002206	-117.9087091	Orange County
209758	Fee-for-Service	1710085204	1710085204	1	1	GARFIELD BEACH CVS LLC	12/14/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5030 LONG BEACH BLVD	None	LONG BEACH	CA	90805	6317	19	06037	33.84747331	-118.1940922	Los Angeles County
209803	Fee-for-Service	1316575624	1316575624	1	1	GUIDABEN, DANIELLE MD	3/4/2024	208M00000X	NA	Other	026	PHYSICIANS	187410	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
209810	Fee-for-Service	1861569782	1861569782	1	1	GROSS, ABBY E MD	6/26/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66097	84	Surgery-Head and Neck	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
209812	Fee-for-Service	1861609919	1861609919	2	1	GARFIELD BEACH CVS LLC	3/21/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2300 PARK AVE	None	TUSTIN	CA	92782	2702	30	06059	33.70008479	-117.8286769	Orange County
209862	Fee-for-Service	1477904571	1477904571	1	1	GB EASTERN MEDICINE CLINIC,	11/7/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INC	4010 BARRANCA PKWY	SUITE 205	IRVINE	CA	92604	1721	30	06059	33.68346716	-117.8075649	Orange County
209866	Fee-for-Service	1588823686	1588823686	1	1	GHODSI, PARI M MD	7/13/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	137151	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
209871	Fee-for-Service	1205033990	1205033990	1	1	GREENFELD, ANDREA H MD	1/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130800	41	Internal Medicine	0	In state provider	None	2182 HWY 4	STE A-100	ARNOLD	CA	95223	9908	05	06009	38.23858651	-120.3630901	Calaveras County
209872	Fee-for-Service	1114992146	1114992146	1	1	GROSJEAN, BERNADETTE M	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84221	36	Psychiatry	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
209878	Fee-for-Service	1124625652	1124625652	1	1	G AND P HOSPICE INC	12/16/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	350 10TH AVE	SUITE 1000	SAN DIEGO	CA	92101	8706	37	06073	32.708898	-117.1555415	San Diego County
209918	Fee-for-Service	1881677268	1881677268	1	1	GERSHWIN, MERRILL E MD	8/18/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	28104	41	Internal Medicine	0	In state provider	UCD PROF SVCS GRP	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
209938	Fee-for-Service	1639307267	1639307267	1	1	GARNER, RENEE C	3/10/2011	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
209953	Fee-for-Service	1801440136	1801440136	1	1	GONZALEZ, FRANCES R	6/16/2022	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
209955	Fee-for-Service	1942220330	1942220330	1	1	GLAVINOVICH, JOHN L MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	31910	01	General Practice	0	In state provider	None	9542 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87472553	-118.1294775	Los Angeles County
209963	Fee-for-Service	1295056596	1295056596	1	1	GAO, LIANYING MD	10/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112722	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
209975	Fee-for-Service	1497704761	1497704761	2	1	GARCIA, SYLVIA L MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	70849	08	Family Practice	0	In state provider	None	14442 WHITTIER BLVD	STE 105	WHITTIER	CA	90605	2162	19	06037	33.95385901	-118.0164461	Los Angeles County
210020	Fee-for-Service	1346701455	1346701455	1	1	GOMEZ RUEDA, HUGO	5/25/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	176601	36	Psychiatry	0	In state provider	None	999 N. TUSTIN AVE	UNIT # 216	SANTA ANA	CA	92705	3528	30	06059	33.754167	-117.834191	Orange County
210043	Fee-for-Service	1982155198	1982155198	1	1	GOLDMAN, JAKE E 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
210044	Fee-for-Service	1639243769	1639243769	1	1	GAMBOA, JOSE C MD INC	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45291	36	Psychiatry	0	In state provider	None	1020 S ANAHEIM BLVD	STE 214	ANAHEIM	CA	92805	5808	30	06059	33.82002206	-117.9087091	Orange County
210082	Fee-for-Service	1326450610	1326450610	1	1	GOROUHI, FARZAM MD	12/8/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	144137	07	Dermatology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
210093	Fee-for-Service	1477039667	1477039667	1	1	GRUBSTAD, FREDERICK NP	3/30/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95019498	-	NOT APPLICABLE	0	In state provider	None	1777 BUCKMAN SPRINGS RD	None	CAMPO	CA	91906	2022	37	06073	32.64997421	-116.4873596	San Diego County
210099	Fee-for-Service	1861569782	1861569782	1	1	GROSS, ABBY E MD	6/26/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66097	04	Otology, Laryngology, Rhinology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
210114	Fee-for-Service	1033825245	1033825245	1	1	GAMUEDA, MAY ANNE OT	4/7/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
210120	Fee-for-Service	1427014166	1427014166	1	1	GONZALES, MARIO J OD	10/3/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
210121	Fee-for-Service	1679891790	1679891790	1	1	GOLDMAN MOSQUEDA, ANNETTE R	4/2/2012	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
210172	Fee-for-Service	1639191232	1639191232	2	1	GARFIELD BEACH CVS LLC	3/21/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2059 CADENASSO DR	None	FAIRFIELD	CA	94533	6806	48	06095	38.24773169	-122.067823	Solano County
210191	Fee-for-Service	1982875464	1982875464	1	1	GUPTA, BRIJ MD INC	5/20/2008	207R00000X	NA	Other	026	PHYSICIANS	52283	41	Internal Medicine	0	In state provider	None	10158 BUENA VISTA AVE	None	SANTEE	CA	92071	9998	37	06073	32.83494162	-116.9760477	San Diego County
210242	Fee-for-Service	1942220330	1942220330	1	1	GLAVINOVICH, JOHN L MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	31910	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9542 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87472553	-118.1294775	Los Angeles County
210248	Fee-for-Service	1033322771	1033322771	1	1	GOLDEN VALLEY HEALTH CTR	11/18/2005	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1121 HAMMOND ST	None	MODESTO	CA	95351	3509	50	06099	37.614366	-121.0186465	Stanislaus County
210279	Fee-for-Service	1619928835	1619928835	1	1	GAVINI, FRANK MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	44523	41	Internal Medicine	0	In state provider	None	440 GREENFIELD AVE	STE E	HANFORD	CA	93230	3568	16	06031	36.32904	-119.6582155	Kings County
210333	Fee-for-Service	1932494929	1932494929	1	1	GREEN, JOSHUA D DO	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14056	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
210387	Fee-for-Service	1154461010	1154461010	1	1	GUPTA, KAJAL MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	92637	41	Internal Medicine	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
210395	Fee-for-Service	1508183211	1508183211	1	1	GUPTA, VIVEK C MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118825	41	Internal Medicine	0	In state provider	None	341 E MAIN STREET	None	SAN JACINTO	CA	92583	4206	33	06065	33.78391437	-116.9562698	Riverside County
210411	Fee-for-Service	1184708257	1184708257	1	1	GALSTER, ALLEN D MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36691	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
210427	Fee-for-Service	1972516581	1972516581	1	1	GROSSMAN, PAUL D MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72288	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
210429	Fee-for-Service	1134147762	1134147762	1	1	GARZA, CRISOFORO G MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	33587	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	BRENTWOOD FERTILITY MED	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
210440	Fee-for-Service	1659528602	1659528602	1	1	GABRIELIAN, ANNA MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124559	18	Ophthalmology	0	In state provider	None	409 N CENTRAL AVE	None	GLENDALE	CA	91203	2001	19	06037	34.15248444	-118.2579448	Los Angeles County
210470	Fee-for-Service	1902845050	1902845050	1	1	GOLDBERG, MICHAEL T MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90544	05	Anesthesiology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
210473	Fee-for-Service	1093064420	1093064420	1	1	GOLSHANI, AZADEH PSYD	4/25/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3415 S SEPULVEDA BLVD	STE 1100	LOS ANGELES	CA	90034	7090	19	06037	34.02086527	-118.4235306	Los Angeles County
210479	Fee-for-Service	1982875464	1982875464	1	1	GUPTA, BRIJ MD INC	5/20/2008	207R00000X	NA	Other	026	PHYSICIANS	52283	08	Family Practice	0	In state provider	None	10158 BUENA VISTA AVE	None	SANTEE	CA	92071	9998	37	06073	32.83494162	-116.9760477	San Diego County
210481	Fee-for-Service	1477824399	1477824399	1	1	GIEDRE KARAKALPAKIS MD	6/3/2020	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
210491	Fee-for-Service	1659040947	1659040947	1	1	GUTIERREZ, DAISY PT	10/20/2021	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
210494	Fee-for-Service	1669540423	1669540423	1	1	GHANEM, GHAZI 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	5810 E 2ND ST	STE 100	CASPER	WY	82609	4330	00	None	42.844419	-106.2386955	Natrona County
210504	Fee-for-Service	1316150576	1316150576	1	1	GOLDEN VALLEY HEALTH CTR	3/1/1997	207Q00000X	NA	Adult Primary Care	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	WOMEN'S HEALTH	797 W CHILDS AVE	None	MERCED	CA	95340	6805	24	06047	37.2882498	-120.4963024	Merced County
210552	Fee-for-Service	1063719557	1063719557	1	1	GRIER, DIAN E	3/12/2025	No Taxonomy Provided	NA	None	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
210557	Fee-for-Service	1265666473	1265666473	1	1	GRAUMAN, BENITA LCSW	12/30/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22608 GAULT ST,	None	WEST HILLS	CA	91307	2391	19	06037	34.19968866	-118.6192529	Los Angeles County
210565	Fee-for-Service	1619928835	1619928835	1	1	GAVINI, FRANK MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	44523	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	440 GREENFIELD AVE	STE E	HANFORD	CA	93230	3568	16	06031	36.32904	-119.6582155	Kings County
210577	Fee-for-Service	1285942615	1285942615	1	1	GARCIA, MARU LMFT	12/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2820 SOUTH VERMONT AVENU	16	LOS ANGELES	CA	90007	2291	19	06037	34.028991	-118.291524	Los Angeles County
210627	Fee-for-Service	1568137008	1568137008	1	1	GALEN INPATIENT PHYSICIANS,	12/22/2021	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
210642	Fee-for-Service	1619904109	1619904109	1	1	GRUPP-PHELAN, JACQUELINE M	8/28/2017	2080P0204X	NA	Other	026	PHYSICIANS	149165	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
210655	Fee-for-Service	1235498353	1235498353	1	1	GUSTAVSON-DUFOUR, JENNIFER A	1/31/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	98554	-	NOT APPLICABLE	0	In state provider	LMFT	2000 TRAFFIC WAY	None	ATASCADERO	CA	93422	1523	40	06079	35.52072235	-120.6898156	San Luis Obispo County
210726	Fee-for-Service	1770053233	1770053233	1	1	GUZMAN, SAMUEL J MD	7/30/2021	207ZN0500X	NA	Other	026	PHYSICIANS	148237	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
210733	Fee-for-Service	1346723111	1346723111	1	1	GARBACCIO, GINA LCSW	7/25/2024	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
210760	Fee-for-Service	1366574386	1366574386	1	1	GARVASI, ERIN M LMFT	11/10/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41313	-	NOT APPLICABLE	0	In state provider	None	2101 MAGNOLIA AVE	None	LONG BEACH	CA	90806	4521	19	06037	33.79557701	-118.1981495	Los Angeles County
210775	Fee-for-Service	1306167291	1306167291	1	1	GUNTUR, PAVANI S MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123204	13	Neurology (M.D. only)	0	In state provider	None	8635 W 3RD ST	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
210780	Fee-for-Service	1235372855	1235372855	1	1	GALANINA, NATALIE MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121363	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
210811	Fee-for-Service	1811075302	1811075302	1	1	GIRARD, ROBYN H MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80686	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
210858	Fee-for-Service	1336291558	1336291558	1	1	GYORFFY, EDWIN J MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50097	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
210877	Fee-for-Service	1134160047	1134160047	1	1	GARFIELD BEACH CVS, LLC	10/3/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8601 S. SEPULVEDA BLVD.	None	LOS ANGELES	CA	90045	4001	19	06037	33.959574	-118.396256	Los Angeles County
210886	Fee-for-Service	1740305986	1740305986	1	1	GUPTA, ASHWINI LMFT	11/26/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41690	-	NOT APPLICABLE	0	In state provider	None	2202 N FIRST ST	STE 2210	SAN JOSE	CA	95131	2007	43	06085	37.37749791	-121.921213	Santa Clara County
210915	Fee-for-Service	1568137008	1568137008	1	1	GALEN INPATIENT PHYSICIANS,	10/11/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	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
210918	Fee-for-Service	1023653011	1023653011	1	1	GUARDIAN ANGEL HOME CARE OF	4/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SAN JOSE LLC	1885 THE ALAMEDA	STE 208	SAN JOSE	CA	95126	1744	43	06085	37.34036183	-121.9227298	Santa Clara County
210922	Fee-for-Service	1013322122	1013322122	1	1	GLESS, JEFFREY M OD	7/4/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
210929	Fee-for-Service	1104814706	1104814706	1	1	GREENWALD, MICHAEL D PHD	3/31/1992	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2730 WILSHIRE BLVD	STE 650	SANTA MONICA	CA	90403	4746	19	06037	34.037223	-118.4759177	Los Angeles County
210981	Fee-for-Service	1336606870	1336606870	1	1	GARCIA, ANTHONY LMFT	3/6/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	650 ALAMO PINTADO RD	STE 103	SOLVANG	CA	93463	2266	42	06083	34.600536	-120.128554	Santa Barbara County
211023	Fee-for-Service	1609973965	1609973965	1	1	GAUER, TERRILYN H DO	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	6705	08	Family Practice	0	In state provider	None	824 E CARSON ST	STE 104	CARSON	CA	90745	2262	19	06037	33.83159904	-118.2605506	Los Angeles County
211054	Fee-for-Service	1932739349	1932739349	1	1	GONZALEZ, JUANA LCSW	6/9/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
211057	Fee-for-Service	1487785101	1487785101	1	1	GARDEN, VALERIE S MD	8/31/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52403	18	Ophthalmology	0	In state provider	None	1140 SONOMA AVE	BLDG 2A	SANTA ROSA	CA	95405	4817	49	06097	38.440458	-122.699502	Sonoma County
211068	Fee-for-Service	1235372855	1235372855	1	1	GALANINA, NATALIE MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121363	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
211079	Fee-for-Service	1265510754	1265510754	1	1	GOUROVA, LINA S MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95056	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
211140	Fee-for-Service	1346343225	1346343225	1	1	GONZALES, FERNANDO Q MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	38225	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7872 WALKER ST	None	LA PALMA	CA	90623	1796	30	06059	33.84787056	-118.0372511	Orange County
211192	Fee-for-Service	1821285073	1821285073	1	1	GLENDORA CA ENDOSCOPY ASC LP	7/15/2019	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1794 SOUTH BARRANCA AVE	None	GLENDORA	CA	91740	5421	19	06037	34.10697901	-117.8814671	Los Angeles County
211238	Fee-for-Service	1790002517	1790002517	1	1	GINN, DANIEL N DO	9/27/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	19105	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
211247	Fee-for-Service	1598080442	1598080442	1	1	GIN, AMY L MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	108101	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
211267	Fee-for-Service	1235299850	1235299850	1	1	GUARNACCIA, STEVEN P MD	4/1/2021	208800000X	NA	Other	026	PHYSICIANS	170917	None	None	0	In state provider	None	2900 WHIPPLE	STE 132	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
211278	Fee-for-Service	1972565703	1972565703	1	1	GELPHMAN, KAREN K MD	6/21/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	78072	08	Family Practice	0	In state provider	None	2641 KNOB HILL DR	None	SANTA ROSA	CA	95404	1814	49	06097	38.471553	-122.6927205	Sonoma County
211289	Fee-for-Service	1497893499	1497893499	1	1	GAHIR, JOGA S MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86891	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
211292	Fee-for-Service	1629538418	1629538418	1	1	GHAFOOR, NAILA MD	8/16/2023	207P00000X	NA	Other	026	PHYSICIANS	184777	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
211301	Fee-for-Service	1386611234	1386611234	1	1	GUNNELL, JENNIFER MD	4/1/1999	2086S0122X	NA	General Surgery	026	PHYSICIANS	78785	41	Internal Medicine	0	In state provider	None	3230 BEARD RD	None	NAPA	CA	94558	3673	28	06055	38.3216968	-122.2953847	Napa County
211319	Fee-for-Service	1780624700	1780624700	1	1	GRUNBAUM, LAURA MD	9/1/1996	193400000X	NA	Other	026	PHYSICIANS	80985	40	Pediatrics	0	In state provider	None	27303 SLEEPY HOLLOW S	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
211356	Fee-for-Service	1376033860	1376033860	1	1	GRAZIANO, LISA A LMFT	7/24/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	514 N. PROSPECT AVENUE	SUITE 111 LOWER LEVEL	REDONDO BEACH	CA	90277	3037	19	06037	33.85253987	-118.3796668	Los Angeles County
211398	Fee-for-Service	1952418956	1952418956	1	1	GLENN M. GARCIA, 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
211422	Fee-for-Service	1073921300	1073921300	1	1	GARIBAY, JULIO LCSW	4/10/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9260 ALCOSTA BLVD	BUILDING A, SUITE A5	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
211433	Fee-for-Service	1346343225	1346343225	1	1	GONZALES, FERNANDO Q MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	38225	01	General Practice	0	In state provider	None	7872 WALKER ST	None	LA PALMA	CA	90623	1796	30	06059	33.84787056	-118.0372511	Orange County
211484	Fee-for-Service	1861090417	1861090417	1	1	GUTIERREZ, NAMELE LMFT	10/19/2020	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
211535	Fee-for-Service	1831496058	1831496058	1	1	GONZALEZ, TERESA NP	5/1/2023	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
211573	Fee-for-Service	1891770392	1891770392	1	1	GILL, RAMINDER S MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65970	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
211607	Fee-for-Service	1730386350	1730386350	1	2	GENTLE CARE HOME HEALTH	7/16/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	23133 VENTURA BLVD	STE 201	WOODLAND HILLS	CA	91364	1185	19	06037	34.16321064	-118.629875	Los Angeles County
211650	Fee-for-Service	1295814408	1295814408	1	1	GARRISON, RIC S MD	12/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	50780	08	Family Practice	0	In state provider	None	41210 11TH ST W	STE C	PALMDALE	CA	93551	1447	19	06037	34.631649	-118.150154	Los Angeles County
211654	Fee-for-Service	1083021752	1083021752	1	1	GIRN, VIKRAM S OD	11/10/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	36 W YOKUTS AVE	None	STOCKTON	CA	95207	5713	39	06077	37.99833959	-121.3074229	San Joaquin County
211746	Fee-for-Service	1700954070	1700954070	1	1	GRAY, RANDY CRNA	2/8/2015	207L00000X	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
211790	Fee-for-Service	1003906686	1003906686	1	1	GLASHEEN, JEFFREY J MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
211794	Fee-for-Service	1205317427	1205317427	1	1	GARCIA, JOE A NP	10/16/2018	363LP0808X	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
211816	Fee-for-Service	1598703654	1598703654	1	1	GLUCKSTEIN, DANIEL P MD	8/9/1993	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	56964	77	Infectious Disease	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 104	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
211822	Fee-for-Service	1336138403	1336138403	1	1	GLENDALE ADVENTIST MED	1/1/1995	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
211869	Fee-for-Service	1346077591	1346077591	1	1	GOODMAN, KEECI CRNA	11/22/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
211890	Fee-for-Service	1922026533	1922026533	1	1	GRANT, RUSSELL J MD	10/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	64150	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
211899	Fee-for-Service	1295301646	1295301646	1	1	GUPTA, NIKHIL MD	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
211914	Fee-for-Service	1851505127	1851505127	1	1	GOLDEN VALLEY HLTH CTR	8/15/1996	207V00000X	NA	Obstetrics & Gynecology	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
211924	Fee-for-Service	1972910016	1972910016	1	1	GILL, SANDEEP MD	12/21/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	145698	None	None	0	In state provider	None	1809 W. REDLANDS BLVD	# 234	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
211936	Fee-for-Service	1265476162	1265476162	1	1	GUERRERO, ANNETTE M MD	7/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64097	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
211968	Fee-for-Service	1932328911	1932328911	1	1	GROSS, THOMAS F PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1200 E COLTON AVE	None	REDLANDS	CA	92374	3755	36	06071	34.06278253	-117.163548	San Bernardino County
211975	Fee-for-Service	1356386254	1356386254	1	1	GARFIELD BEACH CVS LLC	3/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9840 SIERRA AVE	None	FONTANA	CA	92335	6719	36	06071	34.07509303	-117.4357116	San Bernardino County
211987	Fee-for-Service	1780795930	1780795930	1	1	GRUENEFELDT, ALAN V MD	4/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	69052	08	Family Practice	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
212021	Fee-for-Service	1457404840	1457404840	1	1	GAMINCHI, FARNAZ MD	12/10/2018	207ND0101X	NA	Dermatology	026	PHYSICIANS	55703	07	Dermatology	0	In state provider	None	7320 WOODLAKE AVE.	SUITE 340	WEST HILLS	CA	91307	7320	19	06037	34.20245266	-118.6321273	Los Angeles County
212048	Fee-for-Service	1669708830	1669708830	1	1	GONZALES, COURTNEY A MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115848	10	Gastroenterology (M.D. only)	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
212090	Fee-for-Service	1528402260	1528402260	1	1	GANTA, JYOTSNA S N D MD	7/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141067	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
212128	Fee-for-Service	1770505554	1770505554	2	1	GARFIELD BEACH CVS LLC	3/23/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 SHOWERS DR	None	MOUNTAIN VIEW	CA	94040	4795	43	06085	37.40176001	-122.1074037	Santa Clara County
212137	Fee-for-Service	1245060920	1245060920	1	1	GREATER SAN DIEGO HEALTH - A	10/23/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LICENSED CLINICAL SOC	705 PIER VIEW WY	STE D	OCEANSIDE	CA	92054	2801	37	06073	33.19784329	-117.3784281	San Diego County
212153	Fee-for-Service	1316945280	1316945280	1	1	GONZALEZ-AMEZCUA, RAFAEL	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	81675	41	Internal Medicine	0	In state provider	None	3727 N FIRST ST	None	FRESNO	CA	93726	5628	10	06019	36.78526681	-119.7727069	Fresno County
212155	Fee-for-Service	1942550587	1942550587	1	1	GODIN, TERRA PT	5/5/2023	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
212157	Fee-for-Service	1801288550	1801288550	1	1	GERBER, KIMBERLY CRNA	11/26/2019	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
212158	Fee-for-Service	1255791224	1255791224	1	1	GILMORE, ALI M CRNA	6/18/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
212225	Fee-for-Service	1164982336	1164982336	1	1	GRAY, ERIN M MD	10/18/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	188623	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
212242	Fee-for-Service	1780053850	1780053850	1	1	GABRIEL, MARIBEL R CNP	1/29/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
212257	Fee-for-Service	1033690649	1033690649	1	1	GO, BEATRIZ JANINE E PT	9/26/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
212356	Fee-for-Service	1851802581	1851802581	1	1	GIBSON, TERESA A BIRTH DOULA	2/21/2023	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	40	06079	0	0	None
212392	Fee-for-Service	1629193966	1629193966	1	1	GUTHRIE, BRYANNE M	1/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER 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
212481	Fee-for-Service	1528371390	1528371390	1	1	GAGLIANO, DIANNA M	2/22/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12281 KNOTT ST	STE 103	GARDEN GROVE	CA	92841	3939	30	06059	33.78524517	-118.0112189	Orange County
212535	Fee-for-Service	1356570758	1356570758	1	1	GENG, BOB MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121364	08	Family Practice	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
212544	Fee-for-Service	1609992171	1609992171	1	3	GHEYSAR, KENNETH	7/24/2023	207QA0401X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	71924	-	NOT APPLICABLE	0	In state provider	None	1316 S COAST HWY	None	LAGUNA BEACH	CA	92651	3118	30	06059	33.53236667	-117.7755797	Orange County
212569	Fee-for-Service	1306882469	1306882469	1	1	GARFIELD BEACH CVS LLC	10/12/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2701 HARBOR BLVD	None	COSTA MESA	CA	92626	5153	30	06059	33.67189199	-117.9193604	Orange County
212598	Fee-for-Service	1639324627	1639324627	1	1	GREY, ANGELA M LMFT	8/5/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	94985	-	NOT APPLICABLE	0	In state provider	None	11512 B AVE	None	AUBURN	CA	95603	2605	31	06061	38.93969517	-121.1046397	Placer County
212617	Fee-for-Service	1578147849	1578147849	1	1	GARABETIAN, CHRISTINE MD	11/15/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
212635	Fee-for-Service	1639735202	1639735202	1	1	GOLDEN AGES PALLIATIVE AND	1/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE INC	44140 20TH ST W	STE 103	LANCASTER	CA	93534	4045	19	06037	34.684956	-118.1655715	Los Angeles County
212689	Fee-for-Service	1790344869	1790344869	1	3	GHODS INC.	3/21/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1086 S FAIRFAX AVE	None	LOS ANGELES	CA	90019	4401	19	06037	34.05592638	-118.3648554	Los Angeles County
212694	Fee-for-Service	1972525665	1972525665	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	39440 10TH ST W	None	PALMDALE	CA	93551	3747	19	06037	34.59978979	-118.1475792	Los Angeles County
212716	Fee-for-Service	1063446722	1063446722	1	1	GONZALEZ-SCARANO, FRANCISCO	2/10/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	159203	None	None	0	In state provider	A MD	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
212737	Fee-for-Service	1902284433	1902284433	1	1	GARCIA-JIMENEZ, MARIA D MD	7/26/2022	207R00000X	NA	Other	026	PHYSICIANS	160893	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
212740	Fee-for-Service	1235365750	1235365750	1	1	GARRETT-PRICE, AHMAD R MD	3/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123927	41	Internal Medicine	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
212742	Fee-for-Service	1952365124	1952365124	1	1	GUPTA, INDU MD	7/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73356	22	Pathology (M.D. only)	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
212771	Fee-for-Service	1871054338	1871054338	1	1	GUO, YING DO	9/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19933	None	None	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
212772	Fee-for-Service	1245330125	1245330125	1	1	GLASS, MARCIA H MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55157	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
212784	Fee-for-Service	1174586192	1174586192	1	1	GREATER LA DIALYSIS CTRS	5/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	1212 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1902	19	06037	34.05317619	-118.2653321	Los Angeles County
212789	Fee-for-Service	1497963268	1497963268	1	1	GAYER, CHRISTOPHER P MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121803	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
212844	Fee-for-Service	1841829413	1841829413	1	1	GARVEY, SARAH L MD	9/29/2023	208M00000X	NA	Other	026	PHYSICIANS	190212	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
212858	Fee-for-Service	1639484678	1639484678	1	1	GRACEFUL PALMS HOSPICE	12/30/2011	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	AND PALLIATIVE CARE CORP	38700 5TH ST W	STE G	PALMDALE	CA	93551	3996	19	06037	34.58578327	-118.1385802	Los Angeles County
212875	Fee-for-Service	1083960413	1083960413	1	1	GULSRUD, AMANDA C PHD	6/12/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	26	Psychiatry (child)	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90024	8353	19	06037	34.06633181	-118.4451729	Los Angeles County
212876	Fee-for-Service	1902122567	1902122567	1	1	GILOTRA, MUDIT M MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151890	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
212882	Fee-for-Service	1639249170	1639249170	1	1	GARMA, FELIZA N MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	44697	36	Psychiatry	0	In state provider	None	18546 ROSCOE BLVD	STE 210	NORTHRIDGE	CA	91324	5454	19	06037	34.22069869	-118.537684	Los Angeles County
212896	Fee-for-Service	1932584505	1932584505	1	1	GLEN PARK AT LONG BEACH INC	6/27/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1046 E. 4TH STREET	None	LONG BEACH	CA	90802	1634	19	06037	33.77170304	-118.1788063	Los Angeles County
212926	Fee-for-Service	1639735202	1639735202	1	1	GOLDEN AGES PALLIATIVE AND	1/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE INC	44140 20TH ST W	STE 103	LANCASTER	CA	93534	4045	19	06037	34.684956	-118.1655715	Los Angeles County
212928	Fee-for-Service	1790789170	1790789170	1	1	GHC OF LAKESIDE, LLC	2/2/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11962 WOODSIDE AVE	None	LAKESIDE	CA	92040	2914	37	06073	32.85551696	-116.9351175	San Diego County
212935	Fee-for-Service	1104199629	1104199629	1	1	GAJDA, DAVID J MD APC	6/5/2012	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	111 RALEY BLVD	#240	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
213026	Fee-for-Service	1235365750	1235365750	1	1	GARRETT-PRICE, AHMAD R MD	3/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123927	01	General Practice	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
213033	Fee-for-Service	1164484507	1164484507	1	1	GLENDRANGE, RAY R MD	7/13/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	61038	18	Ophthalmology	0	In state provider	None	4605 BROCKTON AVENUE	100	RIVERSIDE	CA	92506	0106	33	06065	33.97611422	-117.3860257	Riverside County
213038	Fee-for-Service	1184999369	1184999369	1	1	GLAESER, ALEXANDRA M MD	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128691	None	None	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
213049	Fee-for-Service	1023177698	1023177698	1	1	GREENWAY, SCOTT E MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70848	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
213099	Fee-for-Service	1831118710	1831118710	1	1	GARCIA, OLIVIA MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84219	08	Family Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
213105	Fee-for-Service	1669651881	1669651881	1	1	GUZMAN, JORGE MD	12/19/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	143437	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
213146	Fee-for-Service	1639484678	1639484678	1	1	GRACEFUL PALMS HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	AND PALLIATIVE CARE CORP	38700 5TH ST W	STE G	PALMDALE	CA	93551	3996	19	06037	34.58578327	-118.1385802	Los Angeles County
213160	Fee-for-Service	1932362001	1932362001	1	1	GIBSON, SHANTRICE L PSYD	12/2/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7901 MELROSE AVE	204	LOS ANGELES	CA	90046	7173	19	06037	34.08383059	-118.361684	Los Angeles County
213178	Fee-for-Service	1518022524	1518022524	1	1	GUTKIN, DAVID J DO	9/27/2007	207P00000X	NA	Other	026	PHYSICIANS	9571	66	Emergency Medicine (Urgent Care)	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
213192	Fee-for-Service	1992769194	1992769194	1	1	GIURGIU, DAN L MD	12/1/2000	208600000X	NA	General Surgery	026	PHYSICIANS	84536	None	None	0	In state provider	None	4060 4TH AVE	STE 440	SAN DIEGO	CA	92103	2183	37	06073	32.75053673	-117.1616539	San Diego County
213222	Fee-for-Service	1104199629	1104199629	1	1	GAJDA, DAVID J MD APC	4/1/2012	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	111 RALEY BLVD	#240	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
213228	Fee-for-Service	1861874398	1861874398	1	1	GHAUSSY, OLIVIA S NP	11/8/2018	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
213249	Fee-for-Service	1992997076	1992997076	1	1	GIANG, PHAT T MD	7/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98997	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
213255	Fee-for-Service	1336491810	1336491810	1	1	GHODSI, FRED F	11/23/2023	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
213257	Fee-for-Service	1063944635	1063944635	1	1	GRAFMILLER, KEVIN T MD	6/17/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	179136	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
213269	Fee-for-Service	1275140584	1275140584	1	1	GILL, RAJWINDER K CRNA	10/19/2020	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
213296	Fee-for-Service	1891859310	1891859310	1	1	GERO, MELANIE J MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	47870	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
213309	Fee-for-Service	1023116589	1023116589	1	1	GETTYSBURG MED CLINIC	2/28/1995	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	143 W MAIN ST	STE B	MERCED	CA	95340	4930	24	06047	37.299569	-120.4783286	Merced County
213314	Fee-for-Service	1427342104	1427342104	1	1	GARFIELD BEACH CVS, LLC	11/2/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16461 VENTURA BOULEVARD	None	ENCINO	CA	91436	4368	19	06037	34.15753759	-118.4920221	Los Angeles County
213317	Fee-for-Service	1235365750	1235365750	1	1	GARRETT-PRICE, AHMAD R MD	3/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123927	08	Family Practice	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
213324	Fee-for-Service	1912325721	1912325721	1	1	GOLDMAN, KEVIN S MD	7/1/2017	207P00000X	NA	Other	026	PHYSICIANS	147148	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
213336	Fee-for-Service	1558383166	1558383166	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2755 CANYON SPRINGS PKWY	None	RIVERSIDE	CA	92507	0932	33	06065	33.938604	-117.282465	Riverside County
213358	Fee-for-Service	1982604021	1982604021	1	1	GEORGETOWN MEMORIAL HOSP	1/4/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	606 BLACK RIVER RD	None	GEORGETOWN	SC	29440	3304	00	None	33.37939873	-79.28544723	Georgetown County
213371	Fee-for-Service	1952549156	1952549156	1	1	GAMARRA, ALDO T MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126754	02	General Surgery	0	In state provider	None	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
213372	Fee-for-Service	1063540052	1063540052	1	1	GRAVES, DONALD W MD	7/1/2000	207L00000X	NA	Other	026	PHYSICIANS	63024	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
213412	Fee-for-Service	1407871973	1407871973	1	1	GAUCHER, DONALD J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90303	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
213413	Fee-for-Service	1447236120	1447236120	1	1	GALASKY, STEVEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
213459	Fee-for-Service	1902870892	1902870892	1	1	GATES, GREGORY DO	3/26/2019	207ZP0102X	NA	Other	026	PHYSICIANS	9298	21	Pathologic Anatomy: Clinical Pathology (D.O. 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
213468	Fee-for-Service	1104159441	1104159441	1	1	GOLDSTEIN, TAMARA LMFT	1/9/2020	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
213469	Fee-for-Service	1174579452	1174579452	1	1	GILLINGHAM, FRANK T MD	10/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37503	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23440 CIVIC CENTER WAY	STE 102	MALIBU	CA	90265	5901	19	06037	34.03668879	-118.6868819	Los Angeles County
213587	Fee-for-Service	1265922637	1265922637	1	1	GARCIA, JORGE MD	8/9/2023	207P00000X	NA	Other	026	PHYSICIANS	186561	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
213604	Fee-for-Service	1174644835	1174644835	1	1	GUANZON MED OFFICE INC	12/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2395 MONTPELIER DR	STE 4	SAN JOSE	CA	95116	1619	43	06085	37.36538903	-121.8473325	Santa Clara County
213645	Fee-for-Service	1982604021	1982604021	1	1	GEORGETOWN MEMORIAL HOSP	1/4/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	606 BLACK RIVER RD	None	GEORGETOWN	SC	29440	3304	00	None	33.37939873	-79.28544723	Georgetown County
213672	Fee-for-Service	1750041042	1750041042	1	1	GHANADIAN, MATTHEW J PT	7/5/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
213675	Fee-for-Service	1700997053	1700997053	1	1	GRATTENDICK, DAVID W MD	12/21/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53186	40	Pediatrics	0	In state provider	None	8680 GREENBACK LN	None	ORANGEVALE	CA	95662	3969	34	06067	38.677617	-121.236228	Sacramento County
213682	Fee-for-Service	1316273220	1316273220	1	1	GITUMA, KARIMI J MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112888	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
213703	Fee-for-Service	1629090238	1629090238	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16964 SLOVER AVE	None	FONTANA	CA	92337	7556	36	06071	34.065468	-117.43434	San Bernardino County
213714	Fee-for-Service	1437757259	1437757259	1	1	GLG WEST LLC	10/7/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	TER	9345 BOLSA AVE	None	WESTMINSTER	CA	92683	5928	30	06059	33.7449993	-117.9658293	Orange County
213739	Fee-for-Service	1578909636	1578909636	1	1	GREENSTEIN, ROBIN R DO	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15630	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
213751	Fee-for-Service	1922547074	1922547074	1	1	GEHAAN PLASTIC SURGERY INC	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	111406	24	Plastic Surgery	0	In state provider	None	3144 EL CAMINO REAL	STE 200	CARLSBAD	CA	92009	2194	37	06073	33.17287617	-117.323264	San Diego County
213760	Fee-for-Service	1174579452	1174579452	1	1	GILLINGHAM, FRANK T MD	10/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37503	41	Internal Medicine	0	In state provider	None	23440 CIVIC CENTER WAY	STE 102	MALIBU	CA	90265	5901	19	06037	34.03668879	-118.6868819	Los Angeles County
213766	Fee-for-Service	1538182407	1538182407	1	1	GUPTA, ANIL MD	1/11/2007	207R00000X	NA	Other	026	PHYSICIANS	46009	None	None	0	In state provider	None	409 E MERCED AVE	STE B	WEST COVINA	CA	91790	5061	19	06037	34.05501985	-117.9380648	Los Angeles County
213780	Fee-for-Service	1073635462	1073635462	1	1	GUPTA, AMIT MD	11/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131246	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
213784	Fee-for-Service	1861434060	1861434060	1	1	GARFIELD BEACH CVS LLC	3/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4105 W AVENUE L	None	LANCASTER	CA	93536	4212	19	06037	34.66026619	-118.203814	Los Angeles County
213788	Fee-for-Service	1679733620	1679733620	1	2	GHAFOURIAN, KAMBIZ MD	9/10/2024	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	128170	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8670 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	2930	19	06037	34.06629779	-118.3807407	Los Angeles County
213791	Fee-for-Service	1114053279	1114053279	2	2	GAGE MEDICAL CLINIC INC	6/5/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	13563 VAN NUYS BLVD	None	PACOIMA	CA	91331	3029	19	06037	34.26130021	-118.4287303	Los Angeles County
213850	Fee-for-Service	1649941022	1649941022	1	1	GAGE, MEGAN LPCC	10/25/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
213897	Fee-for-Service	1982925046	1982925046	1	1	GONZALEZ, SOPHIA A LMFT	11/25/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	36997	-	NOT APPLICABLE	0	In state provider	None	1207 E FRUIT ST	None	SANTA ANA	CA	92701	4206	30	06059	33.75238847	-117.8539245	Orange County
213934	Fee-for-Service	1487747051	1487747051	1	1	GILLEN, JANET A LCSW	9/28/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1475 HUNTINGTON AVENUE	SUITE 218	SOUTH SAN FRANCIS	CA	94080	5967	41	06081	37.64239261	-122.4202978	San Mateo County
213977	Fee-for-Service	1669049391	1669049391	1	1	GODUGU, RASHMI MD	9/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1131 W. 6TH ST	STE 150	ONTARIO	CA	91762	1116	36	06071	34.084404	-117.6717015	San Bernardino County
213996	Fee-for-Service	1821033713	1821033713	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14735 VENTURA BLVD	None	SHERMAN OAKS	CA	91403	3679	19	06037	34.15187275	-118.4543653	Los Angeles County
214046	Fee-for-Service	1124361019	1124361019	1	1	GENDY, AMIR S MD	12/9/2021	2086S0102X	NA	General Surgery	026	PHYSICIANS	158937	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
214078	Fee-for-Service	1114053279	1114053279	2	2	GAGE MEDICAL CLINIC INC	6/5/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	13563 VAN NUYS BLVD	None	PACOIMA	CA	91331	3029	19	06037	34.26130021	-118.4287303	Los Angeles County
214139	Fee-for-Service	1487283305	1487283305	1	1	GARCIA PORTALATIN, FRANCHESK	8/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183704	None	None	0	In state provider	A A MD	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
214142	Fee-for-Service	1972740413	1972740413	1	1	GOMEZ, PATRICIA E LCSW	9/24/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2335 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7319	07	06013	37.97021462	-121.7841321	Contra Costa County
214147	Fee-for-Service	1043897515	1043897515	1	1	GALLEY, CHRISTOPHER J MD	11/1/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
214161	Fee-for-Service	1003117391	1003117391	1	1	GONZALEZ, KRYSTELINA LMFT	11/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18077 HWY 18	STE 306	APPLE VALLEY	CA	92307	8645	36	06071	34.54021616	-117.2696677	San Bernardino County
214191	Fee-for-Service	1205009115	1205009115	1	1	GELFAND, JEFFREY M MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103287	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
214196	Fee-for-Service	1720305147	1720305147	1	1	GLYNN, PATRICK T MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
214210	Fee-for-Service	1386740447	1386740447	1	1	GOODMAN, JOEL D OD APC	9/15/1974	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1713 W ARTESIA BLVD	None	GARDENA	CA	90248	3220	19	06037	33.8730063	-118.3076296	Los Angeles County
214213	Fee-for-Service	1932475175	1932475175	1	1	GEORGE ISSA	5/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
214218	Fee-for-Service	1427026517	1427026517	1	1	GOSKOWICZ, RANDALL L MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	71015	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
214224	Fee-for-Service	1730373465	1730373465	1	1	GLENDORA USD	10/20/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	500 N LORAINE AVE	None	GLENDORA	CA	91741	2964	19	06037	34.14418507	-117.8462241	Los Angeles County
214243	Fee-for-Service	1184794331	1184794331	1	1	GELLINEAU III, VICTOR M	1/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75952	None	None	0	In state provider	None	2401 W TURNER RD	None	LODI	CA	95242	2182	39	06077	38.14565233	-121.3055371	San Joaquin County
214276	Fee-for-Service	1386652212	1386652212	1	1	GRISWOLD, BARBARA C LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4010 MOORPARK AVE	STE 118	SAN JOSE	CA	95117	1804	43	06085	37.31585993	-121.9727073	Santa Clara County
214307	Fee-for-Service	1952761710	1952761710	1	1	GOOSE LAKE MEDICAL SERVICES	12/2/2016	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	INC	16 N F ST	None	LAKEVIEW	OR	97630	1528	00	None	42.18962296	-120.3459022	Lake County
214321	Fee-for-Service	1568847929	1568847929	1	1	GLOSSER DIALYSIS LLC	1/23/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2624 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551428	-121.4561835	Sacramento County
214322	Fee-for-Service	1588106249	1588106249	1	1	GEE, JASON F	2/2/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
214325	Fee-for-Service	1154814457	1154814457	1	1	GENUNG, LAUREN A LMFT	12/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
214340	Fee-for-Service	1609188671	1609188671	1	1	GLENN, DANIEL E PHD	2/28/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	6968	19	06037	34.07067	-118.4432445	Los Angeles County
214343	Fee-for-Service	1386802221	1386802221	1	1	GOODWIN, TRESS L MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136425	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
214348	Fee-for-Service	1306000807	1306000807	1	1	GARCIA, EVA V CNM	3/13/2025	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
214367	Fee-for-Service	1114053279	1114053279	2	2	GAGE MEDICAL CLINIC INC	6/5/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	13563 VAN NUYS BLVD	None	PACOIMA	CA	91331	3029	19	06037	34.26130021	-118.4287303	Los Angeles County
214378	Fee-for-Service	1770876716	1770876716	1	1	GREEN, GARY M MD	10/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123099	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
214396	Fee-for-Service	1942690714	1942690714	1	1	GARFIELD BEACH CVS LLC	4/12/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6401 MACK RD	None	SACRAMENTO	CA	95823	4656	34	06067	38.474694	-121.4279415	Sacramento County
214405	Fee-for-Service	1952741662	1952741662	1	1	GRIGORIAN, ANI DO	1/30/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14434 HAMLIN ST	SUITE 1	VAN NUYS	CA	91401	1461	19	06037	34.18863848	-118.447749	Los Angeles County
214429	Fee-for-Service	1952993453	1952993453	1	1	GARFIELD BEACH CVS LLC	10/6/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1707 J ST	None	SACRAMENTO	CA	95811	3007	34	06067	38.577969	-121.4833635	Sacramento County
214437	Fee-for-Service	1902219926	1902219926	1	1	GUZMAN, MARTA DPM	5/17/2022	213ES0103X	NA	Other	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
214438	Fee-for-Service	1164206454	1164206454	1	1	GROUNDED ROOTS FAMILY THERAP	2/27/2024	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	Y COLLECTIVE AND CONSU	1531 CORPORATE WAY	None	SACRAMENTO	CA	95831	3888	34	06067	38.492352	-121.520178	Sacramento County
214442	Fee-for-Service	1902285596	1902285596	1	1	GABBAI-SALDATE, PAULETTE MD	6/28/2018	208M00000X	NA	Other	026	PHYSICIANS	147117	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
214523	Fee-for-Service	1295951705	1295951705	1	1	GHEBREAB, LUWAM Y	4/2/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5 CENTERPOINTE DRIVE	SUITE 200	LA PALMA	CA	90623	1050	30	06059	33.86168254	-118.0308375	Orange County
214547	Fee-for-Service	1225809387	1225809387	1	1	GERONA, CLAIRE LOURDES A PT	3/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
214564	Fee-for-Service	1669579678	1669579678	1	1	GILDER, DAVID A MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	42480	36	Psychiatry	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
214565	Fee-for-Service	1124052311	1124052311	1	1	GOLZARI, MAJID MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	45433	None	None	0	In state provider	None	1141 E THOUSAND OAKS BLV	None	THOUSAND OAKS	CA	91362	2816	56	06111	34.17886911	-118.8590547	Ventura County
214580	Fee-for-Service	1316150600	1316150600	1	1	GHOSTINE, SAMER S MD	2/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86991	14	Neurological Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
214628	Fee-for-Service	1487282513	1487282513	1	1	GARCIA, PHOEBE MD	8/4/2023	207R00000X	NA	Other	026	PHYSICIANS	185307	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
214646	Fee-for-Service	1770631780	1770631780	1	1	GABRIELIAN, ARA MD	1/14/2008	207P00000X	NA	Other	026	PHYSICIANS	93462	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
214678	Fee-for-Service	1528357076	1528357076	1	1	GOLIAN, HELEN A N MD	11/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123904	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	LOS ANGELES	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles
214707	Fee-for-Service	1083855829	1083855829	1	1	GREENBERG, RACHEL L PHD	12/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	4633	07	06013	38.00771973	-122.1331484	Contra Costa County
214712	Fee-for-Service	1972208023	1972208023	1	1	GREENTREE, DAVID MD	3/13/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	185152	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
214726	Fee-for-Service	1164206454	1164206454	1	1	GROUNDED ROOTS FAMILY THERAP	2/27/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	Y COLLECTIVE AND CONSU	1531 CORPORATE WAY	None	SACRAMENTO	CA	95831	3888	34	06067	38.492352	-121.520178	Sacramento County
214786	Fee-for-Service	1578637898	1578637898	1	1	GHALY, MARK A MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86937	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
214787	Fee-for-Service	1740260355	1740260355	1	1	GLIMP, RICHARD A MD	4/26/1994	207R00000X	NA	Other	026	PHYSICIANS	38312	01	General Practice	0	In state provider	None	1043 ELM AVE	STE 104	LONG BEACH	CA	90813	3244	19	06037	33.779655	-118.1880065	Los Angeles County
214806	Fee-for-Service	1922175330	1922175330	1	1	GARCIA-CUESTA, CARLOS PT	1/6/2021	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
214809	Fee-for-Service	1447285754	1447285754	1	1	GILL, HARPREET K MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94839	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
214831	Fee-for-Service	1386664589	1386664589	1	1	GERSOFF, ANDREW S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39885	None	None	0	In state provider	None	300 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1316	42	06083	34.4458497	-119.779596	Santa Barbara County
214858	Fee-for-Service	1396955621	1396955621	1	1	GIBSON, MARY L LMFT	6/24/2021	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	357 W 2ND ST	3	SAN BERNARDINO	CA	92401	1800	36	06071	34.10268251	-117.2909205	San Bernardino County
214879	Fee-for-Service	1184981979	1184981979	1	1	GONZALES, ERIN MD	5/25/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	126616	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
214917	Fee-for-Service	1790720696	1790720696	1	1	GARFIELD BEACH CVS, LLC	12/12/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5960 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	2971	19	06037	33.988554	-118.2232935	Los Angeles County
214918	Fee-for-Service	1851839658	1851839658	1	1	GARFIELD BEACH CVS LLC	11/21/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16049 BASELINE AVE	UNIT 1	FONTANA	CA	92336	1830	36	06071	34.12128247	-117.45477	San Bernardino County
214919	Fee-for-Service	1790211084	1790211084	1	1	GUERRERO ROBLES, ANDREA LMF	5/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	623 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74934351	-116.9656065	Riverside County
214974	Fee-for-Service	1932498110	1932498110	1	1	GANGI, ALEXANDRA MD	10/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116318	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
215009	Fee-for-Service	1942768262	1942768262	1	1	GHAFOOR, NADIA LMFT	6/1/2021	163WP0807X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
215026	Fee-for-Service	1760592190	1760592190	1	1	GEM HEALTHCARE LLC	12/1/2001	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	716 S FAIR OAKS AVE	None	PASADENA	CA	91105	2618	19	06037	34.133481	-118.150333	Los Angeles County
215033	Fee-for-Service	1417003039	1417003039	1	1	GREEN, ADAM L MD	11/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	12605 E 16TH AVE	None	AUROROA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
215067	Fee-for-Service	1366702169	1366702169	1	1	GAPELEH, ANIA M MD	3/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133064	41	Internal Medicine	0	In state provider	None	43839 15TH STREET WEST	None	LANCASTER	CA	92354	4756	19	06037	34.678791	-118.156867	Los Angeles County
215071	Fee-for-Service	1770917049	1770917049	1	1	GIBSON, KEIKO Y	12/1/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	547 E UNION STREET	None	PASADENA	CA	91101	1743	19	06037	34.1472385	-118.139094	Los Angeles County
215072	Fee-for-Service	1013929918	1013929918	1	1	GHARIB, DARIUS	6/18/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	42217	None	None	0	In state provider	None	16133 VENTURA BLVD	STE 350	ENCINO	CA	91436	2426	19	06037	34.15656164	-118.4849569	Los Angeles County
215081	Fee-for-Service	1710395538	1710395538	1	1	GOODWILL, VANESSA S MD	7/12/2021	390200000X	NA	Other	026	PHYSICIANS	160172	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
215111	Fee-for-Service	1205955895	1205955895	1	1	GUERRA-ALFARO, EDELMIRA LMF	4/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
215128	Fee-for-Service	1093802449	1093802449	1	1	GENTRY, STEVEN DC	8/31/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	30486 AVENIDA DE LAS BAN	None	RANCHO SANTA MARG	CA	92688	3948	30	06059	33.64278115	-117.5985362	Orange County
215140	Fee-for-Service	1679537302	1679537302	1	1	GUARDINO, JEFFREY M MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	71159	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
215147	Fee-for-Service	1124015987	1124015987	2	1	GOVINDARAJAN, GOPAL MD	2/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30202	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1640 W 3RD STREET	None	LOS ANGELES	CA	90017	1102	19	06037	34.06044834	-118.2669485	Los Angeles County
215233	Fee-for-Service	1578536462	1578536462	1	1	GORIN, MICHAEL B MD	10/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	45424	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
215234	Fee-for-Service	1649307000	1649307000	1	1	GREENFIELD, ROBERT S MD	2/1/1984	174400000X	NA	Other	026	PHYSICIANS	29135	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11100 WARNER AVE	STE 364	FOUNTAIN VALLEY	CA	92708	7506	30	06059	33.716291	-117.9355051	Orange County
215246	Fee-for-Service	1427402619	1427402619	1	1	GROVA, JULIO A LCSW	12/24/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6840 INDIANA AVE	STE 275	RIVERSIDE	CA	92506	4279	33	06065	33.94246965	-117.3926366	Riverside County
215248	Fee-for-Service	1245314236	1245314236	1	1	GREER, ELIZABETH W MD	8/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87612	30	Radiology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
215254	Fee-for-Service	1497866792	1497866792	1	1	GROUSIS, FRANCESCA A NP	8/20/2024	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
215279	Fee-for-Service	1306936729	1306936729	1	1	GLATT, PATRICIA A MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53034	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
215298	Fee-for-Service	1578959276	1578959276	1	1	GENG, LINDA N MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146333	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
215365	Fee-for-Service	1811008022	1811008022	1	1	GELMAN, ILYA MD	4/1/1999	207RN0300X	NA	Nephrology	026	PHYSICIANS	56511	45	Nephrology (Renal-Kidney)	0	In state provider	None	6333 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90048	5724	19	06037	34.06355697	-118.366413	Los Angeles County
215385	Fee-for-Service	1235744863	1235744863	1	1	GOSWAMI, RAMAN PSYD	9/27/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
215401	Fee-for-Service	1841234192	1841234192	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	690 EAST FOOTHILL	None	UPLAND	CA	91786	3957	36	06071	34.10700327	-117.6421259	San Bernardino County
215409	Fee-for-Service	1336187137	1336187137	1	1	GASPAR, LOWELL S MD	12/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36659	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
215419	Fee-for-Service	1255363628	1255363628	1	1	GREENHOUSE, MICHELE J MD	1/19/2005	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	67495	08	Family Practice	0	In state provider	None	1000 S MADERA AVE	None	KERMAN	CA	93630	1750	10	06019	36.72031784	-120.060276	Fresno County
215430	Fee-for-Service	1164837571	1164837571	1	1	GORDON, ERIN F MD	4/5/2017	390200000X	NA	Other	026	PHYSICIANS	144679	41	Internal Medicine	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
215434	Fee-for-Service	1124015987	1124015987	2	1	GOVINDARAJAN, GOPAL MD	2/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30202	41	Internal Medicine	0	In state provider	None	1640 W 3RD STREET	None	LOS ANGELES	CA	90017	1102	19	06037	34.06044834	-118.2669485	Los Angeles County
215457	Fee-for-Service	1578769477	1578769477	1	1	GROSSMAN, FREDERICK M MD	12/30/1975	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	8924	30	Radiology	0	In state provider	None	2044 ARMACOST AVE	STE 2	LOS ANGELES	CA	90025	6113	19	06037	34.03393989	-118.4533053	Los Angeles County
215459	Fee-for-Service	1225070428	1225070428	1	1	GARFIELD BEACH CVS LLC	1/3/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2456 S GROVE AVE	None	ONTARIO	CA	91761	6224	36	06071	34.028649	-117.630009	San Bernardino County
215461	Fee-for-Service	1356616619	1356616619	1	1	GAUDET, ROSS G MD	1/7/2020	207LC0200X	NA	Other	026	PHYSICIANS	163250	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
215471	Fee-for-Service	1215049663	1215049663	1	1	GORING, CATHERINE J MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
215496	Fee-for-Service	1942584545	1942584545	1	1	GOHARBIN, AMIR MD	10/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118063	01	General Practice	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
215511	Fee-for-Service	1255587358	1255587358	1	1	GERAIS, MOHAMMED A 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
215522	Fee-for-Service	1649307000	1649307000	1	1	GREENFIELD, ROBERT S MD	2/1/1984	174400000X	NA	Other	026	PHYSICIANS	29135	01	General Practice	0	In state provider	None	11100 WARNER AVE	STE 364	FOUNTAIN VALLEY	CA	92708	7506	30	06059	33.716291	-117.9355051	Orange County
215545	Fee-for-Service	1578709515	1578709515	1	1	GUHA-ROY, ASIM MD INC	10/27/2008	207R00000X	NA	Other	026	PHYSICIANS	62010	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
215551	Fee-for-Service	1083068936	1083068936	1	1	GHASEM, WESLEY	8/25/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	153555	None	None	0	In state provider	None	3484 E 1ST ST	None	LOS ANGELES	CA	90063	2946	19	06037	34.0359727	-118.192576	Los Angeles County
215583	Fee-for-Service	1558300947	1558300947	1	1	GOUKASIAN, ASMIK CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	3043 FOOTHILL BLVD	STE 3B	LA CRESCENTA	CA	91214	2782	19	06037	34.22785231	-118.2458632	Los Angeles County
215588	Fee-for-Service	1619260809	1619260809	1	1	GRITTI, JASON K MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130170	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
215600	Fee-for-Service	1528118338	1528118338	1	1	GROVER, DEVINA D MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64814	08	Family Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
215624	Fee-for-Service	1497847123	1497847123	1	1	GILL, MICHAEL MD	4/1/1985	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	54515	20	Orthopedic Surgery	0	In state provider	None	1025 E OCEAN AVE	STE A	LOMPOC	CA	93436	7088	42	06083	34.6389048	-120.4454929	Santa Barbara County
215641	Fee-for-Service	1134360902	1134360902	1	1	GARG, NEHA MD	7/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136579	45	Nephrology (Renal-Kidney)	0	In state provider	None	2340 CLAY ST	2ND FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
215682	Fee-for-Service	1609023845	1609023845	1	1	GARCIA, ROSEMARY MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107622	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
215695	Fee-for-Service	1750458774	1750458774	1	1	GURBANI, SURESH MD	8/10/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53361	79	Neurology-Child	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
215699	Fee-for-Service	1437653052	1437653052	1	1	GANDHI, NIRAJ MD	8/26/2022	207L00000X	NA	Other	026	PHYSICIANS	165576	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
215775	Fee-for-Service	1760970081	1760970081	1	1	GARCIA, MORGAN DPM	6/11/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	576 N SUNRISE AVE	STE 230	ROSEVILLE	CA	95661	2841	31	06061	38.75781026	-121.253352	Placer County
215788	Fee-for-Service	1992876932	1992876932	1	1	GOGAN, SIOBHAN M M.D.	9/30/1989	207W00000X	NA	Ophthalmology	026	PHYSICIANS	47940	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
215820	Fee-for-Service	1205206273	1205206273	1	1	GAUDIOSO-BROOKS, JOANNE NP	8/22/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	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
215829	Fee-for-Service	1639870272	1639870272	1	1	GRANNY'S HOMES, INC	10/3/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	10212 MALINDA LN	None	GARDEN GROVE	CA	92840	2918	30	06059	33.78260833	-117.9545011	Orange County
215840	Fee-for-Service	1538711049	1538711049	1	1	GRANT, NAKISHA L LMFT	8/17/2021	101YM0800X	NA	Other	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
215849	Fee-for-Service	1619988144	1619988144	1	1	GRITMAN MEDICAL CENTER	2/15/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	700 S MAIN ST	None	MOSCOW	ID	83843	3046	00	None	46.728594	-117.0013525	Latah County
215851	Fee-for-Service	1326314766	1326314766	1	1	GINDER, NATHANIEL D MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	130251	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
215894	Fee-for-Service	1710515861	1710515861	1	1	GRESSEN, JACY MD	9/12/2024	390200000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
215942	Fee-for-Service	1356343073	1356343073	1	1	GRAHAM, GEOFFREY L MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39820	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
215981	Fee-for-Service	1164908042	1164908042	1	1	GIRARD, ANGIE M NP	11/6/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	39500 LIBERTY STREET	None	FREMONT	CA	94538	2211	01	06001	37.54845774	-121.9773463	Alameda County
215987	Fee-for-Service	1750458774	1750458774	1	1	GURBANI, SURESH MD	8/10/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53361	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
216044	Fee-for-Service	1437302213	1437302213	1	1	GUERRERO, GUADALUPE E LMFT	6/19/2020	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
216049	Fee-for-Service	1861998650	1861998650	1	1	GONZALEZ, DANIEL MD	5/5/2022	390200000X	NA	Other	026	PHYSICIANS	177801	None	None	0	In state provider	None	208 CONCOURSE BLVD	STE 1	SANTA ROSA	CA	95403	8120	49	06097	38.51255309	-122.7884839	Sonoma County
216062	Fee-for-Service	1437258969	1437258969	1	1	GOOD SAMARITAN HOSP ASSOC	11/1/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 S MAIN AVE	None	RUGBY	ND	58368	2118	00	None	48.36333726	-99.99613832	Pierce County
216110	Fee-for-Service	1275576563	1275576563	1	1	GARFIELD BEACH CVS LLC	7/15/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	222 N MARKET ST	None	INGLEWOOD	CA	90301	1217	19	06037	33.96497849	-118.3519725	Los Angeles County
216138	Fee-for-Service	1619988144	1619988144	1	1	GRITMAN MEDICAL CENTER	2/15/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	700 S MAIN ST	None	MOSCOW	ID	83843	3046	00	None	46.728594	-117.0013525	Latah County
216160	Fee-for-Service	1508895525	1508895525	4	2	GRCY PHARMACIES LLC	3/21/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	36101 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	2001	33	06065	33.786126	-116.406086	Riverside County
216194	Fee-for-Service	1659303170	1659303170	1	1	GANIATS, TED MD	11/17/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	40435	08	Family Practice	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
216195	Fee-for-Service	1356789812	1356789812	1	1	GIACALONE, NICHOLAS J MD	11/30/2018	2085R0001X	NA	Other	026	PHYSICIANS	154736	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
216238	Fee-for-Service	1881841104	1881841104	1	1	GFK SERVICES, INC	8/31/2009	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8891 WATSON ST	STE 201	CYPRESS	CA	90630	2260	30	06059	33.83297519	-118.0392565	Orange County
216301	Fee-for-Service	1952313405	1952313405	1	1	GOLDEN, MEGAN L PT	9/27/2022	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
216312	Fee-for-Service	1699970830	1699970830	1	2	GILLESPIE, CHARLES P MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
216383	Fee-for-Service	1962447789	1962447789	1	1	GRAYEV, ALLISON 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	601 N 30TH ST	None	OMAHA	NE	68131	2137	00	None	41.2654263	-95.95644327	Douglas County
216430	Fee-for-Service	1316224413	1316224413	1	1	GRUDZINSKI, KLARECE L LCSW	5/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8697 LA MESA BLVD	SUITE C #410	LA MESA	CA	91942	9565	37	06073	32.76979952	-117.0099251	San Diego County
216451	Fee-for-Service	1346545894	1346545894	1	1	GHATAN, TIFFANY R DO	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11512	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
216475	Fee-for-Service	1275043119	1275043119	1	1	GALINDO, JOE T 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
216513	Fee-for-Service	1922032739	1922032739	1	1	GRECO, DONALD J MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75373	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
216519	Fee-for-Service	1043499460	1043499460	1	1	GOWD, PAMPANA MD	1/12/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	115521	None	None	0	In state provider	None	2901 SILLECT AVE	SUITE 100	BAKERSFIELD	CA	93308	6371	15	06029	35.38611256	-119.0393796	Kern County
216560	Fee-for-Service	1346590643	1346590643	1	1	GOLIK, KELLIE A	5/27/2014	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
216603	Fee-for-Service	1699970830	1699970830	1	2	GILLESPIE, CHARLES P MD	1/1/2018	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
216612	Fee-for-Service	1619079522	1619079522	1	1	GOODMAN, LISA ANN MD	5/31/1988	2080P0207X	NA	Hematology	026	PHYSICIANS	64092	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
216617	Fee-for-Service	1396891784	1396891784	1	1	GONZALES, LYNN W LCSW	9/9/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	212 N STEVENSON ST	None	VISALIA	CA	93291	6024	54	06107	36.331569	-119.299635	Tulare County
216621	Fee-for-Service	1316988298	1316988298	1	1	GARFIELD BEACH CVS LLC	4/5/2007	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15700 S WESTERN AVE	None	GARDENA	CA	90247	3702	19	06037	33.887835	-118.3091315	Los Angeles County
216637	Fee-for-Service	1841751385	1841751385	1	1	GYLYS, MARYTE H MD	6/16/2023	207L00000X	NA	Other	026	PHYSICIANS	182111	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
216739	Fee-for-Service	1235236571	1235236571	1	1	GAZI, TAWHID R MD	6/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55922	None	None	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 215	BURBANK	CA	91505	4563	19	06037	34.15872557	-118.3283863	Los Angeles County
216776	Fee-for-Service	1699272195	1699272195	1	1	GISI, CATHERINE J MD	5/20/2022	207R00000X	NA	Other	026	PHYSICIANS	165312	None	None	0	In state provider	None	3330 LOMITA BLVD	CARDIOLOGY DEPARTMENT	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
216783	Fee-for-Service	1578937033	1578937033	1	1	GARINO, ARCHIE R NP	12/11/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
216811	Fee-for-Service	1851966113	1851966113	1	1	GOLDEN VALLEY HEALTHCARE	1/24/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	19231 VICTORY BLVD	SUITE 200	RESEDA	CA	91335	6330	19	06037	34.18659852	-118.552221	Los Angeles County
216888	Fee-for-Service	1497790307	1497790307	1	1	GARFIELD BEACH CVS, LLC	9/30/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2006 W AVENUE J	None	LANCASTER	CA	93536	5913	19	06037	34.68939448	-118.166202	Los Angeles County
216913	Fee-for-Service	1508982760	1508982760	1	1	GARCIA-NGUYEN, MARIA E OD	2/7/2014	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
216927	Fee-for-Service	1760547392	1760547392	1	1	GANTA, SANYASI R MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70985	None	None	0	In state provider	None	850 E LATHAM AVE	STE A	HEMET	CA	92543	4391	33	06065	33.74941446	-116.963559	Riverside County
217000	Fee-for-Service	1598027112	1598027112	1	1	GREEN RIVER MEDICAL &	12/11/2012	261QA0005X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AESTHETIC CENTRE INC	2791 GREEN RIVER ROAD	SUITE 103	CORONA	CA	92882	7453	33	06065	33.87058838	-117.622429	Riverside County
217033	Fee-for-Service	1548659279	1548659279	1	1	GRANT, JONATHAN PT	9/1/2023	225100000X	NA	Physical Therapist	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
217070	Fee-for-Service	1982649786	1982649786	1	1	GARFIELD BEACH CVS, LLC	11/16/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2141 S HACIENDA BLVD	None	HACIENDA HEIGHTS	CA	91745	4243	19	06037	33.99488976	-117.9686141	Los Angeles County
217073	Fee-for-Service	1518990035	1518990035	1	1	GURURAJA, AVINASH N MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78267	08	Family Practice	0	In state provider	None	23838 VALENCIA BLVD	STE 260	VALENCIA	CA	91355	5630	19	06037	34.41337791	-118.5520369	Los Angeles County
217094	Fee-for-Service	1003998147	1003998147	1	1	GUADIZ, RAMON A MD	5/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	72478	41	Internal Medicine	0	In state provider	None	3625 MARTIN LUTHER KING	JR STE 2	LYNWOOD	CA	90262	3509	19	06037	33.93044131	-118.2021564	Los Angeles County
217103	Fee-for-Service	1700216827	1700216827	1	1	GARCIA GALLIANI, ROMIE CCC-	8/4/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SLP	3407 W SIXTH STREET	STE 716	LOS ANGELES	CA	90020	2764	19	06037	34.06363337	-118.295759	Los Angeles County
217127	Fee-for-Service	1780775775	1780775775	1	1	GUPTA, RITA K DO	5/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	9723	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
217245	Fee-for-Service	1659312577	1659312577	1	1	GARFIELD BEACH CVS, LLC	5/19/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1810 MAIN ST	None	RAMONA	CA	92065	2128	37	06073	33.03492453	-116.8809421	San Diego County
217248	Fee-for-Service	1578750758	1578750758	1	1	GUO, HAIWEI H MD	7/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100990	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
217287	Fee-for-Service	1235350836	1235350836	1	1	GARGULINSKI, MATTHEW J MD	9/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9757	20	Orthopedic Surgery	0	In state provider	None	632 WEST GIBSON RD	None	WOODLAND	CA	95695	5143	57	06113	38.66314048	-121.794696	Yolo County
217298	Fee-for-Service	1033520861	1033520861	1	1	GHABOUR, RAMEZ A DO	8/17/2017	208M00000X	NA	Other	026	PHYSICIANS	15670	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
217321	Fee-for-Service	1336163104	1336163104	1	1	GOLDSTEIN, DONALD I MD	9/30/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	23730	18	Ophthalmology	0	In state provider	INC	12626 RIVERSIDE DR	# 5	NORTH HOLLYWOOD	CA	91607	3420	19	06037	34.15758449	-118.408131	Los Angeles County
217350	Fee-for-Service	1508809773	1508809773	1	1	GARFIELD BEACH CVS, LLC	5/19/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 W. VICTORY BLVD	None	BURBANK	CA	91505	1614	19	06037	34.18458013	-118.3388507	Los Angeles County
217351	Fee-for-Service	1598843401	1598843401	1	1	GUO, FANG MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79678	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
217381	Fee-for-Service	1003998147	1003998147	1	1	GUADIZ, RAMON A MD	5/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	72478	45	Nephrology (Renal-Kidney)	0	In state provider	None	3625 MARTIN LUTHER KING	JR STE 2	LYNWOOD	CA	90262	3509	19	06037	33.93044131	-118.2021564	Los Angeles County
217416	Fee-for-Service	1689262131	1689262131	1	1	GORS, ERIN M CCC-SLP	2/17/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
217431	Fee-for-Service	1093868515	1093868515	1	1	GAMAL, REDA MD INC	10/14/2008	193400000X	NA	Other	026	PHYSICIANS	47890	13	Neurology (M.D. only)	0	In state provider	None	1125 E 17TH ST	W238	SANTA ANA	CA	92701	2247	30	06059	33.76004145	-117.854838	Orange County
217450	Fee-for-Service	1700996964	1700996964	1	1	GREEN, ARI J MD	6/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83567	13	Neurology (M.D. only)	0	In state provider	None	400 PASNASSUS AVE	None	SAN FRANCISCO	CA	94143	0001	38	06075	37.76344756	-122.4581992	San Francisco County
217526	Fee-for-Service	1811968860	1811968860	1	1	GRADWELL, LOIS E LMFT	2/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43 QUAIL CT	SUITE 213	WALNUT CREEK	CA	94596	8701	07	06013	37.88807861	-122.0553842	Contra Costa County
217565	Fee-for-Service	1992887897	1992887897	1	1	GARCIA-ALVAREZ,MIRIAM N	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73164	08	Family Practice	0	In state provider	None	1580 VALENCIA ST	STE 201	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
217587	Fee-for-Service	1811934680	1811934680	1	1	GREGORY HILL DO	6/3/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6151 S YALE AVE	None	TULSA	OK	74136	1907	00	None	36.0737937	-95.92202811	Tulsa County
217601	Fee-for-Service	1760787444	1760787444	1	1	GRIVAS, TANIA A MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	53360	02	General Surgery	0	In state provider	None	1149 W 190TH ST	None	TORRANCE	CA	90248	4321	19	06037	33.85834052	-118.2958065	Los Angeles County
217605	Fee-for-Service	1033248216	1033248216	1	1	GOOD, ISABEL D NP	10/5/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	236363	-	NOT APPLICABLE	0	In state provider	None	1310 M STREET	None	FRESNO	CA	93721	6430	10	06019	36.73926478	-119.7905188	Fresno County
217606	Fee-for-Service	1336163104	1336163104	1	1	GOLDSTEIN, DONALD I MD	9/30/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	23730	01	General Practice	0	In state provider	INC	12626 RIVERSIDE DR	# 5	NORTH HOLLYWOOD	CA	91607	3420	19	06037	34.15758449	-118.408131	Los Angeles County
217628	Fee-for-Service	1285654764	1285654764	1	1	GARNETT, MARY J	12/17/2008	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	HEARING SCIENCE OF ANTIO	3701 LONE TREE WAY	STE 4B	ANTIOCH	CA	94509	6015	07	06013	37.98469672	-121.805695	Contra Costa County
217656	Fee-for-Service	1851335103	1851335103	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1835 NEWPORT BLVD	# C	COSTA MESA	CA	92627	5031	30	06059	33.64060991	-117.9194274	Orange County
217675	Fee-for-Service	1841430535	1841430535	1	2	GROBLER ENTERPRISES INC	6/6/2016	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9655 MONTE VISTA AVE	STE 402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
217679	Fee-for-Service	1982113460	1982113460	1	1	GANDHI, SONALIBEN A NP	3/18/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
217703	Fee-for-Service	1538228135	1538228135	1	1	GRAVELY, LANCE E	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87871	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
217720	Fee-for-Service	1912037425	1912037425	1	1	GIBSON, NICOLE LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	94690	-	NOT APPLICABLE	0	In state provider	None	7601 CANBY AVENUE	SUITE 3	RESEDA	CA	91335	2979	19	06037	34.20872085	-118.5347527	Los Angeles County
217750	Fee-for-Service	1497124317	1497124317	1	1	GOUVEA, TYLER	8/24/2020	207L00000X	NA	Other	026	PHYSICIANS	15125	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
217785	Fee-for-Service	1700194941	1700194941	1	1	GRIFFITH, JOHN H PHD	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	8797	-	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
217806	Fee-for-Service	1114229069	1114229069	1	4	GENESIS MANOR I	4/15/2011	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OWNER/ADMINISTRATOR	550 BETHANY CIRCLE	None	CLAREMONT	CA	91711	2231	19	06037	34.12218553	-117.7059915	Los Angeles County
217814	Fee-for-Service	1902961162	1902961162	1	1	GILROY UNIF SCHOOL DIST	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	7810 ARROYO CIR	None	GILROY	CA	95020	7313	43	06085	37.01553707	-121.5621428	Santa Clara County
217895	Fee-for-Service	1336163104	1336163104	1	1	GOLDSTEIN, DONALD I MD	9/30/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	23730	05	Anesthesiology	0	In state provider	INC	12626 RIVERSIDE DR	# 5	NORTH HOLLYWOOD	CA	91607	3420	19	06037	34.15758449	-118.408131	Los Angeles County
217910	Fee-for-Service	1457619447	1457619447	1	1	GIRGIS, CAROLIN A MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115461	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
217989	Fee-for-Service	1952580235	1952580235	1	1	GUTKIN, RACHEL M MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99133	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
218024	Fee-for-Service	1396903621	1396903621	1	1	GERRITZ, PETER K MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106173	36	Psychiatry	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
218029	Fee-for-Service	1073555322	1073555322	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13171 MINDANAO WAY	None	MARINA DEL REY	CA	90292	6307	19	06037	33.98421001	-118.4377644	Los Angeles County
218056	Fee-for-Service	1285151506	1285151506	1	1	GUARDIAN FLIGHT LLC	4/30/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	CVS SPACE 32, US 191	None	CHINLE	AZ	86503	0676	00	None	36.09190805	-109.6237425	Apache County
218075	Fee-for-Service	1689893703	1689893703	1	1	GOULD, WILLIAM M MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	6059	07	Dermatology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
218083	Fee-for-Service	1275771453	1275771453	1	1	GAINES, MATTHEW DO	1/9/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	15731	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
218087	Fee-for-Service	1902032931	1902032931	1	1	GROSS, JORDAN S MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130802	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
218132	Fee-for-Service	1548491012	1548491012	1	1	GRIEST, KELLEY CCC-SLP	8/25/2024	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
218138	Fee-for-Service	1346392552	1346392552	1	1	GAMAYO, KRIS LMFT	5/19/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2015 PIONEER COURT	SUITE B	SAN MATEO	CA	94403	1736	41	06081	37.54712403	-122.3120681	San Mateo County
218183	Fee-for-Service	1366859449	1366859449	1	12	GOLDEN STATE PROVIDERS, A ME	1/14/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	0000	43	06085	37.25111017	-121.9465891	Santa Clara County
218202	Fee-for-Service	1376621912	1376621912	1	1	GABBAY, RICHARD J MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37772	30	Radiology	0	In state provider	None	1500 VETERANS BLVD	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48832878	-122.2137777	San Mateo County
218251	Fee-for-Service	1487668836	1487668836	1	1	GAYAUSKAS, YULIONAS MD	6/13/2006	207R00000X	NA	Other	026	PHYSICIANS	73613	41	Internal Medicine	0	In state provider	None	8540 S SEPULVEDAE	STE 1006	LOS ANGELES	CA	90045	3819	19	06037	33.96022076	-118.3961982	Los Angeles County
218253	Fee-for-Service	1467435727	1467435727	1	1	GOULD, CHARLES F MD DO	4/1/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147172	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
218265	Fee-for-Service	1760896500	1760896500	1	1	GARCIA, RIABIANCA A Q MD	5/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130797	01	General Practice	0	In state provider	None	664 SOUTHLAND MALL DR	None	HAYWARD	CA	94545	2150	01	06001	37.64923768	-122.1020017	Alameda County
218268	Fee-for-Service	1891904686	1891904686	1	1	GAGE MEDICAL CENTER	8/16/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2719 E GAGE AVE	None	HUNTINGTON PARK	CA	90255	4202	19	06037	33.9816993	-118.2217064	Los Angeles County
218294	Fee-for-Service	1629346465	1629346465	2	1	GATES TO PARADISE HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE, INC	7100 HAYVENHURST AVE	SUITE PENTHOUSE A	VAN NUYS	CA	91406	3874	19	06037	34.199064	-118.4923845	Los Angeles County
218310	Fee-for-Service	1396903621	1396903621	1	1	GERRITZ, PETER K MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106173	25	Physical Medicine and Rehabilitation	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
218311	Fee-for-Service	1902813322	1902813322	1	1	GIN, BRIAN A OD	11/14/2007	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
218341	Fee-for-Service	1467672188	1467672188	1	1	GOLDEN VALLEY HEALTH CTR	7/25/2005	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	13161 JEFFERSON ST	None	LE GRAND	CA	95333	9766	24	06047	37.2293683	-120.2509644	Merced County
218348	Fee-for-Service	1659670024	1659670024	1	1	GRACER, TALIA S MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132020	41	Internal Medicine	0	In state provider	None	350 30TH ST	STE 320	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
218362	Fee-for-Service	1275965105	1275965105	1	1	GONZALES, ROMMEL MEDICAL	8/4/2014	193200000X	NA	Other	026	PHYSICIANS	122760	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GROUP INC	508 S ALVARADO ST	None	LOS ANGELES	CA	90057	2904	19	06037	34.06017147	-118.2744308	Los Angeles County
218373	Fee-for-Service	1417503731	1417503731	1	1	GARDUNO, CASSANDRA K LMFT	8/22/2022	101YM0800X	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
218453	Fee-for-Service	1093208670	1093208670	1	1	GALANG, KRISTINE MD	7/29/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
218504	Fee-for-Service	1295313971	1295313971	1	1	GURESKY MENTAL HEALTH AND FA	7/25/2023	106H00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	MILY COUNSELING SPECIALI	24303 WALNUT ST	STE C1	SANTA CLARITA	CA	91321	2900	19	06037	34.37826496	-118.5288897	Los Angeles County
218541	Fee-for-Service	1831329192	1831329192	1	1	GARCIA-TOLEDO, SERGIO M MD	2/23/2010	207R00000X	NA	Other	026	PHYSICIANS	106742	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
218553	Fee-for-Service	1265513352	1265513352	1	1	GREBE, JOHN H MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	501 EAST HAMPDEN AVENUE	None	ENGLEWOOD	CO	80113	2702	00	None	39.6531952	-104.9810967	Arapahoe County
218576	Fee-for-Service	1508124132	1508124132	1	1	GILDE, JASON E MD	5/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131061	84	Surgery-Head and Neck	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	0000	01	06001	37.8237837	-122.2590026	Alameda County
218582	Fee-for-Service	1629346465	1629346465	2	1	GATES TO PARADISE HOSPICE	5/18/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE, INC	7100 HAYVENHURST AVE	SUITE PENTHOUSE A	VAN NUYS	CA	91406	3874	19	06037	34.199064	-118.4923845	Los Angeles County
218640	Fee-for-Service	1922378116	1922378116	1	1	GIRNITA, DIANA M MD	12/11/2020	207RR0500X	NA	Other	026	PHYSICIANS	167653	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
218648	Fee-for-Service	1275965105	1275965105	1	1	GONZALES, ROMMEL MEDICAL	8/4/2014	193200000X	NA	Other	026	PHYSICIANS	122760	01	General Practice	0	In state provider	GROUP INC	508 S ALVARADO ST	None	LOS ANGELES	CA	90057	2904	19	06037	34.06017147	-118.2744308	Los Angeles County
218683	Fee-for-Service	1396917688	1396917688	1	1	GUTIERREZ, ANTONIO J MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95058	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
218688	Fee-for-Service	1336756394	1336756394	1	1	GENTLE CARE SERVICES HOSPICE	8/6/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	19737 VENTURA BLVD	STE 301-D	WOODLAND HILLS	CA	91364	2605	19	06037	34.17249119	-118.5635388	Los Angeles County
218703	Fee-for-Service	1386601326	1386601326	1	1	GROSSMAN, DANIEL K MD	4/30/1989	193400000X	NA	Other	026	PHYSICIANS	67384	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
218714	Fee-for-Service	1275640047	1275640047	1	2	GELMAN, JOEL MD	2/16/2024	208800000X	NA	Other	026	PHYSICIANS	71788	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
218742	Fee-for-Service	1093208670	1093208670	1	1	GALANG, KRISTINE MD	7/29/2024	207R00000X	NA	Other	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
218792	Fee-for-Service	1790725711	1790725711	1	1	GREGORY T HAMMONS DO	5/30/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1703 W BUERKLE ST	None	STUTTGART	AR	72160	0000	00	None	34.487298	-91.557909	Arkansas County
218793	Fee-for-Service	1093793796	1093793796	1	1	GRANT, KENNETH D MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	83	Rheumatology	1	Border provider	None	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
218795	Fee-for-Service	1295313971	1295313971	1	1	GURESKY MENTAL HEALTH AND FA	2/1/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	MILY COUNSELING SPECIALI	24303 WALNUT ST	STE C1	SANTA CLARITA	CA	91321	2900	19	06037	34.37826496	-118.5288897	Los Angeles County
218796	Fee-for-Service	1043480320	1043480320	1	1	GENESEE MEDICAL GROUP INC	11/8/1982	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7830 CLAIREMONT MESA BLV	STE 100	SAN DIEGO	CA	92111	1619	37	06073	32.83285853	-117.1522755	San Diego County
218821	Fee-for-Service	1407529902	1407529902	1	1	GEEDIPALLY, HANISHA MD	10/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	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
218858	Fee-for-Service	1851788665	1851788665	1	1	GUNTHER MAHER, SEAN M MD	9/21/2021	207RC0200X	NA	Other	026	PHYSICIANS	173063	None	None	0	In state provider	None	1508 ALHAMBRA	200	SACRAMENTO	CA	95816	6510	34	06067	38.567007	-121.468068	Sacramento County
218864	Fee-for-Service	1508124132	1508124132	1	1	GILDE, JASON E MD	5/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131061	04	Otology, Laryngology, Rhinology	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	0000	01	06001	37.8237837	-122.2590026	Alameda County
218880	Fee-for-Service	1013974328	1013974328	1	1	GOLDBERG, JAMES B MD	5/13/2020	207P00000X	NA	Other	026	PHYSICIANS	163087	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
218884	Fee-for-Service	1497985832	1497985832	1	1	GRACE, MONIKA M PHD	11/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5575 LAKE PARK WAY	100-6	LA MESA	CA	91942	1664	37	06073	32.78203256	-117.0342041	San Diego County
218911	Fee-for-Service	1649588716	1649588716	1	1	GRIMES, KELLY E	6/6/2011	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
218915	Fee-for-Service	1619088937	1619088937	1	1	GENZLINGER, JEFFREY L MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66955	41	Internal Medicine	0	In state provider	None	2 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3043	31	06061	38.76507948	-121.2477476	Placer County
218939	Fee-for-Service	1417049156	1417049156	1	1	GORSKI, YARA C MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	68154	02	General Surgery	0	In state provider	None	36320 INLAND VALLEY DR	STE 101	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
218941	Fee-for-Service	1184612061	1184612061	2	1	GOVINDARAJAN, SUDHA MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36370	01	General Practice	0	In state provider	None	101 E BEVERLY BLVD	STE 302	MONTEBELLO	CA	90640	4316	19	06037	34.01556395	-118.0983878	Los Angeles County
218966	Fee-for-Service	1124078860	1124078860	1	1	GARVEY MEDICAL CENTER	1/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	201 W GARVEY AVE	STE A108	MONTEREY PARK	CA	91754	7418	19	06037	34.06256747	-118.1246805	Los Angeles County
218971	Fee-for-Service	1134200850	1134200850	1	1	GONSALVES, RACHEL Y	4/14/2015	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
218977	Fee-for-Service	1336756394	1336756394	1	1	GENTLE CARE SERVICES HOSPICE	8/6/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	19737 VENTURA BLVD	STE 301-D	WOODLAND HILLS	CA	91364	2605	19	06037	34.17249119	-118.5635388	Los Angeles County
218997	Fee-for-Service	1659869436	1659869436	1	1	GRIFFIN, GLENN K DPM	6/7/2021	390200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	39000 BOB HOPE DR	PROBST BUILDING STE 207	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
219008	Fee-for-Service	1356632392	1356632392	1	1	GERBER, JENNIFER L MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124480	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
219080	Fee-for-Service	1093793796	1093793796	1	1	GRANT, KENNETH D MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
219108	Fee-for-Service	1073553970	1073553970	1	1	GONZALEZ-DELUNA, MONICA	12/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	106014	30	Radiology	0	In state provider	A MD	1516 COTNER AVENUE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
219118	Fee-for-Service	1588632855	1588632855	1	1	GOENJIAN, ARMEN K MD INC	4/24/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	34978	36	Psychiatry	0	In state provider	None	4525 ATHERTON ST	None	LONG BEACH	CA	90815	3700	19	06037	33.78988246	-118.1397653	Los Angeles County
219173	Fee-for-Service	1407065980	1407065980	1	1	GURROLA, JOSE G II MD	5/12/2017	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	147549	04	Otology, Laryngology, Rhinology	0	In state provider	None	1001 POTRERO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
219221	Fee-for-Service	1568480556	1568480556	1	1	GONZALEZ, CARINA F MD	4/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102039	08	Family Practice	0	In state provider	None	1300 W LODI AVE	STE P	LODI	CA	95242	3038	39	06077	38.13001447	-121.289931	San Joaquin County
219243	Fee-for-Service	1821484098	1821484098	1	1	GRIFFITHS, ELIZABETH P MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145612	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
219251	Fee-for-Service	1043694201	1043694201	1	1	GUYETT, KRISTIN A NP	7/10/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
219253	Fee-for-Service	1124078860	1124078860	1	1	GARVEY MEDICAL CENTER	1/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	201 W GARVEY AVE	STE A108	MONTEREY PARK	CA	91754	7418	19	06037	34.06256747	-118.1246805	Los Angeles County
219311	Fee-for-Service	1891783692	1891783692	1	1	GUPTA, SHALINI MD	9/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	82415	41	Internal Medicine	0	In state provider	None	414 G ST	STE 240	MARYSVILLE	CA	95901	5670	58	06115	39.13913942	-121.5934649	Yuba County
219315	Fee-for-Service	1326758426	1326758426	1	1	GONZALEZ, CITLALLI	9/6/2023	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8700 WARNER	SUITE 140	FOUNTAIN VALLEY	CA	92708	3207	30	06059	33.71568247	-117.977193	Orange County
219316	Fee-for-Service	1255967287	1255967287	1	1	GANIHONG, IVANA L	11/6/2023	207R00000X	NA	Other	026	PHYSICIANS	185633	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
219337	Fee-for-Service	1124118617	1124118617	1	1	GREENFIELD, WAILLIAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	1401	00	None	34.749009	-92.320101	Pulaski County
219367	Fee-for-Service	1669583977	1669583977	1	1	GARRETT, JAMES B MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69712	08	Family Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 101102	ELK GROVE	CA	95758	7901	34	06067	38.421054	-121.405365	Sacramento County
219374	Fee-for-Service	1396312930	1396312930	1	1	GEORGE WILFRED WAWERU	7/6/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1777 W LINCOLN RD	None	STOCKTON	CA	95207	2451	39	06077	38.01381486	-121.333907	San Joaquin County
219420	Fee-for-Service	1841717162	1841717162	1	1	GUARDIAN FLIGHT LLC	9/2/2021	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	205 CRESTWOOD CT	None	GALLUP	NM	87301	7121	00	None	35.50529359	-108.7364076	McKinley County
219432	Fee-for-Service	1699930685	1699930685	1	1	GUPTA, ANKUR MD	3/26/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	169112	None	None	0	In state provider	None	15243 VANOWEN ST	STE 301	VAN NUYS	CA	91405	3605	19	06037	34.19394848	-118.4654115	Los Angeles County
219454	Fee-for-Service	1558631663	1558631663	1	1	GARG, JALAJ MD	7/1/2021	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	171961	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
219455	Fee-for-Service	1548796626	1548796626	1	1	GREEN MEADOW HOMES, LLC	8/15/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2340 PLAZA DEL AMO	SUITE 235	TORRANCE	CA	93551	4301	19	06037	33.83049748	-118.3239598	Los Angeles County
219502	Fee-for-Service	1205697521	1205697521	1	1	GINKENS, SHING CHIN LPCC	2/9/2024	101Y00000X	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
219506	Fee-for-Service	1801888524	1801888524	1	1	GRANDINE,KIMBERLY 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	0000	00	None	47.647989	-117.4112415	Spokane County
219542	Fee-for-Service	1124078860	1124078860	1	1	GARVEY MEDICAL CENTER	1/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	201 W GARVEY AVE	STE A108	MONTEREY PARK	CA	91754	7418	19	06037	34.06256747	-118.1246805	Los Angeles County
219564	Fee-for-Service	1386663029	1386663029	1	1	GWEN. TIFFANI TRANG DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	15751 BROOKHURST ST	STE 209	WESTMINSTER	CA	92683	7568	30	06059	33.7340762	-117.9548199	Orange County
219577	Fee-for-Service	1316967854	1316967854	1	1	GOPURALA, BALAGANESH MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139871	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
219586	Fee-for-Service	1477124337	1477124337	1	1	GALLEGOS, KENNY LCSW	7/8/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE STE 58	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
219609	Fee-for-Service	1023078342	1023078342	1	1	GHAUSI, DAVID R DO INC	12/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8764	09	Gynecology (D.O. only)	0	In state provider	None	3180 WILLOW LANE	STE 214	THOUSAND OAKS	CA	91361	4991	56	06111	34.16552629	-118.8390377	Ventura County
219657	Fee-for-Service	1447527833	1447527833	1	1	GLOUDE, NICHOLAS J MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119146	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
219663	Fee-for-Service	1396312930	1396312930	1	1	GEORGE WILFRED WAWERU	7/6/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1777 W LINCOLN RD	None	STOCKTON	CA	95207	2451	39	06077	38.01381486	-121.333907	San Joaquin County
219683	Fee-for-Service	1851356596	1851356596	1	1	GROVER, RAHUL MD	3/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52335	40	Pediatrics	0	In state provider	None	8733 BEVERLY BLVD	STE 200	WEST HOLLYWOOD	CA	90048	1844	19	06037	34.07688048	-118.3815765	Los Angeles County
219693	Fee-for-Service	1265637706	1265637706	1	1	GRAY, MARIA K MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110894	40	Pediatrics	0	In state provider	None	865 3RD AVE	STE 101	CHULA VISTA	CA	91911	1349	37	06073	32.62189562	-117.0722453	San Diego County
219696	Fee-for-Service	1700860871	1700860871	1	7	GOLDEN STATE DERMATOLOGY ASS	3/3/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	632 W 11TH ST	STE 219	TRACY	CA	95376	3861	39	06077	37.73965648	-121.4352045	San Joaquin County
219712	Fee-for-Service	1669733051	1669733051	1	1	GAMACHE, NICOLE NP	9/8/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
219727	Fee-for-Service	1588617559	1588617559	1	1	GOTT, ROLANDA A MD	3/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153546	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
219774	Fee-for-Service	1891038352	1891038352	1	1	GELLIS, RONALD D PSYD	11/20/2023	103G00000X	NA	Other	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
219798	Fee-for-Service	1073624672	1073624672	1	1	GREER, DANIELLE M DO	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12305	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
219837	Fee-for-Service	1437719168	1437719168	1	1	GIBSON, JAMES R CRNA	8/3/2022	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
219840	Fee-for-Service	1891729745	1891729745	1	6	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	277 RANCHEROS DR	SUITE 100	SAN MARCOS	CA	92069	2959	37	06073	33.13859391	-117.1604009	San Diego County
219852	Fee-for-Service	1053660621	1053660621	1	1	GOMEZ, JULIE LCSW	8/5/2024	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
219873	Fee-for-Service	1073543914	1073543914	1	1	GRIFFIN, MICHAEL L MD	11/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	63051	None	None	0	In state provider	None	2051 PIONEER CT	None	SAN MATEO	CA	94403	1719	41	06081	37.54634234	-122.3117373	San Mateo County
219894	Fee-for-Service	1710427125	1710427125	1	1	GURKIRPA MEDICAL INC	5/9/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3400 PANAMA LN	STE L	BAKERSFIELD	CA	93313	3699	15	06029	35.29601148	-119.040507	Kern County
219895	Fee-for-Service	1962636886	1962636886	1	1	GELMAN, YELENA DO	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12279	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3393	19	06037	33.78003775	-118.1866604	Los Angeles County
219912	Fee-for-Service	1629534094	1629534094	1	1	GARFIELD BEACH CVS LLC	5/31/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 ARTESIA BLVD	SUITE 100	REDONDO BEACH	CA	90278	3013	19	06037	33.87292852	-118.373796	Los Angeles County
219925	Fee-for-Service	1083755060	1083755060	1	1	GARBUTT, LISA MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90909	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
219945	Fee-for-Service	1447527833	1447527833	1	1	GLOUDE, NICHOLAS J MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119146	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
219955	Fee-for-Service	1497917090	1497917090	1	1	GALVAN-NAVA, ANGELICA LMFT	6/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18411 CRENSHAW BLVD	STE 432	TORRANCE	CA	90504	5042	19	06037	33.86333387	-118.3265193	Los Angeles County
220015	Fee-for-Service	1811987571	1811987571	1	1	GIZA, ERIC MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86534	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
220016	Fee-for-Service	1760942510	1760942510	1	1	GLICK, GIANCARLO G MD	10/6/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179455	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
220019	Fee-for-Service	1184798795	1184798795	1	1	GLASSSMAN, JESSICA B MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89804	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
220020	Fee-for-Service	1487699062	1487699062	1	1	GUY, MICHELLE E MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86942	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
220022	Fee-for-Service	1649496118	1649496118	1	1	GULAK, HUBERT M MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	11621	25	Physical Medicine and Rehabilitation	0	In state provider	None	3475 TORRANCE BLVD	STE F	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
220052	Fee-for-Service	1881920882	1881920882	1	1	GIBSON, MICHAEL A MD	5/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114646	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
220058	Fee-for-Service	1194743120	1194743120	1	1	GRALNEK, IAN MARK MD	6/30/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	76803	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
220087	Fee-for-Service	1215190640	1215190640	1	1	GUTIERREZ, GLORIA G MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116199	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
220102	Fee-for-Service	1477268605	1477268605	1	1	GIBSON, JOSEPH H CRNA	8/20/2023	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
220143	Fee-for-Service	1891729745	1891729745	1	6	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	277 RANCHEROS DR	SUITE 100	SAN MARCOS	CA	92069	2959	37	06073	33.13859391	-117.1604009	San Diego County
220146	Fee-for-Service	1396214631	1396214631	1	1	GILL, SURJIT	2/26/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
220161	Fee-for-Service	1457795254	1457795254	1	1	GONZALEZ MARTINEZ, ROXANA M	3/19/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
220163	Fee-for-Service	1659917920	1659917920	1	1	GUTIERREZ, LINDA	11/26/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2560 S MIRAMONTE	None	ONTARIO	CA	91761	6069	36	06071	34.026804	-117.643419	San Bernardino County
220188	Fee-for-Service	1336238328	1336238328	1	1	GENTRY, WILLIAM H MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	60970	02	General Surgery	0	In state provider	None	430 RIO ST	None	RED BLUFF	CA	96080	3417	52	06103	40.17591501	-122.2320956	Tehama County
220202	Fee-for-Service	1114081700	1114081700	1	1	GEORGE KUBAC	9/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2865 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
220206	Fee-for-Service	1922484112	1922484112	1	1	GABRIEL, TONY S G MD	9/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155073	40	Pediatrics	0	In state provider	None	311 WEST I ST	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
220214	Fee-for-Service	1629074687	1629074687	1	1	GALINDO, RAMON MD	1/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43698	40	Pediatrics	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
220220	Fee-for-Service	1336243013	1336243013	1	1	GEYMAN, JOY A PSYD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B ST	STE 2890	SAN DIEGO	CA	92101	8183	37	06073	32.71782447	-117.157905	San Diego County
220227	Fee-for-Service	1437543378	1437543378	1	1	GU, SHERRY MD	9/24/2021	2080P0203X	NA	Other	026	PHYSICIANS	155338	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
220233	Fee-for-Service	1447527833	1447527833	1	1	GLOUDE, NICHOLAS J MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	119146	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
220278	Fee-for-Service	1124195482	1124195482	1	1	GILLESS, JANICE W MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	51007	40	Pediatrics	0	In state provider	None	1800 SULLIVAN AVE	RM 307	DALY CITY	CA	94015	2223	41	06081	37.68077723	-122.4728941	San Mateo County
220298	Fee-for-Service	1225456841	1225456841	1	1	GU, WEI MD	8/20/2020	207ZC0006X	NA	Other	026	PHYSICIANS	142364	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
220316	Fee-for-Service	1154097020	1154097020	1	1	GEHLHAAR, KELLY LCSW	4/23/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27720 JEFFERSON	SUITE 200	TEMECULA	CA	92590	2610	33	06065	33.51188961	-117.1586219	Riverside County
220329	Fee-for-Service	1346261906	1346261906	1	1	GARCIA, ANTONIO MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	57441	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1524 27TH ST	STE 201	BAKERSFIELD	CA	93301	2056	15	06029	35.38387747	-119.0197575	Kern County
220394	Fee-for-Service	1184646713	1184646713	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15614 WHITTWOOD LN	None	WHITTIER	CA	90603	2324	19	06037	33.942618	-117.996561	Los Angeles County
220407	Fee-for-Service	1639246572	1639246572	1	1	GOLDEN, ANDREW M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35972	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
220412	Fee-for-Service	1871715128	1871715128	1	1	GARDEN GROVE UNIFIED SD	5/15/2008	251300000X	NA	Other	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	10331 STANFORD AVE	None	GARDEN GROVE	CA	92840	6351	30	06059	33.77773849	-117.9524509	Orange County
220414	Fee-for-Service	1891729745	1891729745	1	6	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	277 RANCHEROS DR	SUITE 100	SAN MARCOS	CA	92069	2959	37	06073	33.13859391	-117.1604009	San Diego County
220436	Fee-for-Service	1346398302	1346398302	1	1	GOWRIE-KNOX, POLLYANN	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77787	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
220448	Fee-for-Service	1659917920	1659917920	1	1	GUTIERREZ, LINDA	11/26/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2560 S MIRAMONTE	None	ONTARIO	CA	91761	6069	36	06071	34.026804	-117.643419	San Bernardino County
220454	Fee-for-Service	1669602215	1669602215	1	1	GEBAUER, SARAH L MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107704	05	Anesthesiology	0	In state provider	None	4311 3RD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
220478	Fee-for-Service	1770065294	1770065294	1	1	GAO, SARAH C NP	9/28/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4784 PECK RD	STE A	EL MONTE	CA	91732	1360	19	06037	34.09071973	-118.0144474	Los Angeles County
220485	Fee-for-Service	1750554861	1750554861	1	1	GALLOS, GEORGE MD	8/22/2022	207L00000X	NA	Other	026	PHYSICIANS	169454	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
220491	Fee-for-Service	1568824951	1568824951	1	1	GREWE, KASEY MD	9/23/2022	207L00000X	NA	Other	026	PHYSICIANS	168385	None	None	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
220503	Fee-for-Service	1265634604	1265634604	1	1	GALICH, PETER M MD	10/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95676	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
220537	Fee-for-Service	1467744987	1467744987	1	1	GOTO, YUIKA MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150736	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
220611	Fee-for-Service	1215187521	1215187521	2	1	GARFIELD BEACH CVS LLC	10/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2911 JAMACHA RD	None	EL CAJON	CA	92019	4342	37	06073	32.738589	-116.9389215	San Diego County
220616	Fee-for-Service	1346261906	1346261906	1	1	GARCIA, ANTONIO MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	57441	02	General Surgery	0	In state provider	None	1524 27TH ST	STE 201	BAKERSFIELD	CA	93301	2056	15	06029	35.38387747	-119.0197575	Kern County
220627	Fee-for-Service	1841828761	1841828761	1	1	GUIRGUIS, HELPEES	6/7/2023	208M00000X	NA	Other	026	PHYSICIANS	185436	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
220665	Fee-for-Service	1841789229	1841789229	1	1	GOMER, JEREMY V MD	4/30/2021	207R00000X	NA	Other	026	PHYSICIANS	165223	None	None	0	In state provider	None	1800 WESTERN	103	SAN BERNARDINO	CA	92411	1352	36	06071	34.1315778	-117.3182453	San Bernardino County
220683	Fee-for-Service	1194371351	1194371351	1	1	GUAN, JENNIFER	9/3/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	340 DARDANELLI LANE	23	LOS GATOS	CA	95032	1418	43	06085	37.262079	-121.9673345	Santa Clara County
220725	Fee-for-Service	1952397481	1952397481	1	1	GONZALEZ, VINCENT MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140766	66	Emergency Medicine (Urgent Care)	0	In state provider	None	820 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
220726	Fee-for-Service	1699944082	1699944082	1	1	GAOR, JAMES A MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3393	19	06037	33.78003775	-118.1866604	Los Angeles County
220766	Fee-for-Service	1598899213	1598899213	1	1	GEBRE, ERMIAS A MD	1/8/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	5400 S RAINBOW RD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
220777	Fee-for-Service	1073396156	1073396156	1	1	GALINDEZ, JANIS ARIAN H OT	12/1/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
220781	Fee-for-Service	1649417239	1649417239	1	1	GAXIOLA MACIAS, FELIZARDO A	11/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112174	08	Family Practice	0	In state provider	MD	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
220786	Fee-for-Service	1346313525	1346313525	1	1	GONZALEZ, MONICA LCSW	3/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
220883	Fee-for-Service	1528213980	1528213980	1	1	GIP, MUI L LCSW	11/3/2021	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
220891	Fee-for-Service	1154480788	1154480788	1	1	GAUDET, JAMES W MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62534	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
220934	Fee-for-Service	1538303680	1538303680	1	1	GHLANDIAN, ALLEN MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115939	02	General Surgery	0	In state provider	None	1450 SAN PABLO STREET	STE 600	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
220949	Fee-for-Service	1831185792	1831185792	1	1	GARCIA JR, LEO S MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	62775	41	Internal Medicine	0	In state provider	None	435 ARDEN AVE	STE 410	GLENDALE	CA	91203	4020	19	06037	34.15848148	-118.2628845	Los Angeles County
221026	Fee-for-Service	1679921316	1679921316	1	1	GIRGIS, MARK M DO	7/30/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	18395	13	Neurology (M.D. only)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
221107	Fee-for-Service	1336556604	1336556604	1	1	GRIESINGER, MICHAEL G MD	10/4/2018	207P00000X	NA	Other	026	PHYSICIANS	155029	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
221114	Fee-for-Service	1083699805	1083699805	1	1	GENOVA, RONALD T MD	7/16/2010	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
221149	Fee-for-Service	1376925057	1376925057	1	1	GIOIOSO, VALERIA MD	4/6/2022	2085R0204X	NA	Other	026	PHYSICIANS	168394	None	None	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
221159	Fee-for-Service	1326583147	1326583147	1	1	GERE, RYAN PT	2/25/2019	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
221179	Fee-for-Service	1154480788	1154480788	1	1	GAUDET, JAMES W MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62534	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
221221	Fee-for-Service	1487685426	1487685426	1	1	GALOUSTIAN, ARTHUR MD	7/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95220	41	Internal Medicine	0	In state provider	None	4361 LATHAM ST	STE 150	RIVERSIDE	CA	92501	1768	33	06065	34.00212634	-117.3743133	Riverside County
221328	Fee-for-Service	1174825947	1174825947	1	1	GOLD COUNTRY EMERGENCY	12/10/2010	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PHYSICIANS MEDICAL GROUP	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
221371	Fee-for-Service	1528003423	1528003423	1	1	GARFIELD BEACH CVS, LLC	9/14/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	189 S TURNPIKE RD	None	GOLETA	CA	93111	2208	42	06083	34.43707915	-119.7896065	Santa Barbara County
221372	Fee-for-Service	1639115793	1639115793	1	1	GARFIELD BEACH CVS, LLC	10/20/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4404 EL CAJON BLVD	None	SAN DIEGO	CA	92115	4310	37	06073	32.75515147	-117.0999359	San Diego County
221376	Fee-for-Service	1700813565	1700813565	1	1	GESCHWIND, MICHAEL D MD	11/16/2000	2084N0400X	NA	Neurology	026	PHYSICIANS	73472	13	Neurology (M.D. only)	0	In state provider	None	350 PARNASSUS AVE	STE 800	SAN FRANCISCO	CA	94117	3624	38	06075	37.76403932	-122.4561371	San Francisco County
221470	Fee-for-Service	1578612834	1578612834	1	1	GHASSEMI, MAJID MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80487	22	Pathology (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
221499	Fee-for-Service	1578655866	1578655866	1	1	GEOFFRY S JONES M.D.	2/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	714 W PINE ST	None	NEWPORT	WA	99156	9046	00	None	48.1820733	-117.0490023	Pend Oreille County
221501	Fee-for-Service	1659733673	1659733673	1	1	GERDTS, JOSIAH K MD	6/26/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	152707	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
221510	Fee-for-Service	1487685426	1487685426	1	1	GALOUSTIAN, ARTHUR MD	7/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95220	45	Nephrology (Renal-Kidney)	0	In state provider	None	4361 LATHAM ST	STE 150	RIVERSIDE	CA	92501	1768	33	06065	34.00212634	-117.3743133	Riverside County
221523	Fee-for-Service	1255654737	1255654737	1	1	GERBER, ZEROMEH L MD	8/16/2016	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
221528	Fee-for-Service	1780722181	1780722181	1	1	GOLDBERG, NEIL J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	25363	41	Internal Medicine	0	In state provider	None	9808 VENICE BLVD	STE 603	CULVER CITY	CA	90232	6819	19	06037	34.0236396	-118.3980847	Los Angeles County
221550	Fee-for-Service	1184906638	1184906638	1	1	GUTMAN, DAVID A MD	8/4/2020	207L00000X	NA	Other	026	PHYSICIANS	139678	05	Anesthesiology	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
221584	Fee-for-Service	1720668601	1720668601	1	1	GURUNG, PURNIMA MD	10/6/2024	207R00000X	NA	Other	026	PHYSICIANS	None	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
221687	Fee-for-Service	1457638256	1457638256	1	1	GHEORGHE, CIPRIAN P MD	11/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149233	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
221709	Fee-for-Service	1699101550	1699101550	1	1	GUO, SISI PHD	4/29/2019	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
221711	Fee-for-Service	1578550174	1578550174	1	1	GARDEN CITY HOSPITAL	12/14/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OSTEOPATHIC	6245 N INKSTER ROAD	None	GARDEN CITY	MI	48135	4001	00	None	42.33238334	-83.31185156	Wayne County
221734	Fee-for-Service	1568773984	1568773984	1	1	GOLD, JEFFREY J MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111541	13	Neurology (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
221735	Fee-for-Service	1891851861	1891851861	1	1	GILL, CADRIN E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34954	None	None	0	In state provider	None	231 W VERNON AVE	STE 201	LOS ANGELES	CA	90037	2779	19	06037	34.0038305	-118.2774195	Los Angeles County
221736	Fee-for-Service	1265018105	1265018105	1	1	GRADY, FREDERICK MD	9/18/2024	207R00000X	NA	Other	026	PHYSICIANS	189123	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
221806	Fee-for-Service	1386714905	1386714905	1	1	GOOTNICK, SUSAN A M MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	23580	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
221813	Fee-for-Service	1619003761	1619003761	1	2	GRAHAM, JIMMICA NP	4/10/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 N PEPPER AVE	FL 6	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
221816	Fee-for-Service	1881617397	1881617397	1	3	GARCIA, JERRY S MD	5/20/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	86442	08	Family Practice	0	In state provider	None	3940 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1458	15	06029	35.39601	-119.0081515	Kern County
221818	Fee-for-Service	1528146149	1528146149	1	1	GALVIN, EUGENE G MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35211	20	Orthopedic 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
221850	Fee-for-Service	1992740898	1992740898	1	1	GARFIELD BEACH CVS LLC	12/19/2006	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	270 W LINCOLN AVE	None	ANAHEIM	CA	92805	2903	30	06059	33.83532693	-117.9171168	Orange County
221877	Fee-for-Service	1114332111	1114332111	1	1	GASTELUM, ROBERT C LMFT	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3333 SKY PARK DR	STE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
221884	Fee-for-Service	1467728048	1467728048	1	1	GREENBLATT, RACHEL M MD	5/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127198	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
221898	Fee-for-Service	1780799809	1780799809	1	1	GALANT, STANLEY P MD	1/9/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	21143	03	Allergy	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
221938	Fee-for-Service	1043856263	1043856263	1	1	GAURAV GANDOTRA INC	4/3/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	5900 BROCKTON	None	RIVERSIDE	CA	92506	1862	33	06065	33.96263615	-117.395639	Riverside County
221949	Fee-for-Service	1821094764	1821094764	1	1	GOKCEN, ERIC C MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89312	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
221984	Fee-for-Service	1174586531	1174586531	1	1	GUPTA, RAMESH CHANDER MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45356	41	Internal Medicine	0	In state provider	None	2323 16TH ST	STE 300	BAKERSFIELD	CA	93301	3453	15	06029	35.37238027	-119.0288508	Kern County
221998	Fee-for-Service	1578550174	1578550174	1	1	GARDEN CITY HOSPITAL	12/14/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	OSTEOPATHIC	6245 N INKSTER ROAD	None	GARDEN CITY	MI	48135	4001	00	None	42.33238334	-83.31185156	Wayne County
222022	Fee-for-Service	1568773984	1568773984	1	1	GOLD, JEFFREY J MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111541	79	Neurology-Child	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
222024	Fee-for-Service	1912389149	1912389149	1	1	GESSLING, ALIYA MD	11/30/2018	207R00000X	NA	Other	026	PHYSICIANS	152979	41	Internal Medicine	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
222037	Fee-for-Service	1831376862	1831376862	2	1	GARFIELD BEACH CVS LLC	3/2/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	245 S MILLS RD	None	VENTURA	CA	93303	3435	56	06111	34.27018037	-119.2472314	Ventura County
222039	Fee-for-Service	1407830177	1407830177	1	2	GJERDRUM, THOR C MD	10/17/2017	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	16055	20	Orthopedic Surgery	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
222058	Fee-for-Service	1497399471	1497399471	1	1	GOTTSCHALK, RICHARD LMFT	3/3/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
222070	Fee-for-Service	1891728879	1891728879	1	1	GOSKE-RUDICK,MARILYN 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	0000	00	None	39.14105892	-84.50040782	Hamilton County
222073	Fee-for-Service	1265774848	1265774848	1	1	GUERRA BONILLA, GERARDO MD	7/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137864	01	General Practice	0	In state provider	None	632 W GIBSON ROAD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
222098	Fee-for-Service	1689734584	1689734584	1	1	GOH, YINGYING MD	2/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91513	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
222118	Fee-for-Service	1780795096	1780795096	1	1	GARNER, DIANE J	12/1/2005	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9280 W STOCKTON BLVD	STE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
222187	Fee-for-Service	1780799809	1780799809	1	1	GALANT, STANLEY P MD	1/9/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	21143	43	Pediatric Allergy	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
222189	Fee-for-Service	1346696911	1346696911	1	1	GORANTLA, VARUN MD	12/30/2022	2085R0204X	NA	Other	026	PHYSICIANS	172233	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
222190	Fee-for-Service	1316366040	1316366040	1	1	GILBERT, MEGAN M MD	10/3/2022	2080P0207X	NA	Hematology	026	PHYSICIANS	137668	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
222272	Fee-for-Service	1174586531	1174586531	1	1	GUPTA, RAMESH CHANDER MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45356	10	Gastroenterology (M.D. only)	0	In state provider	None	2323 16TH ST	STE 300	BAKERSFIELD	CA	93301	3453	15	06029	35.37238027	-119.0288508	Kern County
222307	Fee-for-Service	1649526203	1649526203	1	1	GRANT, LEON DO	2/22/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	79	Neurology-Child	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
222314	Fee-for-Service	1184898348	1184898348	1	1	GATLIN, MEGAN R DO	1/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12116	05	Anesthesiology	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	9468	37	06073	33.12542915	-117.0764725	San Diego County
222385	Fee-for-Service	1376069179	1376069179	1	1	GREEN PACIFIC COUNSELING &	5/29/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGY INC	23282 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92570	2125	30	06059	33.62362882	-117.735751	Orange County
222413	Fee-for-Service	1043789159	1043789159	1	1	GALINDO, LAURA A NP	11/15/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
222428	Fee-for-Service	1003873522	1003873522	1	1	GIDAYA, ERNESTO P MD JR	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	38770	05	Anesthesiology	0	In state provider	None	1025 E ANAHEIM BLVD	None	ANAHEIM	CA	92805	5878	30	06059	33.81994338	-117.9087416	Orange County
222461	Fee-for-Service	1154772325	1154772325	1	1	GONG, SENA MD	8/15/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
222473	Fee-for-Service	1780799809	1780799809	1	1	GALANT, STANLEY P MD	1/9/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	21143	40	Pediatrics	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
222505	Fee-for-Service	1134129182	1134129182	1	1	GIGLIO, MARK F MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67099	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
222519	Fee-for-Service	1396060869	1396060869	1	1	GARG, VIKRAM K MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111128	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
222520	Fee-for-Service	1396060638	1396060638	1	1	GLOVER, GREGORY S MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141637	None	None	0	In state provider	None	24022 CALLE DE LA PLATA	SUITE 500	LAGUNA HILLS	CA	92653	7612	30	06059	33.6104493	-117.7110924	Orange County
222539	Fee-for-Service	1437168408	1437168408	1	1	GHIDONI, FRANCIS W MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40282	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
222571	Fee-for-Service	1407845365	1407845365	1	1	GREEN-ALTER, LYNDA LMFT	7/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4 VENTURE	STE 230	IRVINE	CA	92618	3338	30	06059	33.6596609	-117.7526937	Orange County
222584	Fee-for-Service	1518552660	1518552660	2	1	GHST RX INC	12/22/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16260 VENTURA BLVD	STE 100	ENCINO	CA	91436	2207	19	06037	34.15687678	-118.4876342	Los Angeles County
222587	Fee-for-Service	1972544849	1972544849	1	1	GARFIELD BEACH CVS LLC	5/17/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21051 SHERMAN WAY	None	CANOGA PARK	CA	91303	1746	19	06037	34.20111498	-118.5922915	Los Angeles County
222601	Fee-for-Service	1881189975	1881189975	1	1	GANGE, KAREN D NP	4/19/2022	363LF0000X	NA	Nurse Practitioner	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
222616	Fee-for-Service	1336672716	1336672716	1	1	GONZALEZ, DANIEL MD	11/14/2023	207ZC0008X	NA	Other	026	PHYSICIANS	186364	None	None	0	In state provider	None	6605 NANCY RIDGE DR	None	SAN DIEGO	CA	92121	2253	37	06073	32.88682438	-117.1796133	San Diego County
222661	Fee-for-Service	1770366833	1770366833	1	1	GABUTINA, MARIA TERESA	9/19/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	25091 PACIFIC CREST ST	None	CORONA	CA	92883	3116	33	06065	33.75483069	-117.4719093	Riverside County
222670	Fee-for-Service	1215965223	1215965223	1	1	GRACE MEDICAL GROUP	10/28/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	OF THE VALLEY INC	2740 N GAREY AVE	STE 100	POMONA	CA	91767	1800	19	06037	34.095168	-117.748473	Los Angeles County
222682	Fee-for-Service	1053589648	1053589648	1	1	GARRIDO, JOSE M MD	5/25/2010	208M00000X	NA	Other	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2640 E BARNETT RD	None	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
222685	Fee-for-Service	1285611376	1285611376	1	1	GEBHART, CYNTHIA A CRNA	7/13/2017	No Taxonomy Provided	NA	None	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
222718	Fee-for-Service	1003873522	1003873522	1	1	GIDAYA, ERNESTO P MD JR	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	38770	01	General Practice	0	In state provider	None	1025 E ANAHEIM BLVD	None	ANAHEIM	CA	92805	5878	30	06059	33.81994338	-117.9087416	Orange County
222721	Fee-for-Service	1851928311	1851928311	1	1	GONZALEZ-ERIVES, CHRISTOPHER	10/23/2023	207R00000X	NA	Other	026	PHYSICIANS	184612	None	None	0	In state provider	MD	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
222787	Fee-for-Service	1124030614	1124030614	1	1	GERSHFIELD, KRISTIN B MD	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74001	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
222797	Fee-for-Service	1457845604	1457845604	1	1	GABRIEL, JON M LCSW	1/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
222818	Fee-for-Service	1477068229	1477068229	1	1	GEBRE, ASMARA CNM	1/31/2018	176B00000X	NA	Licensed Midwife	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
222834	Fee-for-Service	1679713804	1679713804	1	1	GUTDOCTORS INC	6/26/2009	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	57458	41	Internal Medicine	0	In state provider	None	221 W PUEBLO STREET	SUITE B	SANTA BARBARA	CA	93105	6814	42	06083	34.431101	-119.7212764	Santa Barbara County
222859	Fee-for-Service	1851556864	1851556864	1	1	GOLDENSTEIN, LEONARD A MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117171	45	Nephrology (Renal-Kidney)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
222865	Fee-for-Service	1639324627	1639324627	1	2	GREY, ANGELA M LMFT	8/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
222874	Fee-for-Service	1649390600	1649390600	1	1	GHASSEMY, KIMIA	12/30/2024	103TC0700X	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
222875	Fee-for-Service	1043418452	1043418452	1	1	GLENN, JAMIESON S MD	7/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89805	20	Orthopedic Surgery	0	In state provider	None	332 SANTA FE DRIVE	SUITE 110	ENCINITAS	CA	92024	5143	37	06073	33.039567	-117.2850165	San Diego County
222948	Fee-for-Service	1770366833	1770366833	1	1	GABUTINA, MARIA TERESA	9/19/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	25091 PACIFIC CREST ST	None	CORONA	CA	92883	3116	33	06065	33.75483069	-117.4719093	Riverside County
222951	Fee-for-Service	1205834751	1205834751	1	1	GOLDIN, MARK A MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	48132	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
222956	Fee-for-Service	1710924121	1710924121	1	1	GEE, SAMANTHA W	9/16/2020	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
222960	Fee-for-Service	1891310918	1891310918	1	1	GONZALEZ, REBECCA PSYD	2/19/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
222972	Fee-for-Service	1609222561	1609222561	1	1	GUNASELCAM, RATHINARAJ CRNA	12/18/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
223002	Fee-for-Service	1104974039	1104974039	1	1	GLUPCZYNSKI, DEBORAH MD	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85071	08	Family Practice	0	In state provider	None	1510 SAN PABLO ST	STE 104	LOS ANGELES	CA	90033	5392	19	06037	34.06287152	-118.2029433	Los Angeles County
223017	Fee-for-Service	1174011431	1174011431	1	1	GEFTER, MARICELA R LMFT	4/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8523 MELVIN AVE	None	NORTHRIDGE	CA	91324	4136	19	06037	34.22531785	-118.5600293	Los Angeles County
223022	Fee-for-Service	1598782468	1598782468	1	1	GOFMAN, INESSA MD	6/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88685	40	Pediatrics	0	In state provider	None	2340 CLAY ST	FL 3	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
223090	Fee-for-Service	1437112620	1437112620	1	1	GUPTA, DEEPSHIKHA DPM	7/10/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	DPM	2545 WEST HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
223093	Fee-for-Service	1013634013	1013634013	1	1	GARCIA, SANDRA NP	2/24/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
223121	Fee-for-Service	1679713804	1679713804	1	1	GUTDOCTORS INC	6/26/2009	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	57458	10	Gastroenterology (M.D. only)	0	In state provider	None	221 W PUEBLO STREET	SUITE B	SANTA BARBARA	CA	93105	6814	42	06083	34.431101	-119.7212764	Santa Barbara County
223145	Fee-for-Service	1689037756	1689037756	1	1	GEBRESELASSIE, KIRUBEL MD	12/20/2021	207R00000X	NA	Other	026	PHYSICIANS	173761	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
223147	Fee-for-Service	1508849001	1508849001	1	1	GUIRGUIS, LISA M MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	56253	02	General Surgery	0	In state provider	None	50 BELLEFONTAINE ST	STE 104	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
223208	Fee-for-Service	1942388574	1942388574	1	1	GOLDSTEIN, SANFORD M	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	37506	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	# A304	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
223213	Fee-for-Service	1861679730	1861679730	1	1	GREWAL, AMANDEEP K	10/3/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
223228	Fee-for-Service	1619458072	1619458072	1	1	GEBHARDT, BRIANNE E NP	9/5/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	SANTA CLARA	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara
223319	Fee-for-Service	1730610148	1730610148	1	1	GONZALEZ, PATRICIA LMFT	6/10/2019	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
223343	Fee-for-Service	1255531620	1255531620	1	1	GUEVARRA-VITUG, KERSTIN I MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103931	08	Family Practice	0	In state provider	None	3132 WEST MARCH LANE	SUITE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
223425	Fee-for-Service	1659448520	1659448520	1	1	GIN, NANCY MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	62486	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
223454	Fee-for-Service	1558455972	1558455972	2	1	GOODSAMHEALTH INC	5/10/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8530 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4605	30	06059	33.75929606	-117.9795967	Orange County
223459	Fee-for-Service	1114019213	1114019213	1	1	GORDO, JOSE A MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	32884	15	Obstetrics (D.O. only)	0	In state provider	None	1658 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1605523	Los Angeles County
223496	Fee-for-Service	1306282322	1306282322	1	1	GERMAIN, RITA CNP	8/7/2022	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
223529	Fee-for-Service	1174591994	1174591994	1	1	GUJRAL, NAVJYOT MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60836	10	Gastroenterology (M.D. only)	0	In state provider	CARE GASTRO MEDICAL GRP	675 CAMINO DE LOS MARES	STE 403	SAN CLEMENTE	CA	92673	2867	30	06059	33.45710369	-117.6474248	Orange County
223624	Fee-for-Service	1710064357	1710064357	1	1	GUPTHA, SUSHMA N MD	11/19/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158405	40	Pediatrics	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
223669	Fee-for-Service	1790088714	1790088714	1	1	GARCIA, SARAH A DO	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11425	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1147 RED TAIL WAY	None	SIMI VALLEY	CA	93065	7232	56	06111	34.25942227	-118.7951311	Ventura County
223675	Fee-for-Service	1730116385	1730116385	1	1	GONZALEZ, JAIME E MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70475	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
223716	Fee-for-Service	1184925190	1184925190	1	1	GERMON, PATRICIA D LMFT	8/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
223717	Fee-for-Service	1700532298	1700532298	1	1	GRACE RETIREMENT VILLAGE INC	5/26/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1100 E WHITTIER BLVD	None	LA HABRA	CA	90631	3962	30	06059	33.93881562	-117.9337198	Orange County
223723	Fee-for-Service	1356558266	1356558266	1	1	GOODLOVE, GLENN P LCSW	7/1/2001	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	10749 ESCOBAR DR	None	SAN DIEGO	CA	92124	2026	37	06073	32.82347811	-117.0993771	San Diego County
223757	Fee-for-Service	1164957098	1164957098	1	1	GLEASON, AUGUSTUS MD	1/16/2025	208600000X	NA	General Surgery	026	PHYSICIANS	191536	02	General Surgery	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
223800	Fee-for-Service	1942806849	1942806849	1	1	GOOD, TOPAZ LMFT	6/18/2024	101YM0800X	NA	Other	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
223819	Fee-for-Service	1174591994	1174591994	1	1	GUJRAL, NAVJYOT MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60836	41	Internal Medicine	0	In state provider	CARE GASTRO MEDICAL GRP	675 CAMINO DE LOS MARES	STE 403	SAN CLEMENTE	CA	92673	2867	30	06059	33.45710369	-117.6474248	Orange County
223828	Fee-for-Service	1265127450	1265127450	1	1	GOLD STAR MEDICAL TRANSPORT	6/14/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC.	10681 PRODUCTION AVE	R08	FONTANA	CA	92337	8006	36	06071	34.058961	-117.429174	San Bernardino County
223842	Fee-for-Service	1174006787	1174006787	1	1	GRAY, RYAN D PT	3/8/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
223859	Fee-for-Service	1720522063	1720522063	1	1	GLENDALE NEUROLOGICAL CLINIC	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	DR RM HUTCHMAN	517 EAST WILSON AVE	SUITE 103B	GLENDALE	CA	91206	4376	19	06037	34.14818643	-118.2491864	Los Angeles County
223865	Fee-for-Service	1144852534	1144852534	1	1	GUZMAN, STEPHANY C LMFT	4/8/2024	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
223868	Fee-for-Service	1407261886	1407261886	1	1	GRECO, ANTHONY PSYD	1/9/2025	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
223949	Fee-for-Service	1629153788	1629153788	1	1	GLASSER, JAY DPM	7/10/1980	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1178 SAN PABLO AVE	None	BERKELEY	CA	94706	2245	01	06001	37.88303205	-122.2967317	Alameda County
223973	Fee-for-Service	1881836096	1881836096	1	1	GUO, LEI MD	8/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118973	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
223974	Fee-for-Service	1720509219	1720509219	1	1	GORSKI, EMILY OD	8/15/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
224036	Fee-for-Service	1285670349	1285670349	1	1	GARFIELD BEACH CVS LLC	6/29/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13303 E SOUTH ST	None	CERRITOS	CA	90703	7308	19	06037	33.85877648	-118.048464	Los Angeles County
224074	Fee-for-Service	1639503584	1639503584	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	125 SHORELINE PKWY	None	SAN RAFAEL	CA	94901	5521	21	06041	37.95335767	-122.4904394	Marin County
224085	Fee-for-Service	1659419885	1659419885	1	1	GROSS-MOHLER, JACALYN M LMFT	2/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
224086	Fee-for-Service	1740236280	1740236280	1	1	GRODEN, JOEL D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65019	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
224097	Fee-for-Service	1154314102	1154314102	1	1	GARG, RUCHI MD	9/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
224134	Fee-for-Service	1578026050	1578026050	1	1	GOEL, DIVESH MD	7/19/2022	207R00000X	NA	Other	026	PHYSICIANS	178405	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
224191	Fee-for-Service	1346251287	1346251287	1	1	GROVER, RYAN S MD	9/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81474	78	Neoplastic Diseases/Oncology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
224200	Fee-for-Service	1457576563	1457576563	1	1	GLUHOVSKY, INNA M PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	550 HAMILTON AVE	STE 207	PALO ALTO	CA	94301	2010	43	06085	37.44836519	-122.1570275	Santa Clara County
224229	Fee-for-Service	1982650115	1982650115	1	1	GLUCK, STEPHEN L MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84102	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
224283	Fee-for-Service	1871535062	1871535062	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	150 W WILLOW ST	None	POMONA	CA	91768	1828	19	06037	34.07855818	-117.7526573	Los Angeles County
224289	Fee-for-Service	1245760578	1245760578	1	1	GUERIN, WILLIAM A MD	8/10/2018	390200000X	NA	Other	026	PHYSICIANS	157094	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
224440	Fee-for-Service	1740221662	1740221662	1	1	GARFIELD BEACH CVS LLC	5/17/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15210 ROSECRANS AVE	None	LA MIRADA	CA	90638	4735	19	06037	33.89867488	-118.0063517	Los Angeles County
224481	Fee-for-Service	1346251287	1346251287	1	1	GROVER, RYAN S MD	9/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81474	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
224515	Fee-for-Service	1740381177	1740381177	1	1	GARB, KEITH S MD	11/1/2023	207R00000X	NA	Other	026	PHYSICIANS	54512	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
224517	Fee-for-Service	1982650115	1982650115	1	1	GLUCK, STEPHEN L MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84102	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
224522	Fee-for-Service	1346688322	1346688322	1	1	GHARIBIAN GHARGHANI, GEORGE	7/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	28242	-	NOT APPLICABLE	0	In state provider	PSY	3580 WILSHIRE BLVD	2000	LOS ANGELES	CA	90010	2521	19	06037	34.06170677	-118.302787	Los Angeles County
224546	Fee-for-Service	1023428752	1023428752	1	1	GARCIA, CHRISTY L LMFT	11/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2560 CATAMARAN WAY	STE. 27	CHULA VISTA	CA	91914	4533	37	06073	32.65595994	-116.9580562	San Diego County
224547	Fee-for-Service	1245526607	1245526607	1	1	GOEL, GUNJAN MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122057	14	Neurological Surgery	0	In state provider	None	3750 CONVOY ST	STE 301	SAN DIEGO	CA	92111	3741	37	06073	32.81201122	-117.1531108	San Diego County
224550	Fee-for-Service	1942432679	1942432679	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11000 STOCKDALE HWY	None	BAKERSFIELD	CA	93311	3635	15	06029	35.34881549	-119.1250457	Kern County
224587	Fee-for-Service	1538181227	1538181227	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9100 ROSEDALE HWY	None	BAKERSFIELD	CA	93312	2143	15	06029	35.385732	-119.1031425	Kern County
224672	Fee-for-Service	1003006149	1003006149	1	1	GAMBOA, STEPHEN H MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	93276	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
224732	Fee-for-Service	1891177242	1891177242	1	1	GIAFAGLIONE, SARAH M MD	6/6/2019	207L00000X	NA	Other	026	PHYSICIANS	160581	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
224769	Fee-for-Service	1407144330	1407144330	1	1	GREGORY, DWIGHT	8/22/2011	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	11940 FOOTHILL BLVD	SUITE 107	RANCHO CUCAMONGA	CA	91739	9375	36	06071	34.10646853	-117.544239	San Bernardino County
224826	Fee-for-Service	1023737905	1023737905	1	1	GEBROE, DAVID B	9/23/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	4206 WOODRUFF AVENUE	None	LAKEWOOD	CA	90713	3143	19	06037	33.834438	-118.116514	Los Angeles County
224873	Fee-for-Service	1396877494	1396877494	1	1	GONZALES, JENNIFER B NP	10/10/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27309 MADISON AVE	None	TEMECULA	CA	92590	5685	33	06065	33.52449693	-117.166286	Riverside County
224962	Fee-for-Service	1053483875	1053483875	1	1	GONG, MADELINE T MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55959	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
225022	Fee-for-Service	1508098021	1508098021	1	1	GENGENBACHER, MARIA A PSYD	4/23/2019	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
225034	Fee-for-Service	1558741363	1558741363	1	1	GOMEZ, JOANNE MD	8/12/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	171998	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
225061	Fee-for-Service	1124047758	1124047758	1	1	GARG, NALINI MD	8/25/2010	207L00000X	NA	Other	026	PHYSICIANS	50326	05	Anesthesiology	0	In state provider	None	1798 N. GAREY AVENUE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
225091	Fee-for-Service	1952690349	1952690349	1	1	GAUR, SAREL MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	157783	30	Radiology	0	In state provider	None	250 SOUTH GRAND AVE	None	GLENDORA	CA	91740	4218	19	06037	34.132842	-117.872523	Los Angeles County
225130	Fee-for-Service	1275526279	1275526279	1	1	GUIDO, DONALD J OD INC	12/26/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	LAVERNE OPTOMETRY	2248 D ST	None	LA VERNE	CA	91750	5403	19	06037	34.10030594	-117.7702602	Los Angeles County
225161	Fee-for-Service	1063685311	1063685311	2	1	GARDNER FAMILY HEALTH NETWOR	8/12/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	K	160 E VIRGINIA ST	264	SAN JOSE	CA	95112	5857	43	06085	37.32582868	-121.8777868	Santa Clara County
225179	Fee-for-Service	1306413281	1306413281	1	1	GALVAN, ALBERTO PT	7/21/2023	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
225180	Fee-for-Service	1780891945	1780891945	1	1	GONCALVES, LUIS F MD	12/4/2018	2085P0229X	NA	Other	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
225206	Fee-for-Service	1932204385	1932204385	1	1	GEARY COUNTY HOSPITAL	8/22/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1102 SAINT MARYS ROAD	None	JUNCTION CITY	KS	66441	4196	00	None	39.0135326	-96.85014563	Geary County
225213	Fee-for-Service	1669450797	1669450797	1	1	GRAHAM,JAMES 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	708 HILL COUNTY DR	STE 300A	KERRVILLE	TX	78028	0000	00	None	30.04180675	-99.14859192	Kerr County
225247	Fee-for-Service	1053483875	1053483875	1	1	GONG, MADELINE T MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55959	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
225276	Fee-for-Service	1346295409	1346295409	1	1	GREENBERG, GARY MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	37319	05	Anesthesiology	0	In state provider	None	2920 F ST	# 15	BAKERSFIELD	CA	93301	1845	15	06029	35.385993	-119.0234435	Kern County
225320	Fee-for-Service	1699052506	1699052506	1	1	GREEN, ROBERT B AU	4/20/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
225337	Fee-for-Service	1730594797	1730594797	1	1	GEENTY, SHANNON LMFT	11/18/2022	390200000X	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
225345	Fee-for-Service	1114922192	1114922192	1	2	GASTROENTEROLOGY ASSOCIATES	7/1/2016	282N00000X	NA	Hospitals	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ENDOSCOPY CENTER LLC	2179 COURT ST	None	REDDING	CA	96001	2531	45	06089	40.57681053	-122.392999	Shasta County
225356	Fee-for-Service	1821369877	1821369877	1	1	GANDHI, KUMAR S MD	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122756	41	Internal Medicine	0	In state provider	None	612 E JANSS RD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
225385	Fee-for-Service	1154332682	1154332682	1	1	GEORGE, DONALD E MD	10/31/2019	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	165687	10	Gastroenterology (M.D. only)	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
225406	Fee-for-Service	1801924576	1801924576	1	1	GAFFNEY, FELISA D PSYD	2/26/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ND CONSULTING	3700 DELTA FAIR BLVD	STE 210	ANTIOCH	CA	94509	4074	07	06013	38.0038852	-121.8448833	Contra Costa County
225494	Fee-for-Service	1932204385	1932204385	1	1	GEARY COUNTY HOSPITAL	8/22/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1102 SAINT MARYS ROAD	None	JUNCTION CITY	KS	66441	4196	00	None	39.0135326	-96.85014563	Geary County
225500	Fee-for-Service	1124260534	1124260534	1	1	GRENON, MARLENE MD	5/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112403	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
225502	Fee-for-Service	1538857024	1538857024	1	1	GIVE SOMETHING BACK, A NEW J	8/29/2024	1041S0200X	NA	Mental Health Outpatient Services	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	ERSEY NONPROFIT CORPORAT	11374 MT VIEW AVE	DOVER BLDG SUITE D	LOMA LINDA	CA	92354	3815	36	06071	34.0465275	-117.2436991	San Bernardino County
225524	Fee-for-Service	1104043660	1104043660	1	1	GO, SUBIL C MD	5/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102159	41	Internal Medicine	0	In state provider	None	1525 PLUMAS CT	SUITE C	YUBA CITY	CA	95991	2971	51	06101	39.15274768	-121.6184473	Sutter County
225529	Fee-for-Service	1013571231	1013571231	1	1	GEKAS, ANDREA R CNM	6/10/2022	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
225545	Fee-for-Service	1063758738	1063758738	1	1	GRUWELL, CARIN H NP	12/2/2016	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
225562	Fee-for-Service	1346295409	1346295409	1	1	GREENBERG, GARY MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	37319	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2920 F ST	# 15	BAKERSFIELD	CA	93301	1845	15	06029	35.385993	-119.0234435	Kern County
225641	Fee-for-Service	1447001136	1447001136	1	1	GONZALEZ, CRISTINA NP	11/18/2024	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
225704	Fee-for-Service	1487640405	1487640405	1	1	GREENFIELD, ANDREW K MD	2/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	30934	30	Radiology	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
225713	Fee-for-Service	1992701528	1992701528	1	1	GILDERSLEEVE, N MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25652	30	Radiology	0	In state provider	None	1047 R ST	None	FRESNO	CA	93721	1312	10	06019	36.7403869	-119.7827521	Fresno County
225746	Fee-for-Service	1245517028	1245517028	1	1	GARUBBA, KRISTEN LMFT	12/30/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	68 RIO RANCHO RD	UNIT 201-202	POMONA	CA	91766	4898	19	06037	34.02838295	-117.7610355	Los Angeles County
225763	Fee-for-Service	1093066359	1093066359	1	2	GOMEZ, ELENA N PSYD	6/10/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	676 CHENERY ST	None	SAN FRANCISCO	CA	94131	3034	38	06075	37.7345429	-122.4335969	San Francisco County
225867	Fee-for-Service	1477711521	1477711521	1	1	GORDON, CHRISTOPHER J MD	7/31/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	83390	-	NOT APPLICABLE	0	In state provider	None	2136 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1102	37	06073	32.75537928	-117.1416551	San Diego County
225874	Fee-for-Service	1851663173	1851663173	1	1	GEORGE, SONYA M LMFT	12/2/2021	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
225881	Fee-for-Service	1891223608	1891223608	1	1	GHOTRA, GURINDER S MD	9/16/2020	207R00000X	NA	Other	026	PHYSICIANS	169722	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
225897	Fee-for-Service	1548252620	1548252620	1	1	GHC OF CANOGA PARK LLC	1/26/2005	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	22029 SATICOY ST	None	CANOGA PARK	CA	91303	1133	19	06037	34.20833477	-118.6075568	Los Angeles County
225917	Fee-for-Service	1902178304	1902178304	1	1	GADE, VAMSHIDHARA R MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122369	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092468	-117.2977236	San Bernardino County
225933	Fee-for-Service	1891931903	1891931903	1	1	GIFFROW, HELEN LMFT	12/26/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	740 FRONT ST.	STE. 250	SANTA CRUZ	CA	95060	3661	44	06087	36.97547419	-122.0254852	Santa Cruz County
225936	Fee-for-Service	1457474157	1457474157	1	1	GRAHAM-SEGO CORPORATION	3/25/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	T	1317 GARDEN STREET	None	TITUSVILLE	FL	32796	3310	00	None	28.6152987	-80.81841386	Brevard County
225946	Fee-for-Service	1548879422	1548879422	1	1	GREEN, BRANDON M LMFT	7/3/2024	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
225949	Fee-for-Service	1437485166	1437485166	1	1	GEORGE, JONATHAN R MD	6/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111490	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
225952	Fee-for-Service	1922412907	1922412907	1	1	GLISHICH, TINA LMFT	12/20/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5330 PRIMROSE DR	SUITE 240	FAIR OAKS	CA	95628	3542	34	06067	38.662623	-121.275936	Sacramento County
225958	Fee-for-Service	1336234814	1336234814	1	1	GUPTA, SUNEET K OD	6/30/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3233 GRAND AVE	STE M	CHINO HILLS	CA	91709	1489	36	06071	34.00183432	-117.7350487	San Bernardino County
225975	Fee-for-Service	1770872590	1770872590	1	1	GARCIA CORTES,ROBERTINO C MD	8/3/2017	208M00000X	NA	Other	026	PHYSICIANS	144730	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
225994	Fee-for-Service	1447710264	1447710264	1	1	GUSTIN, TAYLOR M DO	10/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19311	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
226068	Fee-for-Service	1467456426	1467456426	1	1	GELFOND, STEPHEN 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	8902 FLOY CURL DRIVE	None	SAN ANTONIO	TX	78240	0000	00	None	29.526624	-98.59073037	Bexar County
226072	Fee-for-Service	1811278112	1811278112	1	1	GONZALEZ MARTINEZ, JUANA MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117419	None	None	0	In state provider	None	250 BON AIR RD	3RD FLR	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
226084	Fee-for-Service	1841894185	1841894185	1	1	GUIRGUIS, JUSTINA	8/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2275 S. MAIN ST.	SUITE 201	CORONA	CA	92882	5303	33	06065	33.85511663	-117.5694892	Riverside County
226093	Fee-for-Service	1730124371	1730124371	1	1	GROVES, MARY J MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156583	01	General Practice	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
226104	Fee-for-Service	1538545835	1538545835	1	1	GIMAG CORP	4/26/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4047 1ST STREET	SUITE 101 AND 103	LIVERMORE	CA	94551	4926	01	06001	37.6934302	-121.7483657	Alameda County
226115	Fee-for-Service	1053575787	1053575787	1	1	GOTSCH, WHITNEY E	10/3/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
226138	Fee-for-Service	1841826781	1841826781	1	1	GURNING, JESSICA S DO	4/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19579	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
226148	Fee-for-Service	1588650436	1588650436	1	1	GARCES, MAXIMILIAN E MD	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	74268	41	Internal Medicine	0	In state provider	None	607 S GLENOAKS BLVD	None	BURBANK	CA	91502	1424	19	06037	34.17950025	-118.3013539	Los Angeles County
226159	Fee-for-Service	1013357789	1013357789	1	1	GREEN, JENNA	5/24/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
226169	Fee-for-Service	1306800180	1306800180	1	2	GEHR, MARC K MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67338	41	Internal Medicine	0	In state provider	None	550 WASHINGTON ST	# 114	SAN DIEGO	CA	92103	2213	37	06073	32.75003652	-117.1603431	San Diego County
226185	Fee-for-Service	1639609001	1639609001	1	1	GINES, CRYSTAL OT	7/19/2021	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
226201	Fee-for-Service	1033153382	1033153382	1	1	GARFIELD BEACH CVS, LLC	8/29/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5117 LAKEWOOD BLVD	None	LAKEWOOD	CA	90712	2413	19	06037	33.85109211	-118.1428488	Los Angeles County
226205	Fee-for-Service	1457988065	1457988065	1	1	GUNZENHAUSER, ROBERT C MD	4/12/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	189179	18	Ophthalmology	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
226380	Fee-for-Service	1487628681	1487628681	1	1	GALDO, BELLA B MD	10/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177240	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
226397	Fee-for-Service	1497765440	1497765440	1	1	GLENN, DANA MD	7/31/1988	207RH0003X	NA	Oncology	026	PHYSICIANS	60159	68	Hematology	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
226439	Fee-for-Service	1730101338	1730101338	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	900 SHAW AVE	None	CLOVIS	CA	93612	3900	10	06019	36.806535	-119.699001	Fresno County
226477	Fee-for-Service	1912534405	1912534405	1	1	GENG, MENG MD	11/7/2022	390200000X	NA	Other	026	PHYSICIANS	181676	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
226517	Fee-for-Service	1902845134	1902845134	1	1	GOODMAN,JONATHAN 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	2601 ROOSEVELT	None	PHOENIX	AZ	85008	0000	00	None	33.457203	-112.0262625	Maricopa County
226586	Fee-for-Service	1669543559	1669543559	1	1	GIBBS, NANCY E MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	45841	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
226600	Fee-for-Service	1932937174	1932937174	1	1	GORDOVE, GERMAN NP	1/8/2025	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
226604	Fee-for-Service	1831196435	1831196435	1	1	GRANT, JOSEPH M MD	2/5/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	49589	20	Orthopedic Surgery	0	In state provider	#320	5565 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4001	01	06001	37.69215143	-121.8800337	Alameda County
226685	Fee-for-Service	1497765440	1497765440	1	1	GLENN, DANA MD	7/31/1988	207RH0003X	NA	Oncology	026	PHYSICIANS	60159	78	Neoplastic Diseases/Oncology	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
226714	Fee-for-Service	1326110347	1326110347	1	1	GREEN, SCOTT D MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65441	24	Plastic Surgery	0	In state provider	None	95 SCRIPPS DR	None	SACRAMENTO	CA	95825	6320	34	06067	38.571831	-121.409604	Sacramento County
226777	Fee-for-Service	1316074107	1316074107	1	1	GUZMAN, MARISELA A LMFT	7/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
226788	Fee-for-Service	1982865606	1982865606	1	1	GHOLAMI, SEPIDEH MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	109810	02	General Surgery	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
226793	Fee-for-Service	1255339644	1255339644	1	1	GOLDEN VALLEY HEALTH CTR	6/9/2021	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
226814	Fee-for-Service	1881751055	1881751055	1	1	GANSKE MORRILL, ELLEN M OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
226839	Fee-for-Service	1922289628	1922289628	1	1	GUPTA, NEELAM MD	4/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
226867	Fee-for-Service	1174046155	1174046155	1	1	GOMEZ, JONATHAN V LMFT	10/4/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
226870	Fee-for-Service	1699947234	1699947234	1	1	GARZA, DAVID A MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108505	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
226894	Fee-for-Service	1487032355	1487032355	1	1	GRANDHE, SIRISHA MD	9/13/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	145369	None	None	0	In state provider	None	200 TAMAL PLAZA	200	CORTE MADERA	CA	94925	1128	21	06041	37.93574053	-122.5199024	Marin County
226934	Fee-for-Service	1316986888	1316986888	1	3	GHAZI-ASKAR, ZAHRA M MD	2/3/2023	207PP0204X	NA	Other	026	PHYSICIANS	133039	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
226960	Fee-for-Service	1699822304	1699822304	1	1	GREENE, ALAN R MD	6/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63446	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
226973	Fee-for-Service	1497765440	1497765440	1	1	GLENN, DANA MD	7/31/1988	207RH0003X	NA	Oncology	026	PHYSICIANS	60159	41	Internal Medicine	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
226980	Fee-for-Service	1396369427	1396369427	1	1	GREAT AMERICAN HOSPICE CARE	12/2/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	221 W ALAMEDA AVE	SUITE 203	BURBANK	CA	91502	3032	19	06037	34.16890032	-118.3057575	Los Angeles County
227026	Fee-for-Service	1144296526	1144296526	1	1	GEARY, DEBORAH D MD	8/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83388	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1530 RAILROAD AVE	None	SAINT HELENA	CA	94574	1106	28	06055	38.50733846	-122.4714652	Napa County
227043	Fee-for-Service	1891724993	1891724993	1	1	GHALILI, SAMAN	4/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88734	41	Internal Medicine	0	In state provider	None	2101 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	1125	19	06037	34.02564628	-118.2587239	Los Angeles County
227081	Fee-for-Service	1255339644	1255339644	1	1	GOLDEN VALLEY HEALTH CTR	11/11/2024	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
227126	Fee-for-Service	1922289628	1922289628	1	1	GUPTA, NEELAM MD	4/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
227134	Fee-for-Service	1114183993	1114183993	1	1	GOLSHAN, ALI MD	5/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108102	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
227146	Fee-for-Service	1851355713	1851355713	1	1	GIRON, ARCHIEVAL H	6/1/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
227152	Fee-for-Service	1962913632	1962913632	1	1	GRAND AVENUE EMERGENCY PHYSI	4/23/2018	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	CIANS MEDICAL GROUP INC	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
227223	Fee-for-Service	1457998254	1457998254	1	1	GARY BRITO, D.P.T., A PHYSIC	11/19/2020	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3117 FLORINDA	None	POMONA	CA	91767	1013	19	06037	34.10397671	-117.7556703	Los Angeles County
227227	Fee-for-Service	1609152917	1609152917	1	1	GPS TRANSPORTATION LLC	9/17/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2667 CAMINO DEL RIO SOUT	110-1	SAN DIEGO	CA	92108	3707	37	06073	32.76979794	-117.1355701	San Diego County
227269	Fee-for-Service	1396369427	1396369427	1	1	GREAT AMERICAN HOSPICE CARE	12/2/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	221 W ALAMEDA AVE	SUITE 203	BURBANK	CA	91502	3032	19	06037	34.16890032	-118.3057575	Los Angeles County
227280	Fee-for-Service	1114008885	1114008885	1	1	GILLANDERS, KENNETH W DC	12/1/1993	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	5100 N 6TH ST	STE 156	FRESNO	CA	93710	7506	10	06019	36.810666	-119.763204	Fresno County
227297	Fee-for-Service	1790144830	1790144830	1	1	GLORY HOME HEALTH INC	9/22/2017	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3111 LOS FELIZ BLVD	STE 203	LOS ANGELES	CA	90039	1585	19	06037	34.12432566	-118.2669792	Los Angeles County
227314	Fee-for-Service	1306938139	1306938139	1	1	GROSSMONT ORTHOPAEDIC	12/1/1981	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	MED GRP INC	5565 GROSSMONT CENTER DR	STE 256	LA MESA	CA	91942	3098	37	06073	32.77978322	-117.0094766	San Diego County
227320	Fee-for-Service	1114066818	1114066818	1	1	GATELY, PAUL F MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58180	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
227329	Fee-for-Service	1740719228	1740719228	1	1	GOVIL, SHWESHA DO	9/17/2021	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	16991	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
227331	Fee-for-Service	1891724993	1891724993	1	1	GHALILI, SAMAN	4/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88734	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2101 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	1125	19	06037	34.02564628	-118.2587239	Los Angeles County
227351	Fee-for-Service	1891866554	1891866554	1	1	GLANDORF, MICHAEL J DC	6/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	GLANDORF CHIROPRACTIC	1111 W TOWN AND COUNTRY	STE 6	ORANGE	CA	92868	4635	30	06059	33.77669958	-117.8643288	Orange County
227354	Fee-for-Service	1285111468	1285111468	1	1	GOLDBERG, CASEY B LMFT	7/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
227361	Fee-for-Service	1851739882	1851739882	1	1	GRONINGEN, NICOLE J V MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144199	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
227367	Fee-for-Service	1033671656	1033671656	1	1	GANDHI, ASHISH MD	10/10/2023	208M00000X	NA	Other	026	PHYSICIANS	191034	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
227368	Fee-for-Service	1255339644	1255339644	1	1	GOLDEN VALLEY HEALTH CTR	10/12/2021	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
227414	Fee-for-Service	1922289628	1922289628	1	1	GUPTA, NEELAM MD	4/1/1998	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	45395	41	Internal Medicine	0	In state provider	None	341 E MAIN ST	None	SAN JACINTO	CA	92583	4231	33	06065	33.78391437	-116.9562698	Riverside County
227420	Fee-for-Service	1932291937	1932291937	1	1	GAVIN, THERESA ANN MD	8/17/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79667	08	Family Practice	0	In state provider	None	370 DISTEL CIR	None	LOS ALTOS	CA	94022	1404	43	06085	37.39572142	-122.1051204	Santa Clara County
227434	Fee-for-Service	1366523946	1366523946	1	1	GLENN, JEFFREY S MD	1/1/2000	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	80422	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
227445	Fee-for-Service	1871873802	1871873802	1	1	GLIGAN, SONIA R LCSW	5/7/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1175 SARATOGA AVE	STE 14	SAN JOSE	CA	95129	3427	43	06085	37.30311805	-121.9800175	Santa Clara County
227463	Fee-for-Service	1891729745	1891729745	1	5	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	31537 RANCHO PUEBLO RD	SUITE 102	TEMECULA	CA	92592	4841	33	06065	33.47933034	-117.1103293	Riverside County
227475	Fee-for-Service	1669817615	1669817615	1	1	GLUCKSMAN, AARON MD	5/15/2019	207R00000X	NA	Other	026	PHYSICIANS	141914	41	Internal Medicine	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
227489	Fee-for-Service	1861038770	1861038770	1	1	GUARDADO SALAZAR, CRISTO MD	7/12/2023	207ZP0213X	NA	Other	026	PHYSICIANS	175915	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
227505	Fee-for-Service	1235479395	1235479395	1	1	GRUPE, HOLLY L LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
227511	Fee-for-Service	1710936653	1710936653	1	1	GREWAL-BAHL, RANU MD	8/8/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	ALAMEDA RADIATION ONCOLO	27204 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63300085	-122.089673	Alameda County
227535	Fee-for-Service	1710134630	1710134630	1	1	GINDI, MARK M MD	1/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138786	36	Psychiatry	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
227551	Fee-for-Service	1821225459	1821225459	1	1	GESTUVO, MARIA KRISTINA P MD	1/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121233	38	Geriatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
227585	Fee-for-Service	1477796225	1477796225	1	1	GARDNER, RYAN P LCSW	6/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3099 TELEGRAPH AVE	SUITE 202	BERKELEY	CA	94705	2035	01	06001	37.85389859	-122.2599904	Alameda County
227593	Fee-for-Service	1649685835	1649685835	1	1	GLEBOVA, TATIANA N LMFT	11/8/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3010 I STREET	None	SACRAMENTO	CA	95816	4420	34	06067	38.573793	-121.4657685	Sacramento County
227596	Fee-for-Service	1700099041	1700099041	1	1	GHUMAN, ANOOPINDAR K MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103876	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
227597	Fee-for-Service	1285926279	1285926279	1	1	GABE, MICHAEL J MD	1/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117274	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
227624	Fee-for-Service	1396919262	1396919262	1	1	GORDON, ZACHARY M MD	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93906	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
227641	Fee-for-Service	1407237860	1407237860	1	1	GUPTA, PUJA MD	8/30/2019	207R00000X	NA	Other	026	PHYSICIANS	154242	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
227650	Fee-for-Service	1154556355	1154556355	1	1	GALINDO, GUILLERMO MD	11/20/2010	207L00000X	NA	Other	026	PHYSICIANS	93718	05	Anesthesiology	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
227657	Fee-for-Service	1255339644	1255339644	1	1	GOLDEN VALLEY HEALTH CTR	11/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
227677	Fee-for-Service	1245336270	1245336270	1	1	GHANDEHARI, SARA MD	8/19/2008	207R00000X	NA	Other	026	PHYSICIANS	87240	29	Pulmonary Diseases (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
227685	Fee-for-Service	1841538634	1841538634	1	1	GOLDEY, LAURIE M LMFT	6/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
227743	Fee-for-Service	1902847932	1902847932	1	1	GAMBOA, RUDOLPH MD	2/8/2015	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	68222	08	Family Practice	0	In state provider	None	340 4TH AVE	STE 14	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
227754	Fee-for-Service	1891729745	1891729745	1	5	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	31537 RANCHO PUEBLO RD	SUITE 102	TEMECULA	CA	92592	4841	33	06065	33.47933034	-117.1103293	Riverside County
227784	Fee-for-Service	1205903143	1205903143	1	1	GOYAL, SEEMA	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84873	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
227789	Fee-for-Service	1225058597	1225058597	2	1	GIRGIS, RAFIK R MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	39470	01	General Practice	0	In state provider	None	415 W ALOSTA AVE	SUITE 201	GLENDORA	CA	91740	4335	19	06037	34.1288673	-117.8699632	Los Angeles County
227866	Fee-for-Service	1386962041	1386962041	1	1	GALA DIALYSIS LLC	10/24/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1666 WEST THIRD STRET	None	LOS ANGELES	CA	90017	1138	19	06037	34.0607173	-118.2675891	Los Angeles County
227885	Fee-for-Service	1700099041	1700099041	1	1	GHUMAN, ANOOPINDAR K MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103876	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
227900	Fee-for-Service	1639603756	1639603756	1	1	GARCIA, RENE MD	8/21/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159019	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
227901	Fee-for-Service	1033416292	1033416292	1	1	GREEN, KRISTIN A LMFT	1/7/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
227938	Fee-for-Service	1801936323	1801936323	1	1	GUZMAN, LESLIE C	2/21/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 GREEN VALLEY RD	None	FREEDOM	CA	95019	3138	44	06087	36.93810448	-121.7709537	Santa Cruz County
227944	Fee-for-Service	1184001976	1184001976	1	1	GARCIA BLANCO, JOSE C MD	7/15/2022	207RC0200X	NA	Other	026	PHYSICIANS	176916	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
227950	Fee-for-Service	1255339644	1255339644	1	1	GOLDEN VALLEY HEALTH CTR	11/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
227952	Fee-for-Service	1700845286	1700845286	1	1	GREATER LOS ANGELES	5/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIALYSIS CENTERS LLC	5108 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5708	19	06037	34.09808952	-118.300896	Los Angeles County
227965	Fee-for-Service	1245336270	1245336270	1	1	GHANDEHARI, SARA MD	8/19/2008	207R00000X	NA	Other	026	PHYSICIANS	87240	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
227983	Fee-for-Service	1003524844	1003524844	1	1	GATIMU, LEAH WAMBUI	12/6/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	716 TURQUOISE DRIVE	None	HERCULES	CA	94547	1763	07	06013	37.99654457	-122.2723606	Contra Costa County
228015	Fee-for-Service	1104833888	1104833888	1	1	GOMEZ, ANTONIO D MD	1/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86536	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
228031	Fee-for-Service	1902847932	1902847932	1	1	GAMBOA, RUDOLPH MD	2/8/2015	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	68222	03	Allergy	0	In state provider	None	340 4TH AVE	STE 14	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
228041	Fee-for-Service	1891729745	1891729745	1	5	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	31537 RANCHO PUEBLO RD	SUITE 102	TEMECULA	CA	92592	4841	33	06065	33.47933034	-117.1103293	Riverside County
228045	Fee-for-Service	1891730792	1891730792	1	1	GARFIELD BEACH CVS LLC	12/13/2006	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	755 E FOOTHILL BOULEVARD	None	POMONA	CA	91767	1223	19	06037	34.1072493	-117.7376535	Los Angeles County
228078	Fee-for-Service	1225058597	1225058597	2	1	GIRGIS, RAFIK R MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	39470	08	Family Practice	0	In state provider	None	415 W ALOSTA AVE	SUITE 201	GLENDORA	CA	91740	4335	19	06037	34.1288673	-117.8699632	Los Angeles County
228171	Fee-for-Service	1689716524	1689716524	1	1	GOLIANU, BRENDA MD	3/20/1996	207L00000X	NA	Other	026	PHYSICIANS	82212	05	Anesthesiology	0	In state provider	None	16795 LARK AVE	STE 230	LOS GATOS	CA	95032	7650	43	06085	37.25302151	-121.966891	Santa Clara County
228191	Fee-for-Service	1437349982	1437349982	1	1	GAYAGOY, JOSEPH D MD APC	6/30/2005	193400000X	NA	Other	026	PHYSICIANS	56352	41	Internal Medicine	0	In state provider	None	999 S FAIRMONT AVE	STE 135	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
228233	Fee-for-Service	1255339644	1255339644	1	1	GOLDEN VALLEY HEALTH CTR	11/22/2024	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
228270	Fee-for-Service	1003524844	1003524844	1	1	GATIMU, LEAH WAMBUI	12/6/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	716 TURQUOISE DRIVE	None	HERCULES	CA	94547	1763	07	06013	37.99654457	-122.2723606	Contra Costa County
228291	Fee-for-Service	1609220961	1609220961	1	1	GUSSMAN, KATHRYN O MD	4/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192133	08	Family Practice	0	In state provider	None	20311 SW ACACIA ST	UNIT 140	NEWPORT BEACH	CA	92660	1733	30	06059	33.65825868	-117.8791294	Orange County
228292	Fee-for-Service	1699706127	1699706127	1	1	GILBERT,SUNAO L MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70497	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
228302	Fee-for-Service	1619990355	1619990355	1	1	GREENBARG, JAMES R MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80805	02	General Surgery	0	In state provider	None	701 E OLIVE AVE	None	TURLOCK	CA	95380	4015	50	06099	37.49914308	-120.8417859	Stanislaus County
228329	Fee-for-Service	1568987691	1568987691	1	1	GILMORE, TERESA R NP	8/18/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
228330	Fee-for-Service	1134430226	1134430226	1	1	GRAHAM-HINES, NZINGA MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116917	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
228351	Fee-for-Service	1346952033	1346952033	1	1	GREEN, CHAVONNA DOULA	3/28/2023	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	34	06067	0	0	None
228360	Fee-for-Service	1790918753	1790918753	2	1	GARFIELD BEACH CVS LLC	12/19/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10881 OLSON DR	None	RANCHO CORDOVA	CA	95670	5646	34	06067	38.59542	-121.284594	Sacramento County
228366	Fee-for-Service	1225058597	1225058597	2	1	GIRGIS, RAFIK R MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	39470	40	Pediatrics	0	In state provider	None	415 W ALOSTA AVE	SUITE 201	GLENDORA	CA	91740	4335	19	06037	34.1288673	-117.8699632	Los Angeles County
228392	Fee-for-Service	1538767694	1538767694	1	1	GLORY HEALTH NETWORK	3/25/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	410 SOUTH MELROSE DRIVE	STE 222	VISTA	CA	92081	6607	37	06073	33.19049793	-117.2538503	San Diego County
228406	Fee-for-Service	1871975763	1871975763	1	1	GUPTA, ADITI MD	11/27/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	173201	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
228415	Fee-for-Service	1336469899	1336469899	1	1	GOLEZ, CANDICE D MD INC	8/2/2010	193400000X	NA	Other	026	PHYSICIANS	110303	08	Family Practice	0	In state provider	None	460 N GREENFIELD AVE	STE 4	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
228510	Fee-for-Service	1104113885	1104113885	1	1	GREENAWAY, STACI N LMFT	8/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
228517	Fee-for-Service	1316403330	1316403330	1	1	GOLEZ, JERRY B RCP	9/20/2020	227900000X	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
228520	Fee-for-Service	1255339644	1255339644	1	1	GOLDEN VALLEY HEALTH CTR	12/14/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
228523	Fee-for-Service	1235342981	1235342981	1	2	GOLDEN VALLEY HEALTH CTR	9/24/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	301 HOWARD RD	None	WESTLEY	CA	95387	0000	50	06099	37.54449453	-121.1984213	Stanislaus County
228540	Fee-for-Service	1013958933	1013958933	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1830 N BROADWAY	None	SANTA MARIA	CA	93454	1449	42	06083	34.97319	-120.435553	Santa Barbara County
228544	Fee-for-Service	1962247205	1962247205	1	1	GARCIA, LIZETTE LMFT	1/31/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6501 HOMAN CT	None	CHINO	CA	91710	7353	36	06071	34.00521472	-117.6625289	San Bernardino County
228574	Fee-for-Service	1508944257	1508944257	1	1	GREER, SELDON E JR MD	5/7/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	34803	None	None	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
228621	Fee-for-Service	1679665350	1679665350	1	1	GOLDEN GATE CARDIOLOGY	4/19/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2340 CLAY ST	# 525	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
228640	Fee-for-Service	1225696396	1225696396	1	1	GORSI, GAHFORA B CNP	6/28/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
228681	Fee-for-Service	1538767694	1538767694	1	1	GLORY HEALTH NETWORK	3/25/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	410 SOUTH MELROSE DRIVE	STE 222	VISTA	CA	92081	6607	37	06073	33.19049793	-117.2538503	San Diego County
228683	Fee-for-Service	1801807482	1801807482	2	1	GLENDALE PHARMACY INC	4/23/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	GLENDALE PHARMACY	1122 N BRAND BLVD	None	GLENDALE	CA	91202	2547	19	06037	34.162236	-118.2550335	Los Angeles County
228724	Fee-for-Service	1366716649	1366716649	1	1	GAGNON, CASSIDY V MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137759	40	Pediatrics	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
228732	Fee-for-Service	1811084718	1811084718	1	1	GOOD SAMARITAN HOSPITAL	2/16/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5601 LOCH RAVEN BLVD	None	BALTIMORE	MD	21239	2905	00	None	39.35890355	-76.58886421	Baltimore city
228746	Fee-for-Service	1629597208	1629597208	1	1	GOSSETT, AMY L PHD	3/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PKWY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
228811	Fee-for-Service	1255339644	1255339644	1	1	GOLDEN VALLEY HEALTH CTR	11/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
228845	Fee-for-Service	1639186802	1639186802	1	1	GALINDO, ALVARO MD	12/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
228894	Fee-for-Service	1033100045	1033100045	1	1	GALLIK, DONNA M MD	2/1/1995	207R00000X	NA	Other	026	PHYSICIANS	80598	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
228895	Fee-for-Service	1811099203	1811099203	1	1	GARDNER, KERI K MD	11/30/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68395	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
228918	Fee-for-Service	1720649403	1720649403	1	1	GURROLA, AMANDA CCC-SLP	2/14/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	147 E OLIVE AVE	None	MONROVIA	CA	91016	3407	19	06037	34.14486607	-117.9989444	Los Angeles County
228922	Fee-for-Service	1134589559	1134589559	1	1	GRIFFITH, FREDERICK P MD	1/8/2021	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
228934	Fee-for-Service	1609171933	1609171933	1	1	GOLDBERG, LEONARD S MD	3/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	26721	41	Internal Medicine	0	In state provider	None	3737 SAN DIMAS ST	STE 101	BAKERSFIELD	CA	93301	5733	15	06029	35.39412578	-119.0082617	Kern County
228937	Fee-for-Service	1760818371	1760818371	1	1	GRIFFIN DONALSON, ROSEMARY	9/23/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
228943	Fee-for-Service	1063656908	1063656908	1	1	GELSDORF, CHRISTOPH MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113751	08	Family Practice	0	In state provider	None	3883 AIRWAY DR	STE 201	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
228975	Fee-for-Service	1164073052	1164073052	1	1	GRACIOUS CARE HOME INC.	12/24/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4110 E JORDAN AVE	None	ORANGE	CA	92869	5429	30	06059	33.77885651	-117.8093925	Orange County
229021	Fee-for-Service	1811084718	1811084718	1	1	GOOD SAMARITAN HOSPITAL	2/16/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5601 LOCH RAVEN BLVD	None	BALTIMORE	MD	21239	2905	00	None	39.35890355	-76.58886421	Baltimore city
229026	Fee-for-Service	1245432632	1245432632	1	1	GUPTA, NIDHI MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102557	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4236	01	06001	37.63011596	-122.0960694	Alameda County
229042	Fee-for-Service	1528138336	1528138336	1	1	GARDUNO, LEONARDO MD	7/4/1980	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	33758	02	General Surgery	0	In state provider	None	7750 KATELLA AVE	STE 1	STANTON	CA	90680	3122	30	06059	33.80273729	-117.9974903	Orange County
229050	Fee-for-Service	1114015963	1114015963	1	1	GRAY, BRENT J MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	49940	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12291 WASHINGTON BLVD	STE 500	WHITTIER	CA	90606	2551	19	06037	33.96734104	-118.0508773	Los Angeles County
229056	Fee-for-Service	1427439983	1427439983	1	1	GUNEL, JOHN DO	5/15/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19318	08	Family Practice	0	In state provider	None	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	04	06007	39.750084	-121.7934327	Butte County
229074	Fee-for-Service	1710417365	1710417365	1	1	GODIL, RANIA MD	11/17/2022	207R00000X	NA	Other	026	PHYSICIANS	175090	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
229083	Fee-for-Service	1831170232	1831170232	1	2	GOTTLIEB MEMORIAL HOSPITAL	12/8/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LIEB	701 W NORTH AVE	None	MELROSE PARK	IL	60160	1612	00	None	41.910318	-87.8424615	Cook County
229130	Fee-for-Service	1356722706	1356722706	1	1	GT RIDE LLC	6/17/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4448 EAGLE ROCK BLVD	STE. I	LOS ANGELES	CA	90041	3512	19	06037	34.12550387	-118.2193928	Los Angeles County
229145	Fee-for-Service	1801006457	1801006457	1	1	GARZALOZANO, GILBERTO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4154 LOOP 20	STE 101-B	LAREDO	TX	78043	4718	00	None	27.49685223	-99.44752937	Webb County
229156	Fee-for-Service	1548268790	1548268790	1	1	GORY, DENNIS J MD	6/11/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	3311 RIVER BEND DR	STE 300	SPRINGFIELD	OR	97477	0000	00	None	44.08199228	-123.0283538	Lane County
229166	Fee-for-Service	1669466215	1669466215	1	1	GLASSCO, JOHN E MD	3/11/2008	207ZP0102X	NA	Other	026	PHYSICIANS	41222	22	Pathology (M.D. only)	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
229178	Fee-for-Service	1942309018	1942309018	1	2	GERALDE, NICOLO B MD	4/13/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	18607	None	None	0	In state provider	None	1400 E CHURCH ST	BUILDING 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
229196	Fee-for-Service	1134154941	1134154941	1	1	GRAY, DEVIN 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	3555 S VAL VISTA DR	None	GILBERT	AZ	85297	7323	00	None	33.286572	-111.7527525	Maricopa County
229199	Fee-for-Service	1487748943	1487748943	1	1	GROVES, KATRINA C MD	1/2/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	69202	-	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
229209	Fee-for-Service	1891729745	1891729745	1	8	GRAYBILL MEDICAL GROUP INC	1/27/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2067 W VISTA WAY	STE 250	VISTA	CA	92083	6034	37	06073	33.18505594	-117.285958	San Diego County
229215	Fee-for-Service	1336673730	1336673730	2	1	GILBURD, ALEXANDER	1/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1508 GREENFIELD AVE.	302	LOS ANGELES	CA	90025	8022	19	06037	34.05153161	-118.4437181	Los Angeles County
229220	Fee-for-Service	1609171933	1609171933	1	1	GOLDBERG, LEONARD S MD	3/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	26721	68	Hematology	0	In state provider	None	3737 SAN DIMAS ST	STE 101	BAKERSFIELD	CA	93301	5733	15	06029	35.39412578	-119.0082617	Kern County
229230	Fee-for-Service	1972186815	1972186815	1	1	GENOA HEALTHCARE LLC	8/4/2021	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12264 EL CAMINO REAL	SUITE 203P	SAN DIEGO	CA	92130	3061	37	06073	32.93959909	-117.2401598	San Diego County
229330	Fee-for-Service	1528138336	1528138336	1	1	GARDUNO, LEONARDO MD	7/4/1980	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	33758	01	General Practice	0	In state provider	None	7750 KATELLA AVE	STE 1	STANTON	CA	90680	3122	30	06059	33.80273729	-117.9974903	Orange County
229335	Fee-for-Service	1548318330	1548318330	1	1	GALPERIN, EUGENE E MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64275	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
229349	Fee-for-Service	1669416723	1669416723	1	1	GRIMSLEY, PATRICK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 E 19TH ST	None	THE DALLES	OR	97058	3317	00	None	45.58806554	-121.164498	Wasco County
229372	Fee-for-Service	1831170232	1831170232	1	2	GOTTLIEB MEMORIAL HOSPITAL	12/8/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LIEB	701 W NORTH AVE	None	MELROSE PARK	IL	60160	1612	00	None	41.910318	-87.8424615	Cook County
229375	Fee-for-Service	1306940325	1306940325	1	1	GASTER, RONALD N MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	26039	18	Ophthalmology	0	In state provider	None	19732 MACARTHUR BLVD	None	IRVINE	CA	92612	2419	30	06059	33.65659666	-117.8624166	Orange County
229390	Fee-for-Service	1689214744	1689214744	1	1	GARFIELD BEACH CVS LLC	3/27/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 N BROADWAY	None	LOS ANGELES	CA	90012	4700	19	06037	34.05813356	-118.2407321	Los Angeles County
229405	Fee-for-Service	1013234061	1013234061	1	1	GANAPATHI, ASVIN M MD	10/22/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	227 WEST JANSS ROAD	SUITE 340	THOUSAND OAKS	CA	91360	1879	56	06111	34.20611691	-118.883861	Ventura County
229490	Fee-for-Service	1487748943	1487748943	1	1	GROVES, KATRINA C MD	12/20/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	69202	08	Family Practice	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
229497	Fee-for-Service	1891729745	1891729745	1	8	GRAYBILL MEDICAL GROUP INC	1/27/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2067 W VISTA WAY	STE 250	VISTA	CA	92083	6034	37	06073	33.18505594	-117.285958	San Diego County
229509	Fee-for-Service	1104436542	1104436542	1	1	GUADALUPE PHARMACY INC	7/20/2021	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16444 PARAMOUNT BLVD	STE 101	PARAMOUNT	CA	90723	5453	19	06037	33.8848179	-118.1599671	Los Angeles County
229511	Fee-for-Service	1609171933	1609171933	1	1	GOLDBERG, LEONARD S MD	3/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	26721	83	Rheumatology	0	In state provider	None	3737 SAN DIMAS ST	STE 101	BAKERSFIELD	CA	93301	5733	15	06029	35.39412578	-119.0082617	Kern County
229522	Fee-for-Service	1043477243	1043477243	1	1	GORMAN, MATTHEW F MD	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86994	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
229538	Fee-for-Service	1114235744	1114235744	1	1	GRIER, KENNETH H MD	3/9/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150771	None	None	0	In state provider	None	18564 US HIGHWAY 18	STE 101-102	APPLE VALLEY	CA	92307	2312	36	06071	34.53926652	-117.2592564	San Bernardino County
229552	Fee-for-Service	1275799298	1275799298	1	1	GONZALEZ, SOHA H PSYD	8/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	601 E DAILY DR	210	CAMARILLO	CA	93010	5806	56	06111	34.21906637	-119.0621709	Ventura County
229576	Fee-for-Service	1396994034	1396994034	1	1	GOODGLICK, RETHA MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111460	None	None	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
229608	Fee-for-Service	1477620359	1477620359	1	1	GREEN, ANDREA L MD	1/31/1986	207L00000X	NA	Other	026	PHYSICIANS	57355	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
229622	Fee-for-Service	1548318330	1548318330	1	1	GALPERIN, EUGENE E MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64275	45	Nephrology (Renal-Kidney)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
229647	Fee-for-Service	1578640421	1578640421	1	1	GATTUPALLI, SUDHA R MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50145	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
229649	Fee-for-Service	1801933684	1801933684	1	1	GRISOLIA, JAMES S MD INC	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42884	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4033 3RD AVE	STE 410	SAN DIEGO	CA	92103	2140	37	06073	32.75053781	-117.1627168	San Diego County
229656	Fee-for-Service	1558409771	1558409771	1	1	GLASSMAN, JAGA N MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55004	36	Psychiatry	0	In state provider	None	9834 GENESEE AVE	STE 420	LA JOLLA	CA	92037	1264	37	06073	32.884074	-117.225855	San Diego County
229661	Fee-for-Service	1750541561	1750541561	1	1	GOMEZ-SIMMONDS, ANGELA MD	8/1/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
229677	Fee-for-Service	1487662722	1487662722	1	1	GROVE, BRANDON K MD	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68102	08	Family Practice	0	In state provider	None	5888 EDINGER AVE	None	HUNTINGTON BEACH	CA	92649	1705	30	06059	33.72993249	-118.0255995	Orange County
229715	Fee-for-Service	1073569604	1073569604	2	1	GAREHGRAT, RAVI P MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	133726	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
229719	Fee-for-Service	1811342983	1811342983	1	1	GAW, STEPHEN CPO	7/18/2016	1744P3200X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	26440 LA ALAMEDA	SUITE 320	MISSION VIEJO	CA	92691	6304	30	06059	33.5636138	-117.6689254	Orange County
229741	Fee-for-Service	1750412342	1750412342	1	1	GARCIA, ANTONIO LMFT	9/29/2023	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
229750	Fee-for-Service	1669658720	1669658720	1	1	GOLDSTEIN, LISA B	11/4/2010	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5525 ETIWANDA AVE	STE 309	TARZANA	CA	91356	6145	19	06037	34.17046451	-118.5308463	Los Angeles County
229755	Fee-for-Service	1790066090	1790066090	1	1	GENG, ALEXANDER B MD	3/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117696	None	None	0	In state provider	None	125 SIR FRANCIS DRAKE	BLVD	KENTFIELD	CA	94904	1418	21	06041	37.94496361	-122.5189097	Marin County
229785	Fee-for-Service	1891729745	1891729745	1	8	GRAYBILL MEDICAL GROUP INC	1/27/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2067 W VISTA WAY	STE 250	VISTA	CA	92083	6034	37	06073	33.18505594	-117.285958	San Diego County
229788	Fee-for-Service	1710599030	1710599030	1	1	GRACIOUS CARE HOME INC	1/20/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14661 BROOKLINE WAY	None	TUSTIN	CA	92780	2517	30	06059	33.751107	-117.825388	Orange County
229807	Fee-for-Service	1881671907	1881671907	1	1	GLASS, GRAHAM A MD	8/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96413	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
229834	Fee-for-Service	1780602706	1780602706	1	1	GAAL, STEPHEN A MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	19322	20	Orthopedic Surgery	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
229859	Fee-for-Service	1053386763	1053386763	1	1	GROSS, ERIC M MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60281	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
229868	Fee-for-Service	1598836546	1598836546	1	1	GUTTA, RAVI MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76479	18	Ophthalmology	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
229871	Fee-for-Service	1073519393	1073519393	1	1	GERADTS, JOSEPH MD	1/4/2018	207ZP0101X	NA	Other	026	PHYSICIANS	65531	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
229878	Fee-for-Service	1336184233	1336184233	1	1	GARFIELD BEACH CVS LLC	5/7/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11851 ARTESIA BLVD	None	ARTESIA	CA	90701	4002	19	06037	33.87314052	-118.0808086	Los Angeles County
229888	Fee-for-Service	1225431505	1225431505	1	1	GURKIRPA MEDICAL INC	12/18/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 F ST	STE 200	BAKERSFIELD	CA	93301	1848	15	06029	35.384184	-119.023442	Kern County
229896	Fee-for-Service	1528071545	1528071545	1	1	GORELIK,LYUBOV	6/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PARKWAY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
229909	Fee-for-Service	1780125146	1780125146	1	1	GAINES, DANIEL DO	10/3/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	21420	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
229933	Fee-for-Service	1801933684	1801933684	1	1	GRISOLIA, JAMES S MD INC	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42884	14	Neurological Surgery	0	In state provider	None	4033 3RD AVE	STE 410	SAN DIEGO	CA	92103	2140	37	06073	32.75053781	-117.1627168	San Diego County
229937	Fee-for-Service	1942510607	1942510607	1	1	GHAHREMANI-GHAJAR, MEHRDAD	7/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11526	41	Internal Medicine	0	In state provider	None	1180 E SHAW	#125	FRESNO	CA	93710	7814	10	06019	36.80891142	-119.768244	Fresno County
229970	Fee-for-Service	1487166120	1487166120	1	1	GOOD SAMARITAN SHELTER	8/28/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	N AND CHILDREN	412 AND 412C E TUNNELL S	None	SANTA MARIA	CA	93454	4146	42	06083	34.9574637	-120.4311771	Santa Barbara County
229978	Fee-for-Service	1124106257	1124106257	1	1	GROVE, ALAN L MD	2/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64264	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
229979	Fee-for-Service	1033470174	1033470174	1	1	GUPTA, VIBHA K MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144409	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
229989	Fee-for-Service	1730854217	1730854217	1	1	GUACHINO, ROLLENA NP	1/15/2024	363L00000X	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
230039	Fee-for-Service	1083639264	1083639264	1	1	GANZ, TOMAS MD	1/1/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	40227	41	Internal Medicine	0	In state provider	UCLA CTR C/T HLTH SCIENC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
230055	Fee-for-Service	1073103057	1073103057	1	1	GOOD SAMARITAN HOSPITAL	12/8/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1217 7TH ST	None	WASCO	CA	93280	1820	15	06029	35.5942104	-119.339607	Kern County
230058	Fee-for-Service	1235404583	1235404583	1	1	GASKILL, CAMERON E MD	10/12/2021	208600000X	NA	General Surgery	026	PHYSICIANS	174935	None	None	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
230059	Fee-for-Service	1043251952	1043251952	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2130 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795738	-118.1252225	Los Angeles County
230116	Fee-for-Service	1114547833	1114547833	1	1	GARCHA, JASPREET DO	11/1/2023	207R00000X	NA	Other	026	PHYSICIANS	20925	None	None	0	In state provider	None	1205 EAST NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
230135	Fee-for-Service	1902033210	1902033210	1	1	GLENN, ROBERT C MD	8/22/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	181406	None	None	0	In state provider	None	308 W STATE ST	STE 3D	REDLANDS	CA	92373	4653	36	06071	34.05649746	-117.18603	San Bernardino County
230161	Fee-for-Service	1861238107	1861238107	1	1	GILLESPIE, JILL L LCSW	8/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2850 COMMERCIAL CROSSING	None	SANTA CRUZ	CA	95065	1816	44	06087	36.98796413	-121.9825327	Santa Cruz County
230168	Fee-for-Service	1073328282	1073328282	1	1	GARRISON, JAMIE	2/16/2025	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
230171	Fee-for-Service	1750469649	1750469649	1	1	GRIFFIN, NICOLE M MD	10/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81794	83	Rheumatology	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
230196	Fee-for-Service	1518285261	1518285261	1	1	GISELLE D KOHLER	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1911 S NATIONAL AVE	STE 301	SPRINGFIELD	MO	65804	2213	00	None	37.17992552	-93.27671151	Greene County
230226	Fee-for-Service	1801933684	1801933684	1	1	GRISOLIA, JAMES S MD INC	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42884	13	Neurology (M.D. only)	0	In state provider	None	4033 3RD AVE	STE 410	SAN DIEGO	CA	92103	2140	37	06073	32.75053781	-117.1627168	San Diego County
230288	Fee-for-Service	1508544362	1508544362	1	1	GUPTA, NICHOLAS M NP	1/22/2025	207L00000X	NA	Other	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
230296	Fee-for-Service	1558678466	1558678466	1	1	GAYOWSKI, WILLIAM M LMFT	4/8/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2400-A COUNTY CENTER DR	None	SANTA ROSA	CA	95403	3004	49	06097	38.46366	-122.7255255	Sonoma County
230327	Fee-for-Service	1083639264	1083639264	1	1	GANZ, TOMAS MD	1/1/1995	207RP1001X	NA	Pulmonology	026	PHYSICIANS	40227	29	Pulmonary Diseases (M.D. only)	0	In state provider	UCLA CTR C/T HLTH SCIENC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
230344	Fee-for-Service	1073103057	1073103057	1	1	GOOD SAMARITAN HOSPITAL	12/8/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1217 7TH ST	None	WASCO	CA	93280	1820	15	06029	35.5942104	-119.339607	Kern County
230345	Fee-for-Service	1225672967	1225672967	1	1	GALEN INPATIENT PHYSICIANS P	1/3/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	15248 ELEVENTH ST	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
230384	Fee-for-Service	1861082356	1861082356	1	1	GRATIFY CARE HOSPICE	11/4/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8622 RESEDA BLVD	UNIT 201	NORTHRIDGE	CA	91324	4036	19	06037	34.22719786	-118.5360442	Los Angeles County
230410	Fee-for-Service	1497897292	1497897292	1	1	GLENDALE UNIFIED SD	3/15/1993	251300000X	NA	Other	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	223 N JACKSON ST	None	GLENDALE	CA	91206	4380	19	06037	34.14893716	-118.2502138	Los Angeles County
230424	Fee-for-Service	1447668991	1447668991	1	1	GL HOME HEALTH CARE, INC	9/3/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	SUITE 209	BURBANK	CA	91502	1850	19	06037	34.18064474	-118.3089507	Los Angeles County
230596	Fee-for-Service	1700881653	1700881653	1	1	GEORGE, ENE G MD	7/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100112	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
230598	Fee-for-Service	1366070815	1366070815	1	1	GANCAYCO, JOSEPH MD	10/6/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187631	None	None	0	In state provider	None	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	19	06037	34.137603	-118.101464	Los Angeles County
230621	Fee-for-Service	1184034696	1184034696	1	1	GOLD, JACOB M MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142821	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
230674	Fee-for-Service	1861082356	1861082356	1	1	GRATIFY CARE HOSPICE	11/4/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8622 RESEDA BLVD	UNIT 201	NORTHRIDGE	CA	91324	4036	19	06037	34.22719786	-118.5360442	Los Angeles County
230679	Fee-for-Service	1629170998	1629170998	1	1	GASTROENTEROLOGY SPECIAL	6/17/2004	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL GROUP INC APC	19845 LAKE CHABOT RD	STE 104	CASTRO VALLEY	CA	94546	5305	01	06001	37.69995352	-122.087795	Alameda County
230682	Fee-for-Service	1003443086	1003443086	1	1	GANJIAN, SHAINA MD	4/4/2023	390200000X	NA	Other	026	PHYSICIANS	184150	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
230697	Fee-for-Service	1285704213	1285704213	1	1	GIANNINA, GREGG 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
230701	Fee-for-Service	1356390181	1356390181	1	1	GRANDO, SERGEI A MD	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61043	07	Dermatology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
230790	Fee-for-Service	1528167830	1528167830	1	2	GHANEM, BASSAM MD	3/26/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	97459	68	Hematology	0	In state provider	None	2950 SYCAMORE DRIVE	SUITE 303	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
230835	Fee-for-Service	1407350549	1407350549	1	1	GARFIELD BEACH CVS LLC	11/6/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	328 CENTRAL AVE	None	FILLMORE	CA	93015	1921	56	06111	34.39958823	-118.9135193	Ventura County
230904	Fee-for-Service	1023172558	1023172558	1	1	GOMEZ, RAMON MD	8/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60279	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
230975	Fee-for-Service	1699834200	1699834200	1	1	GOLDBERG, BRUCE J MD	5/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40598	03	Allergy	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
230976	Fee-for-Service	1992125546	1992125546	1	1	GERBER, DANIEL A MD	7/21/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	138539	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
231062	Fee-for-Service	1326761347	1326761347	1	1	GOOD WAY HOME HEALTH INC.	11/13/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11871 SHELDON ST.	UNIT C	SUN VALLEY	CA	91352	1583	19	06037	34.2406343	-118.391947	Los Angeles County
231132	Fee-for-Service	1043742703	1043742703	1	1	GOPAL, MANGALA DO	8/8/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	18662	None	None	0	In state provider	None	2 MEDICAL PLAZA	STE 130	ROSEVILLE	CA	95661	3038	31	06061	38.76507948	-121.2477476	Placer County
231143	Fee-for-Service	1609504174	1609504174	1	1	GARFIELD BEACH CVS, L.L.C.	6/12/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	609 N DILLON ST	None	LOS ANGELES	CA	90026	7368	19	06037	34.078689	-118.278938	Los Angeles County
231171	Fee-for-Service	1952073991	1952073991	1	1	GOMEZ, FRANCISCO NP	10/25/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
231174	Fee-for-Service	1205930831	1205930831	1	1	GRAY, LISSA W S NP	5/14/2013	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
231198	Fee-for-Service	1568071256	1568071256	1	1	GOMES, MACKENZIE M	10/21/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2160 WEST ADAMS BLVD.	None	LOS ANGELES	CA	90018	2039	19	06037	34.03262662	-118.3138579	Los Angeles County
231220	Fee-for-Service	1174592687	1174592687	1	1	GOLOGORSKY, DEBRA MD	5/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59865	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
231230	Fee-for-Service	1508040585	1508040585	1	1	GARSHYNA, OLGA MD	9/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107841	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
231298	Fee-for-Service	1366560112	1366560112	1	1	GRAFF, ROBERT MD	11/8/2024	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	70479	-	NOT APPLICABLE	0	In state provider	None	7233 SOUTH DELIVERY RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88418172	-121.2882227	San Joaquin County
231329	Fee-for-Service	1811924491	1811924491	1	1	GUZMAN, ERNIE MD	3/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61703	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
231339	Fee-for-Service	1013244102	1013244102	1	1	GLASSCOCK, JENNA	11/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	331E EAST REDWOOD AVENU	None	FORT BRAGG	CA	95437	3551	23	06045	39.4442763	-123.8028876	Mendocino County
231365	Fee-for-Service	1396768321	1396768321	1	1	GARBER, STEPHEN Z MD	5/6/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	50535	01	General Practice	0	In state provider	None	10572 CALLE LEE	STE 122	LOS ALAMITOS	CA	90720	8528	30	06059	33.80890075	-118.0573006	Orange County
231383	Fee-for-Service	1699383620	1699383620	1	1	GUO, ANQI LMFT	2/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
231399	Fee-for-Service	1912046517	1912046517	1	1	GREENBERG, MARCIA B PT	7/1/2000	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
231415	Fee-for-Service	1992973010	1992973010	1	2	GRIFFIN, GAYE L	7/21/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5602 VALLEY GLEN WAY	None	LOS ANGELES	CA	90043	2122	19	06037	33.99110528	-118.3497137	Los Angeles County
231444	Fee-for-Service	1437127651	1437127651	1	1	GARCIA, JAIME MD	9/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55176	40	Pediatrics	0	In state provider	None	1191 CENTRAL BOULEVARD	SUITE D	BRENTWOOD	CA	94598	2253	07	06013	37.93792459	-121.6995092	Contra Costa County
231465	Fee-for-Service	1326207077	1326207077	1	1	GAUDREAU, PHILIP A III MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149585	04	Otology, Laryngology, Rhinology	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
231470	Fee-for-Service	1366433153	1366433153	1	1	GAGGERO, DWIGHT	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58937	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13855 E 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
231510	Fee-for-Service	1386683969	1386683969	1	1	GETZ, JONATHAN D MD	12/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55457	36	Psychiatry	0	In state provider	None	1761 BROADWAY STREET	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
231548	Fee-for-Service	1902391576	1902391576	1	1	GURNE, DONNA JOY C NP	1/14/2019	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
231571	Fee-for-Service	1063434751	1063434751	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1280 DANA DR	None	REDDING	CA	96003	4038	45	06089	40.58583353	-122.348161	Shasta County
231584	Fee-for-Service	1679159818	1679159818	1	1	GOYA ARCE, ANA B PHD	11/30/2021	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
231604	Fee-for-Service	1487679486	1487679486	1	1	GILL, HARMANDEEP K MD	10/5/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL CORP	43830 10TH ST W	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
231625	Fee-for-Service	1831148048	1831148048	1	1	GOLOMB, ROBERT J MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	55349	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
231649	Fee-for-Service	1295173417	1295173417	1	1	GALVIS, JUAN M MD	7/25/2022	207RC0200X	NA	Other	026	PHYSICIANS	174961	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
231653	Fee-for-Service	1811282619	1811282619	1	1	GOVERDHANA, SHYAM MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130615	01	General Practice	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8539	08	06015	41.77272521	-124.1940494	Del Norte County
231689	Fee-for-Service	1538579578	1538579578	1	1	GRIGORIAN, AREG MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138676	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
231693	Fee-for-Service	1942484837	1942484837	2	1	GLEN PARK AT VALLEY VILLAGE	1/27/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5527 LAUREL CANYON BLVD	None	VALLEY VILLAGE	CA	91607	2116	19	06037	34.1710759	-118.396532	Los Angeles County
231694	Fee-for-Service	1669609780	1669609780	1	1	GANTMAN, ALEXANDER PHD	11/9/2010	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90024	1759	19	06037	34.06633181	-118.4451729	Los Angeles County
231704	Fee-for-Service	1992973010	1992973010	1	2	GRIFFIN, GAYE L	7/21/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5602 VALLEY GLEN WAY	None	LOS ANGELES	CA	90043	2122	19	06037	33.99110528	-118.3497137	Los Angeles County
231721	Fee-for-Service	1194365916	1194365916	1	1	GRIGORIAN, AIDA LCSW	1/10/2025	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
231728	Fee-for-Service	1689320459	1689320459	1	1	GALEN INPATIENT PHYSICIANS,	4/28/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1205 EAST NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
231749	Fee-for-Service	1255660973	1255660973	1	1	GOLDSTEIN, JILLIAN L LCSW	6/23/2016	No Taxonomy Provided	NA	None	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
231769	Fee-for-Service	1891086328	1891086328	1	1	GLOVER, REAGAN R LMFT	9/23/2019	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
231779	Fee-for-Service	1134562234	1134562234	1	1	GAINES, NATHAN MD	6/25/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	134201	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
231828	Fee-for-Service	1356305254	1356305254	1	1	GRADUS-PIZLO, IRMINA MD	12/4/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150958	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
231829	Fee-for-Service	1649328634	1649328634	1	1	GRACE, LORRAINE Y MD	5/31/1986	207R00000X	NA	Other	026	PHYSICIANS	59293	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
231836	Fee-for-Service	1154357010	1154357010	1	2	GLASER, JEFFREY B MD	1/6/2020	207L00000X	NA	Other	026	PHYSICIANS	64352	05	Anesthesiology	0	In state provider	None	16311 VENTURA BLVD	SUITE #518	ENCINO	CA	91436	2124	19	06037	34.15706864	-118.4885978	Los Angeles County
231872	Fee-for-Service	1689789414	1689789414	1	1	GOLLUB, MATTHEW I MD	3/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80374	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
231873	Fee-for-Service	1194831727	1194831727	1	1	GUPTA, ANITA MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78025	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
231874	Fee-for-Service	1245650696	1245650696	1	1	GOPAL, DIPIKA J MD	10/13/2020	207R00000X	NA	Other	026	PHYSICIANS	168283	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
231892	Fee-for-Service	1609189737	1609189737	1	1	GOLLAPALLE, ESHA MD	2/24/2025	207ZP0102X	NA	Other	026	PHYSICIANS	128612	22	Pathology (M.D. only)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
231946	Fee-for-Service	1669448361	1669448361	1	1	GARBARINI, MICHAEL P MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	48896	08	Family Practice	0	In state provider	None	2140 COTNER AVENUE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
231951	Fee-for-Service	1508860016	1508860016	1	1	GONZALEZ, DAVID R MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	78684	01	General Practice	0	In state provider	None	26732 CROWN VALLEY PKWY	STE 151	MISSION VIEJO	CA	92691	6337	30	06059	33.56347704	-117.66546	Orange County
231977	Fee-for-Service	1700860871	1700860871	1	1	GOLDEN STATE DERMATOLOGY ASS	1/20/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	2255 YGNACIO VALLEY RD	STE B1	WALNUT CREEK	CA	94598	3335	07	06013	37.92242643	-122.0301696	Contra Costa County
231993	Fee-for-Service	1700860871	1700860871	1	5	GOLDEN STATE DERMATOLOGY ASS	2/22/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	370 N WIGET LN	STE 250	WALNUT CREEK	CA	94598	2488	07	06013	37.92948925	-122.0275099	Contra Costa County
232026	Fee-for-Service	1245288216	1245288216	1	1	GUADIZ, STEVEN U	10/18/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	444 GLENOAKS BLVD	None	GLENDALE	CA	91202	2917	19	06037	34.1598361	-118.2632528	Los Angeles County
232029	Fee-for-Service	1205213063	1205213063	1	1	GHARBAOUI, JAMES MD	9/26/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161817	36	Psychiatry	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
232057	Fee-for-Service	1508937558	1508937558	1	1	GERTLER, STANFORD L MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39886	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
232066	Fee-for-Service	1932298577	1932298577	1	1	GALLARDO, BESSIE L MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47806	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
232081	Fee-for-Service	1821651779	1821651779	1	1	GANDHI, ANAND MD	6/18/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	178494	67	Endocrinology	0	In state provider	None	16003 TUSCOLA RD	SUITE H	APPLE VALLEY	CA	92307	0825	36	06071	34.54197921	-117.2692581	San Bernardino County
232082	Fee-for-Service	1518028711	1518028711	1	1	GUO, SHI SONG LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	GUO'S CHINESE HERBAL MED	1929 IRVING ST	STE 201	SAN FRANCISCO	CA	94122	1763	38	06075	37.76347125	-122.4785395	San Francisco County
232091	Fee-for-Service	1245436591	1245436591	1	1	GOPAL, ARUN K MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121687	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
232108	Fee-for-Service	1164622429	1164622429	1	1	GARZA, DANIEL H MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	94896	01	General Practice	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
232109	Fee-for-Service	1467834697	1467834697	1	1	GOGIA, SHAWNBIR S MD	7/4/2022	207R00000X	NA	Other	026	PHYSICIANS	175821	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
232117	Fee-for-Service	1649328634	1649328634	1	1	GRACE, LORRAINE Y MD	5/31/1986	207R00000X	NA	Other	026	PHYSICIANS	59293	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
232125	Fee-for-Service	1245764893	1245764893	1	1	GRIMM, JADE M MD	1/23/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181429	None	None	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
232128	Fee-for-Service	1669826566	1669826566	1	1	GANDJIAN, MATTHEW MD	3/15/2021	208600000X	NA	General Surgery	026	PHYSICIANS	155689	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
232138	Fee-for-Service	1700357662	1700357662	1	1	GARIN, AISSA LMFT	3/18/2025	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
232157	Fee-for-Service	1629757927	1629757927	1	1	GROSS, RENEE L	9/8/2023	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	19	06037	0	0	None
232160	Fee-for-Service	1013322056	1013322056	1	1	GADRE, ABHISHEK MD	4/19/2021	207R00000X	NA	Other	026	PHYSICIANS	153850	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
232186	Fee-for-Service	1134340037	1134340037	1	1	GANJI, SHIVA K MD	6/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147047	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
232259	Fee-for-Service	1336455609	1336455609	1	1	GAZZIGLI, CATHERINE M LCSW	9/20/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1135 PINE ST	21	REDDING	CA	96001	0750	45	06089	40.58859278	-122.3911662	Shasta County
232346	Fee-for-Service	1508937558	1508937558	1	1	GERTLER, STANFORD L MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39886	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
232370	Fee-for-Service	1821651779	1821651779	1	1	GANDHI, ANAND MD	6/18/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	178494	41	Internal Medicine	0	In state provider	None	16003 TUSCOLA RD	SUITE H	APPLE VALLEY	CA	92307	0825	36	06071	34.54197921	-117.2692581	San Bernardino County
232381	Fee-for-Service	1699041970	1699041970	1	1	GOLSHANI, KEVIN R MD	10/14/2024	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2650 N TENAYA WAY	STE 301	LAS VEGAS	NV	89128	1112	00	None	36.20804839	-115.2501292	Clark County
232396	Fee-for-Service	1164622429	1164622429	1	1	GARZA, DANIEL H MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	94896	30	Radiology	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
232433	Fee-for-Service	1477046936	1477046936	1	1	GOMELLA, ANDREW A MD	6/19/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184233	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
232482	Fee-for-Service	1710704960	1710704960	1	1	GIL, SERGIO SORIA NP	10/16/2024	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
232564	Fee-for-Service	1811084676	1811084676	1	20	GOLDEN BEAR PHYSICAL THERAPY	10/16/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NJURY CENTER, INC.	1400 S MERCEY SPRINGS RD	STE I	LOS BANOS	CA	93635	4928	24	06047	37.054854	-120.835392	Merced County
232639	Fee-for-Service	1306828157	1306828157	1	1	GOODNIGHT, JAMES MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37062	02	General Surgery	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
232655	Fee-for-Service	1578631032	1578631032	1	1	GABRIEL, RODNEY A MD	3/1/2000	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	56204	20	Orthopedic Surgery	0	In state provider	None	2400 S FLOWER STREET	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
232671	Fee-for-Service	1700833662	1700833662	1	1	GIVLER, JANICE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2835 FORT MISSOULA RD	BLDG 3	MISSOULA	MT	59804	7423	00	None	46.846044	-114.0489675	Missoula County
232732	Fee-for-Service	1942088570	1942088570	1	1	GARZA, MICHAEL J	1/28/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
232737	Fee-for-Service	1104438142	1104438142	1	1	GRACIOUS CARE HOME INC	6/13/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	17602 AMAGANSET WAY	None	TUSTIN	CA	92780	2517	30	06059	33.75134175	-117.8248213	Orange County
232749	Fee-for-Service	1821450057	1821450057	1	1	GOGINENI, SWETHA MD	10/27/2022	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
232763	Fee-for-Service	1881366367	1881366367	1	1	GO, MARY ANN	6/13/2024	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
232764	Fee-for-Service	1700145224	1700145224	1	1	GOWAN, JESSPREET K MD	7/6/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	130045	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
232768	Fee-for-Service	1275523888	1275523888	1	1	GULATI, MARTHA MD	9/12/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	181579	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
232785	Fee-for-Service	1003130634	1003130634	1	1	GREWAL PITTA, AMEET K MD	6/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135173	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
232800	Fee-for-Service	1578512620	1578512620	1	1	GRAJO, JOSEPH P DO	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13748	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
232822	Fee-for-Service	1336379247	1336379247	1	1	GUAN, HUAN X OD	2/11/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
232832	Fee-for-Service	1891851861	1891851861	1	2	GILL, CADRIN E MD	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	34954	-	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
232842	Fee-for-Service	1841492915	1841492915	1	1	GABBUR, GOPAL K MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103073	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
232848	Fee-for-Service	1811084676	1811084676	1	25	GOLDEN BEAR PHYSICAL THERAPY	11/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	468 WINTON PKWY	None	LIVINGSTON	CA	95334	9809	24	06047	37.3865854	-120.7370705	Merced County
232878	Fee-for-Service	1578566808	1578566808	1	1	GCC IMAGING LLC	12/22/2016	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	633 AERICK ST	SUITE 105	INGLEWOOD	CA	90301	1902	19	06037	33.9635805	-118.345563	Los Angeles County
232927	Fee-for-Service	1437594223	1437594223	1	1	GOMEZ, GREGORY V MD	9/1/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	160904	20	Orthopedic Surgery	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
232936	Fee-for-Service	1639442320	1639442320	1	1	GARNER, JACKIE L LCSW	7/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
232989	Fee-for-Service	1669552022	1669552022	1	1	GREEN ACRES LODGE	10/1/2004	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8101 E HILL DRIVE	None	ROSEMEAD	CA	91770	4197	19	06037	34.04543501	-118.0925129	Los Angeles County
233000	Fee-for-Service	1548861768	1548861768	1	1	GHUMAN, PAM K CNM	3/8/2022	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
233051	Fee-for-Service	1194275412	1194275412	1	1	GEDDINS, REGINA LCSW	2/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
233056	Fee-for-Service	1003262908	1003262908	1	1	GOSS, ADELINE MD	5/5/2020	207R00000X	NA	Other	026	PHYSICIANS	152708	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
233085	Fee-for-Service	1740627280	1740627280	1	1	G0-WHEELER, MARIANNE G MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132593	77	Infectious Disease	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
233087	Fee-for-Service	1669821245	1669821245	1	1	GUPTA, ANEESH MD	4/2/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168160	09	Gynecology (D.O. only)	0	In state provider	None	200 MED PLAZA STE 430	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
233093	Fee-for-Service	1588040786	1588040786	1	1	GLENDALE ADVENTIST MEDICAL C	11/16/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1509 WILSON TERRACE	WEST TOWER RM 4B13	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
233161	Fee-for-Service	1841254893	1841254893	1	1	GILKAR, NAZIR A MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	51445	40	Pediatrics	0	In state provider	None	11333 N SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
233170	Fee-for-Service	1285402172	1285402172	1	1	GINA RICO PSYCHIATRIC NURSIN	1/24/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	G SERVICES CORP	415 W ROUTE 66 STE 202	None	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
233195	Fee-for-Service	1891944914	1891944914	1	1	GILMER, DARRYL S LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
233209	Fee-for-Service	1679519573	1679519573	1	1	GRANT BROWN, LATAI MD	9/1/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	165239	13	Neurology (M.D. only)	0	In state provider	None	869 NORTH CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
233291	Fee-for-Service	1538296744	1538296744	1	1	GUL, KHAWAR M MD	11/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89941	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	136 NORTH THIRD ST	STE 1	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
233313	Fee-for-Service	1093125676	1093125676	1	1	GIBBS, STEPHEN J MD	7/6/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	142440	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
233319	Fee-for-Service	1174537021	1174537021	1	1	GROSSMAN, KENNETH R MD	1/24/2023	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	580 COLLINS DR	None	MERCED	CA	95348	3121	24	06047	37.32266954	-120.4774245	Merced County
233327	Fee-for-Service	1013522051	1013522051	1	1	GARON, JENNISAH CCC-SLP	12/21/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3416 AMERICAN RIVER DR S	None	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
233370	Fee-for-Service	1740627280	1740627280	1	1	G0-WHEELER, MARIANNE G MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132593	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
233385	Fee-for-Service	1356568752	1356568752	1	1	GREY, ERLINDA DY MD	1/1/1982	170100000X	NA	Other	026	PHYSICIANS	30427	01	General Practice	0	In state provider	None	8215 VAN NUYS BLVD	STE 102	PANORAMA CITY	CA	91402	4846	19	06037	34.22026244	-118.4488066	Los Angeles County
233395	Fee-for-Service	1790129575	1790129575	1	1	GOLD, DONNA M LCSW	11/21/2014	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5440 MOREHOUSE DRIVE	SUITE 3800	SAN DIEGO	CA	92121	6703	37	06073	32.89370849	-117.2010904	San Diego County
233435	Fee-for-Service	1447235155	1447235155	1	1	GLASER, NICOLE S MD	2/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77306	67	Endocrinology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
233437	Fee-for-Service	1770964504	1770964504	1	1	GOUGH, MICHELLE A NP	1/2/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
233479	Fee-for-Service	1396909768	1396909768	1	1	GABBAY, JOUBIN S MD	1/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84648	02	General Surgery	0	In state provider	None	863 N DOUGLAS ST	STE 100	EL SEGUNDO	CA	90245	2081	19	06037	33.92830583	-118.3831669	Los Angeles County
233480	Fee-for-Service	1871055384	1871055384	1	1	GIDDINGS, PHILIP MD	8/19/2022	207P00000X	NA	Other	026	PHYSICIANS	180284	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
233500	Fee-for-Service	1689734584	1689734584	1	2	GOH, YINGYING MD	2/12/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	91513	-	NOT APPLICABLE	0	In state provider	None	1845 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	19	06037	34.177806	-118.1507985	Los Angeles County
233511	Fee-for-Service	1013412873	1013412873	1	1	GARAVATTI, EMILY K MD	1/17/2025	2080P0008X	NA	Neurology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
233515	Fee-for-Service	1083607055	1083607055	1	1	GHOSH, SUBRATO MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132473	41	Internal Medicine	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
233539	Fee-for-Service	1619323821	1619323821	1	1	GIRGIS, STEVE MD	7/30/2019	208M00000X	NA	Other	026	PHYSICIANS	160727	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
233570	Fee-for-Service	1154428613	1154428613	1	1	GLADSTEIN, JAY E MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83112	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
233581	Fee-for-Service	1538296744	1538296744	1	1	GUL, KHAWAR M MD	11/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89941	41	Internal Medicine	0	In state provider	None	136 NORTH THIRD ST	STE 1	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
233585	Fee-for-Service	1154453702	1154453702	1	1	GILLIS, ERIN M MD	5/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96811	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
233607	Fee-for-Service	1174537021	1174537021	1	1	GROSSMAN, KENNETH R MD	2/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	580 COLLINS DR	None	MERCED	CA	95348	3121	24	06047	37.32266954	-120.4774245	Merced County
233649	Fee-for-Service	1154357010	1154357010	1	1	GLASER, JEFFREY B MD	2/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	64352	None	None	0	In state provider	None	16311 VENTURA BLVD	STE 518	ENCINO	CA	91436	4672	19	06037	34.15706864	-118.4885978	Los Angeles County
233695	Fee-for-Service	1417942228	1417942228	1	1	GHOREISHI, EASA MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147933	01	General Practice	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
233722	Fee-for-Service	1447235155	1447235155	1	1	GLASER, NICOLE S MD	2/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77306	40	Pediatrics	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
233747	Fee-for-Service	1356436984	1356436984	1	1	GOLDZWEIG, CAROLINE L MD	2/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	77381	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
233766	Fee-for-Service	1396909768	1396909768	1	1	GABBAY, JOUBIN S MD	1/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84648	24	Plastic Surgery	0	In state provider	None	863 N DOUGLAS ST	STE 100	EL SEGUNDO	CA	90245	2081	19	06037	33.92830583	-118.3831669	Los Angeles County
233887	Fee-for-Service	1093377574	1093377574	1	1	GUMMI, ROHIT R MD	5/9/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	182027	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
233908	Fee-for-Service	1619928504	1619928504	1	1	GOLKAR, SADEGH MD	3/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87773	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
233910	Fee-for-Service	1730189655	1730189655	1	1	GILLARD,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	1601 W ST MARYS RD	None	TUCSON	AZ	85745	0000	00	None	32.228199	-111.0000825	Pima County
233919	Fee-for-Service	1700818457	1700818457	1	1	GIBSON, JORELY MAY CRNA	5/21/2019	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
233951	Fee-for-Service	1295722809	1295722809	1	1	GARDEN GROVE CONV HOSP	5/1/1991	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12882 SHACKELFORD LN	None	GARDEN GROVE	CA	92841	5109	30	06059	33.77512936	-117.972012	Orange County
233988	Fee-for-Service	1942589460	1942589460	1	1	GANEV, KATELYN PT	12/13/2023	225100000X	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
234002	Fee-for-Service	1255376059	1255376059	1	1	GARFIELD BEACH CVS, LLC	9/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 WEST SLAUSON AVE.	None	LOS ANGELES	CA	90043	2719	19	06037	33.9889233	-118.3545857	Los Angeles County
234131	Fee-for-Service	1275012890	1275012890	1	1	GANATA, JOSEPH CNP	3/19/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 S BALDWIN AVE	None	ARCADIA	CA	91007	7922	19	06037	34.12357479	-118.0551359	Los Angeles County
234160	Fee-for-Service	1083198550	1083198550	1	1	GRIGORYAN, ELIZABETH MD	10/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174398	None	None	0	In state provider	None	445 W BROADWAY	None	GLENDALE	CA	91204	1208	19	06037	34.14684551	-118.2633525	Los Angeles County
234186	Fee-for-Service	1295893501	1295893501	1	1	GADDIPATI, ANITHA MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74879	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
234199	Fee-for-Service	1912037425	1912037425	1	2	GIBSON, NICOLE LMFT	2/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1060 E FOOTHILL BLVD	204	UPLAND	CA	91786	4070	36	06071	34.1070235	-117.6371235	San Bernardino County
234208	Fee-for-Service	1366462491	1366462491	1	1	GYNN, MICHAEL C MD	11/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79766	02	General 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
234215	Fee-for-Service	1386649044	1386649044	1	1	GARRISON, DOUGLAS E DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	6292	08	Family Practice	0	In state provider	None	1025 VILLAGE LN	None	CHICO	CA	95926	2812	04	06007	39.74919745	-121.8251095	Butte County
234240	Fee-for-Service	1841219243	1841219243	1	1	GARCIA, TERESA H MD	8/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	71922	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1201 W LA VETA AVE	STE 401	ORANGE	CA	92868	4209	30	06059	33.78034779	-117.8655767	Orange County
234356	Fee-for-Service	1205496239	1205496239	1	1	GARCIA RICARDO, WILMER E MD	10/11/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176543	08	Family Practice	0	In state provider	None	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
234404	Fee-for-Service	1144508995	1144508995	1	1	GOMEZ-ENGLER, HUGO E MD	3/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	33949	33	Thoracic 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
234433	Fee-for-Service	1952808891	1952808891	1	1	GUZEL, CAMILLE R MD	10/3/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	181167	None	None	0	In state provider	None	140 HERMAN AVE	SUITE A	WATSONVILLE	CA	95076	2920	44	06087	36.92377188	-121.7846892	Santa Cruz County
234460	Fee-for-Service	1760560361	1760560361	1	1	GANDHI, MANMOHAN K. MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	46597	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
234507	Fee-for-Service	1265522072	1265522072	1	1	GURLEY, SUSAN B MD	4/2/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	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
234567	Fee-for-Service	1568492635	1568492635	1	1	GIANG, DANIEL W MD	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	52932	13	Neurology (M.D. only)	0	In state provider	None	250 SOUTH G STREET	None	SAN BERNARDINO	CA	92410	3320	36	06071	34.09693522	-117.2986838	San Bernardino County
234599	Fee-for-Service	1629195508	1629195508	1	1	GOSHIKE, DEEPIKA S MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55155	08	Family Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
234622	Fee-for-Service	1578554150	1578554150	1	1	GUZMAN, RAMONA L NP	8/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
234668	Fee-for-Service	1225696206	1225696206	1	1	GAMBUTO, SOFIA MD	11/7/2023	390200000X	NA	Other	026	PHYSICIANS	185837	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
234691	Fee-for-Service	1417029265	1417029265	1	1	GILFORD, MARGARET A MD	8/2/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80681	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
234704	Fee-for-Service	1689106205	1689106205	1	1	GOLDBERG, AARON J MD	5/12/2020	390200000X	NA	Other	026	PHYSICIANS	159162	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
234714	Fee-for-Service	1861816886	1861816886	1	1	GHAZI, SARA H DO	8/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13144	None	None	0	In state provider	None	120 S MONTEBELLO BLVD	None	MONTEBELLO	CA	90640	4730	19	06037	34.00902509	-118.1084052	Los Angeles County
234722	Fee-for-Service	1952808891	1952808891	1	1	GUZEL, CAMILLE R MD	3/1/2023	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	140 HERMAN AVE	SUITE A	WATSONVILLE	CA	95076	2920	44	06087	36.92377188	-121.7846892	Santa Cruz County
234756	Fee-for-Service	1972611911	1972611911	1	1	GAUTHAM, KANEKAL S 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
234772	Fee-for-Service	1114968021	1114968021	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4615 FRAZEE RD	None	OCEANSIDE	CA	92057	6100	37	06073	33.23838924	-117.2979655	San Diego County
234837	Fee-for-Service	1982281507	1982281507	1	1	GOGINENI, ANISHA MD	1/23/2025	208M00000X	NA	Other	026	PHYSICIANS	182184	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
234839	Fee-for-Service	1477630762	1477630762	2	1	GOEBEL, MELISSA M MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125980	41	Internal Medicine	0	In state provider	None	2100 WEBSTER STREET	SUITE 516	SAN FRANCISCO	CA	94115	2381	38	06075	37.7904826	-122.4324477	San Francisco County
234852	Fee-for-Service	1518146414	1518146414	1	1	GUZMAN, JULIO V MD INC	9/1/2001	193400000X	NA	Other	026	PHYSICIANS	66211	08	Family Practice	0	In state provider	JULIO V GUZMAN MD INC	4214 W BEVERLY BLVD	STE 212	LOS ANGELES	CA	90004	4429	19	06037	34.07626052	-118.301031	Los Angeles County
234867	Fee-for-Service	1114946860	1114946860	1	1	GRODE, MARSHALL L MD INC	2/8/2015	207T00000X	NA	General Surgery	026	PHYSICIANS	11754	14	Neurological Surgery	0	In state provider	None	8635 W 3RD ST	STE 1080W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
234869	Fee-for-Service	1477977916	1477977916	1	1	GARFIELD BEACH CVS LLC	12/10/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1151 S HARBOR BLVD	None	LA HABRA	CA	90631	6840	30	06059	33.917967	-117.9330655	Orange County
234886	Fee-for-Service	1629195508	1629195508	1	1	GOSHIKE, DEEPIKA S MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55155	01	General Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
234898	Fee-for-Service	1619630068	1619630068	1	1	GUARDIAN BROTHERS HOME	11/9/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE INC	13731 VENTURA BLVD	SUITE A	SHERMAN OAKS	CA	91423	3078	19	06037	34.14822875	-118.4323329	Los Angeles County
234899	Fee-for-Service	1649215534	1649215534	1	1	GARFIELD BEACH CVS, LLC	9/24/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1750 NORTH GRAND AVE	None	SANTA ANA	CA	92705	7011	30	06059	33.76072239	-117.8519234	Orange County
234916	Fee-for-Service	1588642656	1588642656	1	1	GANDHOKE, RONNIE MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102183	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
234953	Fee-for-Service	1003853029	1003853029	1	1	GAFORI, VALERIE V MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87949	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
234962	Fee-for-Service	1376125120	1376125120	1	1	GENTLE LOVING CARE	10/3/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 301E	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
234977	Fee-for-Service	1417029265	1417029265	1	1	GILFORD, MARGARET A MD	8/2/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80681	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
234986	Fee-for-Service	1902161631	1902161631	2	1	GILL, PUNEET MD	5/22/2023	207R00000X	NA	Other	026	PHYSICIANS	176068	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
234998	Fee-for-Service	1457732216	1457732216	1	1	GILMER, RACHEAL A	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	153767	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
235005	Fee-for-Service	1285692509	1285692509	1	1	GORDON, ROBERT L OD	1/1/1979	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16255 VENTURA BLVD	STE 705	ENCINO	CA	91436	2302	19	06037	34.15693902	-118.4876816	Los Angeles County
235025	Fee-for-Service	1962528117	1962528117	1	1	GORDON, DEBORAH J 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
235046	Fee-for-Service	1134179047	1134179047	1	1	GREENWALD, LEONARD DPM	4/5/2022	213E00000X	NA	Other	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
235074	Fee-for-Service	1669416913	1669416913	1	1	GARFIELD BEACH CVS, LLC	3/21/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	460 S.ANAHEIM HILLS RD.	None	ANAHEIM	CA	92807	4241	30	06059	33.84495282	-117.7770782	Orange County
235085	Fee-for-Service	1235699166	1235699166	1	1	GANESHAN, SMITHA MD	8/2/2022	208M00000X	NA	Other	026	PHYSICIANS	176827	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
235098	Fee-for-Service	1134290117	1134290117	1	1	GEORGE, SHAJU MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82526	08	Family Practice	0	In state provider	None	2732 NAVAJO RD	STE 200	EL CAJON	CA	92020	2123	37	06073	32.80217534	-117.0025853	San Diego County
235140	Fee-for-Service	1518146414	1518146414	1	1	GUZMAN, JULIO V MD INC	9/1/2001	193400000X	NA	Other	026	PHYSICIANS	66211	22	Pathology (M.D. only)	0	In state provider	JULIO V GUZMAN MD INC	4214 W BEVERLY BLVD	STE 212	LOS ANGELES	CA	90004	4429	19	06037	34.07626052	-118.301031	Los Angeles County
235145	Fee-for-Service	1497218812	1497218812	1	1	GOHIL, RAJIT R MD	8/29/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176689	None	None	0	In state provider	None	2390 E. FLORIDA AVE.	SUITE 104	HEMET	CA	92544	4707	33	06065	33.7477405	-116.94681	Riverside County
235161	Fee-for-Service	1649828914	1649828914	1	1	GOLDEN STANDARDS HEALTHCARE	12/23/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14545 FRIAR ST	STE 129	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
235221	Fee-for-Service	1588423651	1588423651	1	1	GUERRERO, VIRGINIA NP	5/6/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	921 W 7TH ST	None	OXNARD	CA	93030	6755	56	06111	34.19516476	-119.1890959	Ventura County
235253	Fee-for-Service	1356083588	1356083588	1	1	GARFIELD BEACH CVS, L.L.C.	2/17/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	270 MOUNT HERMON RD	None	SCOTTS VALLEY	CA	95066	4024	44	06087	37.04751632	-122.0317468	Santa Cruz County
235264	Fee-for-Service	1518220656	1518220656	1	1	GHAEMMAGHAMI, MASOUD MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132472	41	Internal Medicine	0	In state provider	None	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
235266	Fee-for-Service	1417029265	1417029265	1	1	GILFORD, MARGARET A MD	8/2/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80681	08	Family Practice	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
235277	Fee-for-Service	1659316545	1659316545	1	1	GARFIELD BEACH CVS, LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12143 VENTURA BLVD.	None	STUDIO CITY	CA	91604	2515	19	06037	34.14347064	-118.3966333	Los Angeles County
235323	Fee-for-Service	1811084676	1811084676	1	9	GOLDEN BEAR PHYSICAL THERAPY	12/29/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	2303 GEER RD	None	TURLOCK	CA	95382	2408	50	06099	37.514097	-120.848997	Stanislaus County
235331	Fee-for-Service	1386711307	1386711307	1	1	GUTIERREZ, GODFREDO R MD	6/27/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60481	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
235383	Fee-for-Service	1215970538	1215970538	1	1	GOLDSCHLAGER, NORA F MD	11/27/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	14678	06	Cardiovascular Disease (M.D. only)	0	In state provider	SFGH CARDIOLOGY SVC	1001 POTRERO AVE	# 5G	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
235410	Fee-for-Service	1467969931	1467969931	1	1	GARFIELD BEACH CVS LLC	5/30/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	620 S VIRGIL AVE	STE 100	LOS ANGELES	CA	90005	4080	19	06037	34.06326037	-118.2870366	Los Angeles County
235428	Fee-for-Service	1518146414	1518146414	1	1	GUZMAN, JULIO V MD INC	9/1/2001	193400000X	NA	Other	026	PHYSICIANS	66211	03	Allergy	0	In state provider	JULIO V GUZMAN MD INC	4214 W BEVERLY BLVD	STE 212	LOS ANGELES	CA	90004	4429	19	06037	34.07626052	-118.301031	Los Angeles County
235441	Fee-for-Service	1619126562	1619126562	1	1	GUSTS, KRISTIN L LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
235483	Fee-for-Service	1932195567	1932195567	1	1	GIBBS, NEIL F MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62389	07	Dermatology	0	In state provider	None	3030 CHILDRENS WAY	STE 210	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
235506	Fee-for-Service	1154410629	1154410629	1	1	GENSER, PAUL A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32897	40	Pediatrics	0	In state provider	None	18102 IRVINE BLVD	STE 107	TUSTIN	CA	92780	3423	30	06059	33.74819092	-117.816792	Orange County
235563	Fee-for-Service	1720136385	1720136385	1	1	GROSSMONT UNION HIGH SD	4/12/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1100 MURRAY DR	None	EL CAJON	CA	92020	5664	37	06073	32.77981849	-116.9861154	San Diego County
235590	Fee-for-Service	1104202621	1104202621	1	1	GAINE, SHANNON K NP	6/18/2019	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
235615	Fee-for-Service	1851882930	1851882930	1	1	GOODARZI, MEHDI PSYD	12/31/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178394	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
235625	Fee-for-Service	1609319532	1609319532	1	1	GENERATIONS HOSPICE AND	1/29/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	6422 BELLINGHAM AVE	STE 201	NORTH HOLLYWOOD	CA	91606	1417	19	06037	34.187391	-118.398713	Los Angeles County
235632	Fee-for-Service	1144378597	1144378597	1	1	GARCIA, GABRIEL MD	1/1/1982	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38402	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
235660	Fee-for-Service	1457315533	1457315533	1	1	GLENN, CHRIS MD	1/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	79975	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
235664	Fee-for-Service	1699791822	1699791822	1	1	GLAIBERMAN, CRAIG B MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103135	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
235718	Fee-for-Service	1871734814	1871734814	1	1	GENTZ, ALLISON A LMFT	8/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39180 LIBERTY ST	205	FREMONT	CA	94538	2586	01	06001	37.55089505	-121.982082	Alameda County
235731	Fee-for-Service	1386827988	1386827988	1	1	GUSTAFSON, GEORGE A MD	5/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	24086	20	Orthopedic Surgery	0	In state provider	GUSTAFSON ORTHPAEDIC INC	10459 MT VIEW AVE	STE #B	LOMA LINDA	CA	92254	2033	36	06071	34.063722	-117.2436545	San Bernardino County
235733	Fee-for-Service	1902835572	1902835572	1	1	GARNER, WARREN L MD	4/16/1999	2086S0122X	NA	General Surgery	026	PHYSICIANS	85136	02	General Surgery	0	In state provider	None	7601 E IMPERIAL HWY	STE 514	LOS ANGELES	CA	90033	0000	19	06037	33.9309663	-118.4309476	Los Angeles County
235763	Fee-for-Service	1063100535	1063100535	1	1	GREEN, NIA BIRTH DOULA	1/1/2025	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
235772	Fee-for-Service	1932195567	1932195567	1	1	GIBBS, NEIL F MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	62389	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 210	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
235777	Fee-for-Service	1174607246	1174607246	1	1	GAINES, RONALD F MD	8/15/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	32224	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
235819	Fee-for-Service	1306139043	1306139043	1	1	GILBERT, SARA ANN B MD	10/28/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162891	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
235911	Fee-for-Service	1487161535	1487161535	1	1	GREENWOOD, CAITLIN LCSW	8/1/2024	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
235913	Fee-for-Service	1609319532	1609319532	1	1	GENERATIONS HOSPICE AND	1/29/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	6422 BELLINGHAM AVE	STE 201	NORTH HOLLYWOOD	CA	91606	1417	19	06037	34.187391	-118.398713	Los Angeles County
235922	Fee-for-Service	1144378597	1144378597	1	1	GARCIA, GABRIEL MD	1/1/1982	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38402	10	Gastroenterology (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
235975	Fee-for-Service	1023495330	1023495330	1	1	GAO, HAN T MD	6/27/2018	207P00000X	NA	Other	026	PHYSICIANS	154520	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
236032	Fee-for-Service	1679588602	1679588602	1	1	GLENESK, GARY A MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53123	05	Anesthesiology	0	In state provider	None	792 W TOWN AND COUNTRY R	None	ORANGE	CA	92868	4710	30	06059	33.77649954	-117.860409	Orange County
236070	Fee-for-Service	1467819938	1467819938	1	1	GARFIELD BEACH CVS LLC	5/26/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3710 FRANKLIN BLVD	None	SACRAMENTO	CA	95820	1128	34	06067	38.540493	-121.4763255	Sacramento County
236096	Fee-for-Service	1558441600	1558441600	1	1	GUPTA, GEETA K MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60411	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
236121	Fee-for-Service	1386806495	1386806495	1	1	GOGIA, RAVEEN K MD	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102855	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
236137	Fee-for-Service	1659487171	1659487171	1	1	GOODFAITH MED TRANS INC	1/27/1992	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	GOODFAITH MED TRANS INC	820 NORTH E STREET	None	SAN BERNARDINO	CA	92410	2929	36	06071	34.114401	-117.2941895	San Bernardino County
236158	Fee-for-Service	1922715697	1922715697	1	1	GRIGORYAN, SHUSHANIK LCSW	8/17/2023	1041C0700X	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
236176	Fee-for-Service	1578870234	1578870234	1	1	GILL, SUKHPAL K MD AMC	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	47807	41	Internal Medicine	0	In state provider	None	550 W DUARTE RD	STE 4	DUARTE	CA	91007	7360	19	06037	34.12657349	-118.0511514	Los Angeles County
236206	Fee-for-Service	1679042402	1679042402	1	1	GSA HOME HEALTH CARE INC	4/28/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2829 N GLENOAKS BLVD	STE 106	BURBANK	CA	91504	2660	19	06037	34.2035185	-118.3349635	Los Angeles County
236228	Fee-for-Service	1659399681	1659399681	1	1	GRABIE, MORRIS T MD	10/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	34196	45	Nephrology (Renal-Kidney)	0	In state provider	None	1301 20TH ST	STE 200	SANTA MONICA	CA	90404	2088	19	06037	34.02976782	-118.4812493	Los Angeles County
236239	Fee-for-Service	1518973510	1518973510	1	1	GORDON, NAYVIN MD	9/20/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32948	08	Family Practice	0	In state provider	None	350 30TH ST	STE 405	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
236292	Fee-for-Service	1619351558	1619351558	1	1	GHAYOURI, SARA MD	11/4/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	145611	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
236366	Fee-for-Service	1992574289	1992574289	1	1	GARSON, BENJAMIN PT	3/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
236372	Fee-for-Service	1780180166	1780180166	1	1	GIUCA, ANNE-MARIE MD	8/14/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178577	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
236379	Fee-for-Service	1639728942	1639728942	1	1	GUTIERREZ, CRYSTAL D NP	12/10/2019	363LF0000X	NA	Nurse Practitioner	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
236386	Fee-for-Service	1891931069	1891931069	1	1	GARNETT MILLER	3/23/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1064 BREEDLOVE ST	None	MEMPHIS	TN	38107	2805	00	None	35.16899095	-90.02166926	Shelby County
236391	Fee-for-Service	1265073670	1265073670	1	1	GWINN, SARAH M CCC-SLP	3/25/2020	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
236413	Fee-for-Service	1992803480	1992803480	1	1	GARFIELD BEACH CVS LLC	10/29/2004	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23806 MAIN ST	None	CARSON	CA	90745	5746	19	06037	33.80850386	-118.275525	Los Angeles County
236457	Fee-for-Service	1104993112	1104993112	1	1	GARABEDIAN, MIHRAN H MD	8/1/1998	207RC0200X	NA	Other	026	PHYSICIANS	55515	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
236461	Fee-for-Service	1578870234	1578870234	1	1	GILL, SUKHPAL K MD AMC	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	47807	45	Nephrology (Renal-Kidney)	0	In state provider	None	550 W DUARTE RD	STE 4	DUARTE	CA	91007	7360	19	06037	34.12657349	-118.0511514	Los Angeles County
236514	Fee-for-Service	1659399681	1659399681	1	1	GRABIE, MORRIS T MD	10/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	34196	41	Internal Medicine	0	In state provider	None	1301 20TH ST	STE 200	SANTA MONICA	CA	90404	2088	19	06037	34.02976782	-118.4812493	Los Angeles County
236515	Fee-for-Service	1295316396	1295316396	1	1	GAMBARDELLA, BRIAN MD	9/8/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187316	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
236546	Fee-for-Service	1962601500	1962601500	1	1	GREEN-SMITH, LATOYA A	8/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111079	40	Pediatrics	0	In state provider	None	44216 N 10TH STREET W	None	LANCASTER	CA	93534	4134	19	06037	34.6862307	-118.1479298	Los Angeles County
236550	Fee-for-Service	1649803099	1649803099	1	1	GUARDIAN FLIGHT LLC	10/5/2020	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	145 GRANITE POINT CT	None	KENAI	AK	99961	1000	00	None	60.56254559	-151.2507104	Kenai Peninsula Borough
236572	Fee-for-Service	1417586801	1417586801	1	1	GINN, MADISON DO	9/7/2023	207P00000X	NA	Other	026	PHYSICIANS	19843	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
236581	Fee-for-Service	1881784452	1881784452	1	1	GLASIER, CHARLES 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	#653	LITTLE ROCK	AR	72202	3510	00	None	34.742745	-92.2927905	Pulaski County
236590	Fee-for-Service	1902944788	1902944788	1	1	GREEN, MICHAEL M DO	5/18/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	4975	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
236636	Fee-for-Service	1487072922	1487072922	1	1	GREENLEE, ALECIA MD	2/12/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	169680	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
236637	Fee-for-Service	1285624155	1285624155	1	1	GUIMARAES, PEDRO D MD	2/17/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	52093	None	None	0	In state provider	None	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	40	06079	35.12986992	-120.6006027	San Luis Obispo County
236640	Fee-for-Service	1811275399	1811275399	1	1	GUPTA, DEEPTI MD	8/25/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164431	None	None	0	In state provider	None	350 30TH ST	411	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
236657	Fee-for-Service	1700475357	1700475357	1	1	GEBREKRISTOS, SELAM LMFT	3/10/2025	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
236664	Fee-for-Service	1295822294	1295822294	1	1	GEE, QUINN MD	9/12/2012	207L00000X	NA	Other	026	PHYSICIANS	98127	05	Anesthesiology	0	In state provider	None	400 W MINERAL AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
236685	Fee-for-Service	1902981863	1902981863	1	1	GARFIELD BEACH CVS LLC	3/23/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	68-010 VISTA CHINO	None	CATHEDRAL CITY	CA	92234	3660	33	06065	33.84495	-116.474623	Riverside County
236738	Fee-for-Service	1922286962	1922286962	1	1	GARCIA TOMAS, VICENTE A MD	11/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115158	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	SUITE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
236740	Fee-for-Service	1043224389	1043224389	1	1	GARAHAN, MARGARET B MD	12/6/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82055	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
236834	Fee-for-Service	1174588503	1174588503	1	1	GIANNINI, MARCHELLE J MD	7/14/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53482	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
236923	Fee-for-Service	1609935212	1609935212	1	1	GREHIAN, MARY V MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84430	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
236947	Fee-for-Service	1720390834	1720390834	1	1	GHIAS, ALI MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112175	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
236991	Fee-for-Service	1992731798	1992731798	1	1	GONZALEZ, EDUARDO J MD	9/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73502	01	General Practice	0	In state provider	None	3625 MARTIN LUTHER KING	STE 7	LYNWOOD	CA	90262	3509	19	06037	33.93044131	-118.2021564	Los Angeles County
237021	Fee-for-Service	1992785042	1992785042	1	1	GELBART, MICHAEL S LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	333 ESTUDILLO AVE	STE C	SAN LEANDRO	CA	94577	4717	01	06001	37.72569478	-122.1533134	Alameda County
237050	Fee-for-Service	1154710911	1154710911	1	1	GONZALEZ, ROXANA CCC-SLP	1/27/2025	235Z00000X	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
237113	Fee-for-Service	1043731987	1043731987	1	1	GOOD SAMARITAN SHELTER	12/5/2017	207QA0401X	NA	Adult Primary Care	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	113 SOUTH M STREET	None	LOMPOC	CA	93436	6620	42	06083	34.63843246	-120.4643325	Santa Barbara County
237116	Fee-for-Service	1285600403	1285600403	1	1	GREENE, DAVID MD	2/28/2024	2085R0001X	NA	Other	026	PHYSICIANS	54574	None	None	0	In state provider	None	125 SOUTH DRIVE	None	MOUNTAIN VIEW	CA	94040	4310	43	06085	37.36722947	-122.079033	Santa Clara County
237125	Fee-for-Service	1013135003	1013135003	1	1	GOYAL, NILUFER R MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100347	None	None	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
237140	Fee-for-Service	1255434890	1255434890	1	1	GEWERTZ, BRUCE L MD	3/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87711	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
237157	Fee-for-Service	1326721218	1326721218	1	1	GUERRERO, CRISTINA PT	3/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 N TUSTIN AVE	407	SANTA ANA	CA	92705	3608	30	06059	33.752286	-117.8341735	Orange County
237174	Fee-for-Service	1346309044	1346309044	1	1	GRELLING, BARBARA PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVENUE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
237236	Fee-for-Service	1720390834	1720390834	1	1	GHIAS, ALI MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112175	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
237263	Fee-for-Service	1255482014	1255482014	1	1	GANNON, LAURA R LAC	1/22/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
237279	Fee-for-Service	1194967216	1194967216	1	1	GILL, GURKIRAN K MD	8/20/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157950	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
237302	Fee-for-Service	1316576002	1316576002	1	1	GRAYSON, KAITLYN MD	11/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189796	None	None	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
237329	Fee-for-Service	1932689577	1932689577	1	1	GOLD STAR HOME HEALTH INC	3/23/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	421 ARDEN AVE	STE B	GLENDALE	CA	91203	4008	19	06037	34.15847954	-118.2624135	Los Angeles County
237385	Fee-for-Service	1841775343	1841775343	1	1	GARNER, LLANEH	1/22/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1144 COFFEE RD	None	MODESTO	CA	95355	4205	50	06099	37.659627	-120.9756125	Stanislaus County
237418	Fee-for-Service	1952479602	1952479602	1	1	GARDNER FAMILY HEALTH	1/1/2000	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	55 E JULIAN ST	STE 102	SAN JOSE	CA	95112	4007	43	06085	37.34118198	-121.8925795	Santa Clara County
237442	Fee-for-Service	1619119617	1619119617	1	1	GREEN, ERIN M	1/30/2013	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
237502	Fee-for-Service	1437331832	1437331832	1	1	GOLSON, DAVIS M PA	2/26/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	11533	-	NOT APPLICABLE	0	In state provider	None	700 ADELINE STREET	None	OAKLAND	CA	94607	2608	01	06001	37.80430011	-122.2879962	Alameda County
237532	Fee-for-Service	1821049149	1821049149	1	1	GARCIA, REYNALDO Y MD	1/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89529	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
237534	Fee-for-Service	1730340811	1730340811	1	1	GANDHI, SHARON DO	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11354	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
237551	Fee-for-Service	1669419065	1669419065	1	1	GIVERTZ, RICHARD MD	9/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62145	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
237558	Fee-for-Service	1922149756	1922149756	1	1	GEAGHAN, SHARON M MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	60618	22	Pathology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
237587	Fee-for-Service	1538588934	1538588934	1	1	GOLDMAN, MATTHEW L MD	10/21/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	162534	36	Psychiatry	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
237631	Fee-for-Service	1679019319	1679019319	1	1	GARFIELD BEACH CVS LLC	11/21/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	657 US HWY 101 N	None	CRESCENT CITY	CA	95531	2306	08	06015	41.7624334	-124.1972855	Del Norte County
237666	Fee-for-Service	1972916955	1972916955	1	1	GAYNOR, PRYCE MD	5/3/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	147971	77	Infectious Disease	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
237698	Fee-for-Service	1427135607	1427135607	1	1	GERSHBERG, DONALD M LMFT	10/29/2018	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
237701	Fee-for-Service	1114167236	1114167236	1	1	GERBER, EMILY PHD	2/4/2020	103TC2200X	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
237704	Fee-for-Service	1104117514	1104117514	1	1	GOMES, DANILO D MD	5/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148054	30	Radiology	0	In state provider	None	2301 BAHAMAS DRIVE	None	BAKERSFIELD	CA	93309	0663	15	06029	35.37447628	-119.0453594	Kern County
237727	Fee-for-Service	1639475254	1639475254	1	1	GUSTAFSON, JENNIFER CNP	7/18/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
237744	Fee-for-Service	1447692793	1447692793	1	1	GRK, DEJANA OD	12/15/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4650 SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
237745	Fee-for-Service	1134661697	1134661697	1	1	GHORBANI FAMILY SOLUTIONS	1/2/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6401-4 PLATT AVE	None	WEST HILLS	CA	91307	3200	19	06037	34.18702776	-118.6427884	Los Angeles County
237760	Fee-for-Service	1871048470	1871048470	1	1	GORDON, KONWRE C NP	3/6/2024	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
237767	Fee-for-Service	1861759870	1861759870	1	1	GIURINTANO, JONATHAN P MD	5/10/2017	390200000X	NA	Other	026	PHYSICIANS	145217	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1001 POTREREO AVE	RM 4M45	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
237812	Fee-for-Service	1013097120	1013097120	1	1	GLENOAKS URGENT CARE MEDICAL	10/15/2012	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP	1100 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2606	19	06037	34.16406001	-118.28021	Los Angeles County
237822	Fee-for-Service	1962973040	1962973040	1	1	GOH, HENRY G PT	3/1/2019	2251X0800X	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
237896	Fee-for-Service	1205020344	1205020344	2	1	GARFIELD BEACH CVS LLC	12/19/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2195 E PROSPERITY AVE	None	TULARE	CA	93274	7754	54	06107	36.2258605	-119.314602	Tulare County
237907	Fee-for-Service	1831829076	1831829076	1	1	GACHARA, TERESA W	7/14/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4441 MARE CT	None	ANTIOCH	CA	94531	8164	07	06013	37.97510205	-121.7558376	Contra Costa County
237911	Fee-for-Service	1497827141	1497827141	1	1	GERSTENBERGER, AMY E	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61144	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
237937	Fee-for-Service	1497793343	1497793343	1	1	GUBBELS,CINDY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE PHYSICANS NETWORK	555 S 70TH STREET	None	LINCOLN	NE	68510	0000	00	None	40.808151	-96.62516802	Lancaster County
238002	Fee-for-Service	1487666996	1487666996	1	1	GUERRERO, JOSEFINA T MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41364	40	Pediatrics	0	In state provider	None	641 E PENNSYLVANIA AVE	STE 102	ESCONDIDO	CA	92025	3047	37	06073	33.12660916	-117.0744425	San Diego County
238005	Fee-for-Service	1144651092	1144651092	1	1	GEIGER PROSTHETICS AND	3/21/2014	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS INC	917 W CENTER AVE	None	VISALIA	CA	93291	5915	54	06107	36.330867	-119.302038	Tulare County
238014	Fee-for-Service	1255560983	1255560983	1	1	GRITZNER, SUSAN M PSY	2/4/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
238038	Fee-for-Service	1871576694	1871576694	1	1	GOGARTY, WILLIAM S 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	2745	00	None	38.28171999	-104.6119963	Pueblo County
238065	Fee-for-Service	1376990317	1376990317	1	1	GABBARD, MICHAEL	3/29/2020	225100000X	NA	Physical Therapist	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
238096	Fee-for-Service	1326168865	1326168865	1	1	GAHRE, TERI L	2/12/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6 WILLARD	None	IRVINE	CA	92604	4694	30	06059	33.67534801	-117.7900415	Orange County
238099	Fee-for-Service	1013097120	1013097120	1	1	GLENOAKS URGENT CARE MEDICAL	10/15/2012	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	1100 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2606	19	06037	34.16406001	-118.28021	Los Angeles County
238188	Fee-for-Service	1215446315	1215446315	1	1	GALINATO, MELVIN M NP	3/11/2019	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
238194	Fee-for-Service	1831829076	1831829076	1	1	GACHARA, TERESA W	7/14/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4441 MARE CT	None	ANTIOCH	CA	94531	8164	07	06013	37.97510205	-121.7558376	Contra Costa County
238219	Fee-for-Service	1275151425	1275151425	1	1	GERAS HOME HEALTH CARE, INC	3/17/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4225 VALLEY FAIR ST	SUITE 209B	SIMI VALLEY	CA	93063	2952	56	06111	34.2726333	-118.7125045	Ventura County
238227	Fee-for-Service	1669754073	1669754073	1	1	GURAI, RAMANDEEP S MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124322	01	General Practice	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
238235	Fee-for-Service	1881004398	1881004398	1	1	GIDWANI, POOJA N MD	4/16/2024	207R00000X	NA	Other	026	PHYSICIANS	185843	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
238246	Fee-for-Service	1417275819	1417275819	1	1	GUPTA, SANJIV MD	6/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112178	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
238263	Fee-for-Service	1265847479	1265847479	1	1	GRANT-TEJADA, MARIA P MD	3/4/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	156650	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
238278	Fee-for-Service	1629298401	1629298401	1	1	GOLDEN VALLEY HEALTH CTR	7/1/2005	1041C0700X	NA	Mental Health Outpatient Services	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	13161 JEFFERSON ST	None	LE GRAND	CA	95333	9766	24	06047	37.2293683	-120.2509644	Merced County
238290	Fee-for-Service	1245420660	1245420660	1	1	GEORGE L MEE MEM HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
238313	Fee-for-Service	1417181470	1417181470	1	1	GARCIA, TERESA H MD INC	4/21/2010	261QM2500X	NA	Other	026	PHYSICIANS	71922	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1140 W LA VETA	SUITE 480	ORANGE	CA	92868	4200	30	06059	33.7802984	-117.8651669	Orange County
238378	Fee-for-Service	1073691820	1073691820	1	1	GAIND, ANITA C MD	3/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87476	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
238414	Fee-for-Service	1750849071	1750849071	1	1	GLENDORA RECOVERY CENTER	7/9/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1340 E ROUTE 66	106	GLENDORA	CA	91740	3701	19	06037	34.12873255	-117.840681	Los Angeles County
238437	Fee-for-Service	1487015558	1487015558	1	1	GENTRY ICF, INC	1/3/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2725 SHANNON DR	None	S SAN FRANCISCO	CA	94080	5319	41	06081	37.63598336	-122.4494858	San Mateo County
238459	Fee-for-Service	1417277195	1417277195	1	1	GE, QIQING MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134598	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
238517	Fee-for-Service	1669754073	1669754073	1	1	GURAI, RAMANDEEP S MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124322	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
238523	Fee-for-Service	1205439155	1205439155	1	1	GINA REED LICENSED CLINICAL	1/29/2021	261QM0801X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5170 GOLDEN FOOTHILL PKW	None	EL DORADO HILLS	CA	95762	7648	09	06017	38.64013136	-121.0681138	El Dorado County
238564	Fee-for-Service	1629298401	1629298401	1	1	GOLDEN VALLEY HEALTH CTR	7/1/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	13161 JEFFERSON ST	None	LE GRAND	CA	95333	9766	24	06047	37.2293683	-120.2509644	Merced County
238569	Fee-for-Service	1992823546	1992823546	1	1	GREENHILL, LAURENCE L MD	2/27/2018	2084P0804X	NA	Psychiatry	026	PHYSICIANS	150442	26	Psychiatry (child)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
238615	Fee-for-Service	1679540389	1679540389	1	1	GARRIGUES, NED W MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	30275	24	Plastic Surgery	0	In state provider	None	3405 KENYON ST	STE 401	SAN DIEGO	CA	92110	5007	37	06073	32.74866031	-117.2135544	San Diego County
238640	Fee-for-Service	1427687326	1427687326	1	1	GUTIERREZ FERNANDEZ, NANCY	6/9/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2731 MORSE AVE	None	SACRAMENTO	CA	95821	6142	34	06067	38.615112	-121.390344	Sacramento County
238651	Fee-for-Service	1487913661	1487913661	1	1	GEARTY, REBECCA L OT	3/23/2021	101Y00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	16800 ASTON	STE 175	IRVINE	CA	92606	4820	30	06059	33.70035445	-117.8435881	Orange County
238663	Fee-for-Service	1376576520	1376576520	1	1	GANDY, JODIE E MD	8/1/1998	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	62679	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
238746	Fee-for-Service	1861900912	1861900912	1	1	GALASSI, KATHRYN A LCSW	8/19/2021	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
238750	Fee-for-Service	1528216454	1528216454	1	1	GUERRA SANCHEZ, CARLOS H MD	10/19/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	130029	40	Pediatrics	0	In state provider	None	401 E SCHOOL AVE	None	VISALIA	CA	93291	5032	54	06107	36.332757	-119.288682	Tulare County
238870	Fee-for-Service	1659588754	1659588754	1	1	GUPTA, SHILPA MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104340	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92056	3912	33	06065	33.94354395	-117.394926	Riverside County
238885	Fee-for-Service	1336897560	1336897560	1	1	GEORGY, MOLLAR G	4/21/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	879 WEST 190TH ST	4TH FLOOR	GARDENA	CA	90248	4223	19	06037	33.85927671	-118.2896516	Los Angeles County
238886	Fee-for-Service	1447798921	1447798921	1	1	GOREN, ALISON P	5/8/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	12791 NEWPORT AVENUE	SUITE 101	TUSTIN	CA	92780	2785	30	06059	33.75168784	-117.808677	Orange County
238928	Fee-for-Service	1427687326	1427687326	1	1	GUTIERREZ FERNANDEZ, NANCY	6/9/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2731 MORSE AVE	None	SACRAMENTO	CA	95821	6142	34	06067	38.615112	-121.390344	Sacramento County
238944	Fee-for-Service	1447758966	1447758966	2	1	GROUPS - RECOVER TOGETHER CA	8/14/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1550 HUMBOLDT ROAD	SUITE 3	CHICO	CA	95928	9115	04	06007	39.73641173	-121.8122593	Butte County
239005	Fee-for-Service	1467684316	1467684316	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	855 E BIRCH ST	None	BREA	CA	92821	5769	30	06059	33.91782733	-117.8878904	Orange County
239024	Fee-for-Service	1235541996	1235541996	1	1	GRACIANO, ELIZABETH LMFT	1/13/2023	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
239039	Fee-for-Service	1437236189	1437236189	1	1	GIBSON, DESMOND D MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41983	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
239087	Fee-for-Service	1124738828	1124738828	1	1	GALUSHA, MCKENSIE PT	4/25/2023	261QR0400X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
239159	Fee-for-Service	1841797032	1841797032	1	1	GORHAM, BRET MD DO	5/18/2020	390200000X	NA	Other	026	PHYSICIANS	17615	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
239213	Fee-for-Service	1265483622	1265483622	1	1	GARCIA, EUGENIA MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79241	01	General Practice	0	In state provider	None	3327 M ST	STE B	MERCED	CA	95348	2714	24	06047	37.32427496	-120.4783917	Merced County
239228	Fee-for-Service	1134280464	1134280464	1	1	GRUTKOWSKI, LORA L CNS	5/6/2003	No Taxonomy Provided	NA	None	085	CLINICAL NURSE SPECIALIST X-OVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5883 VINE HILL RD	None	SEBASTOPOL	CA	95472	2045	49	06097	38.47629156	-122.8595361	Sonoma County
239233	Fee-for-Service	1679644637	1679644637	1	1	GALFAYAN, ANI MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72695	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
239275	Fee-for-Service	1033167853	1033167853	1	1	GILBERT, JO PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1303 JEFFERSON ST	STE 600A	NAPA	CA	94559	2473	28	06055	38.30015229	-122.2932731	Napa County
239283	Fee-for-Service	1184790735	1184790735	1	1	GAVIN, CHARLES J	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	32896	None	None	0	In state provider	None	6327 N FRESNO ST	STE 101	FRESNO	CA	93710	5236	10	06019	36.82875536	-119.781417	Fresno County
239316	Fee-for-Service	1932712924	1932712924	1	1	GOLDEN TIME HOSPICE INC	7/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	27125 SIERRA HWY	SUITE 340	SANTA CLARITA	CA	91351	5433	19	06037	34.4082627	-118.4611389	Los Angeles County
239328	Fee-for-Service	1437236189	1437236189	1	1	GIBSON, DESMOND D MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41983	07	Dermatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
239334	Fee-for-Service	1780762427	1780762427	1	1	GRABER, DAVID J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38958	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
239381	Fee-for-Service	1780286716	1780286716	1	1	GONZALEZ, DELIA	10/25/2024	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
239391	Fee-for-Service	1871534784	1871534784	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	188 LAS TUNAS DR	None	ARCADIA	CA	91007	8512	19	06037	34.10768836	-118.0377152	Los Angeles County
239425	Fee-for-Service	1962913632	1962913632	1	2	GRAND AVENUE EMERGENCY PHYSI	4/23/2018	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	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
239436	Fee-for-Service	1063090900	1063090900	1	1	GOLIS SERVICES L.L.C	1/24/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1900 CAMDEN AVE	101	SAN JOSE	CA	95124	2944	43	06085	37.26166552	-121.9236804	Santa Clara County
239475	Fee-for-Service	1184603128	1184603128	1	1	GOMBERG, CRAIG J MD	12/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	77225	None	None	0	In state provider	None	2601 E CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
239501	Fee-for-Service	1265483622	1265483622	1	1	GARCIA, EUGENIA MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79241	08	Family Practice	0	In state provider	None	3327 M ST	STE B	MERCED	CA	95348	2714	24	06047	37.32427496	-120.4783917	Merced County
239511	Fee-for-Service	1679006175	1679006175	1	1	GALOOSIAN, ARTIN MD	4/8/2021	208M00000X	NA	Other	026	PHYSICIANS	159944	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
239527	Fee-for-Service	1861816886	1861816886	1	2	GHAZI, SARA H DO	12/4/2019	208M00000X	NA	Other	026	PHYSICIANS	13144	41	Internal Medicine	0	In state provider	None	10840 WARNER AVE STE 103	None	FOUNTAIN VALLEY	CA	92708	3847	30	06059	33.71625443	-117.9396853	Orange County
239528	Fee-for-Service	1306193107	1306193107	1	1	GARFIELD BEACH CVS LLC	9/23/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16961 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	4808	30	06059	33.71603836	-117.9892465	Orange County
239564	Fee-for-Service	1518045327	1518045327	1	1	GRAY, JENNIFER A MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	62599	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
239569	Fee-for-Service	1720029648	1720029648	1	1	GARFIELD BEACH CVS LLC	5/17/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12221 CARSON ST	None	HAWAIIAN GARDENS	CA	90716	1601	19	06037	33.83156646	-118.070955	Los Angeles County
239604	Fee-for-Service	1932712924	1932712924	1	1	GOLDEN TIME HOSPICE INC	7/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	27125 SIERRA HWY	SUITE 340	SANTA CLARITA	CA	91351	5433	19	06037	34.4082627	-118.4611389	Los Angeles County
239606	Fee-for-Service	1326126152	1326126152	1	1	GRAY, CARL O MD	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92884	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
239658	Fee-for-Service	1104199629	1104199629	1	2	GAJDA, DAVID J MD APC	4/1/2012	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	5889 CLARK ROAD	None	PARADISE	CA	92969	4861	04	06007	39.75669117	-121.607276	Butte County
239677	Fee-for-Service	1285294496	1285294496	1	1	GLENOAKS HOSPICE CARE	2/26/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7430 COLDWATER CANYON AV	STE B	NORTH HOLLYWOOD	CA	91605	3501	19	06037	34.20551872	-118.413917	Los Angeles County
239699	Fee-for-Service	1306918057	1306918057	1	1	GUZMAN, MELANIE R MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83802	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
239730	Fee-for-Service	1548503683	1548503683	1	1	GHAFARIZADEH, BAHAREH MD	6/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139744	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
239735	Fee-for-Service	1972328458	1972328458	1	1	GIUSTO, EVAN NP	1/30/2025	363LN0000X	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
239762	Fee-for-Service	1659804995	1659804995	1	1	GOMEZ, ALEXANDER MD	8/13/2021	207QS1201X	NA	Adult Primary Care	026	PHYSICIANS	169754	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
239773	Fee-for-Service	1811485394	1811485394	1	1	GRIGORYAN, NATALYA R MD	11/11/2021	207P00000X	NA	Other	026	PHYSICIANS	174112	None	None	0	In state provider	None	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
239782	Fee-for-Service	1124136650	1124136650	1	1	GORTON, RYAN N MD	3/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89440	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
239787	Fee-for-Service	1588921795	1588921795	1	1	GRAVES, CLAIRE E MD	7/31/2019	208600000X	NA	General Surgery	026	PHYSICIANS	137953	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
239844	Fee-for-Service	1437607504	1437607504	1	1	GUY, KATHRYN E PT	12/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
239947	Fee-for-Service	1104199629	1104199629	1	2	GAJDA, DAVID J MD APC	4/1/2012	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5889 CLARK ROAD	None	PARADISE	CA	92969	4861	04	06007	39.75669117	-121.607276	Butte County
239966	Fee-for-Service	1285294496	1285294496	1	1	GLENOAKS HOSPICE CARE	2/26/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7430 COLDWATER CANYON AV	STE B	NORTH HOLLYWOOD	CA	91605	3501	19	06037	34.20551872	-118.413917	Los Angeles County
239992	Fee-for-Service	1407871734	1407871734	1	1	GERARDI, JOSEPH A D0	9/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	4999	85	Surgery-Pediatric	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
240010	Fee-for-Service	1548644495	1548644495	1	1	GALLAGHER, MAREN P LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
240012	Fee-for-Service	1003012733	1003012733	1	1	GANNON, LAUREN C MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105771	40	Pediatrics	0	In state provider	None	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	37	06073	32.75809043	-117.0778038	San Diego County
240026	Fee-for-Service	1619263811	1619263811	1	1	GREWAL, SARAH MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127637	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
240050	Fee-for-Service	1952926289	1952926289	1	1	GUEVARRA, BERNADET NP	10/17/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
240056	Fee-for-Service	1063560035	1063560035	1	1	GUDAL, MOHAMED D MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70671	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
240061	Fee-for-Service	1366980567	1366980567	1	1	GIL, EUGENIA M NP	2/8/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
240077	Fee-for-Service	1700860871	1700860871	1	8	GOLDEN STATE DERMATOLOGY ASS	3/3/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	1324 NELSON AVE	STE B	MODESTO	CA	95350	5374	50	06099	37.66254751	-120.9881942	Stanislaus County
240112	Fee-for-Service	1356765218	1356765218	1	1	GRASS VALLEY EXTENDED CARE I	4/4/2024	305R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	NC	280 SIERRA COLLEGE DR	205	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
240126	Fee-for-Service	1558692657	1558692657	1	1	GAGLANI, RAHUL MD	9/11/2018	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	138057	None	None	0	In state provider	None	29995 TECHNOLOGY DR	302	MURRIETA	CA	92563	2634	33	06065	33.56041691	-117.1370428	Riverside County
240135	Fee-for-Service	1902809551	1902809551	1	1	GRAHAM, SCOTT M MD	4/12/2021	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	61526	None	None	0	In state provider	None	24331 EL TORO ROAD	SUITE 200	LAGUNA WOODS	CA	92637	3116	30	06059	33.60928782	-117.7295058	Orange County
240136	Fee-for-Service	1881952729	1881952729	1	1	GRIBBEN, VALERIE J MD	7/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126908	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
240140	Fee-for-Service	1588113088	1588113088	1	1	GKN RX	10/31/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7072 N CEDAR AVE	None	FRESNO	CA	93720	3300	10	06019	36.83844242	-119.7540735	Fresno County
240185	Fee-for-Service	1518045251	1518045251	1	1	GUPPY, KERN H MD	7/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74708	14	Neurological Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
240189	Fee-for-Service	1073558979	1073558979	1	1	GARFIELD BEACH CVS, LLC	3/20/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	900 N LAKE	None	PASADENA	CA	91104	4563	19	06037	34.160634	-118.132464	Los Angeles County
240209	Fee-for-Service	1639563711	1639563711	1	1	GUEST, BRITTANY	6/21/2019	207P00000X	NA	Other	026	PHYSICIANS	15520	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
240240	Fee-for-Service	1710118443	1710118443	1	1	GENESIS HEALTH SERVICES INC	5/22/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2063 S ATLANTIC BLVD	STE 2H	MONTEREY PARK	CA	91754	6344	19	06037	34.04029716	-118.1422905	Los Angeles County
240253	Fee-for-Service	1316086473	1316086473	1	1	GIBBS, CURTIS A	10/1/1998	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1770 CHURN CREEK RD	None	REDDING	CA	96002	0263	45	06089	40.58105263	-122.3542088	Shasta County
240271	Fee-for-Service	1841388469	1841388469	1	1	GETMAN, CAROLYN E MD	7/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55135	40	Pediatrics	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
240282	Fee-for-Service	1407871734	1407871734	1	1	GERARDI, JOSEPH A D0	9/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	4999	20	Orthopedic Surgery	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
240298	Fee-for-Service	1003012733	1003012733	1	1	GANNON, LAUREN C MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105771	41	Internal Medicine	0	In state provider	None	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	37	06073	32.75809043	-117.0778038	San Diego County
240332	Fee-for-Service	1811931181	1811931181	1	1	GARFIELD BEACH CVS, LLC	5/11/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5969 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	1006	19	06037	34.17943013	-118.3834516	Los Angeles County
240370	Fee-for-Service	1124288170	1124288170	1	1	GORY, ALINA MD	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105619	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
240374	Fee-for-Service	1902844525	1902844525	1	1	GHARAKHANI, HOSSEIN DO	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7070	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
240384	Fee-for-Service	1790269413	1790269413	1	1	GOOD DAY HOME HEALTH CARE	12/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	9608 VAN NUYS BLVD	STE 207	PANORAMA CITY	CA	91402	1043	19	06037	34.24485892	-118.4502135	Los Angeles County
240435	Fee-for-Service	1710055215	1710055215	1	1	GHORI, IMTIAZ A MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65334	40	Pediatrics	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
240438	Fee-for-Service	1891729745	1891729745	1	1	GRAYBILL MEDICAL GROUP INC	6/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	225 E 2ND AVE	STE 203	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
240441	Fee-for-Service	1194361592	1194361592	1	1	GUARDIAN ANGEL HOME CARE OF	4/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SANTA ROSA, LLC	320 COLLEGE AVE	SUITE 230	SANTA ROSA	CA	95401	5144	49	06097	38.445561	-122.721687	Sonoma County
240482	Fee-for-Service	1033646179	1033646179	1	1	GEBREMICHAEL, WINTA T LCSW	11/4/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
240529	Fee-for-Service	1710118443	1710118443	1	1	GENESIS HEALTH SERVICES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2063 S ATLANTIC BLVD	STE 2H	MONTEREY PARK	CA	91754	6344	19	06037	34.04029716	-118.1422905	Los Angeles County
240531	Fee-for-Service	1346321197	1346321197	1	1	GIRON, JAIME E MD	1/2/2008	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	80671	08	Family Practice	0	In state provider	None	600 MAIN ST	None	SOLEDAD	CA	93960	3123	27	06053	36.43281182	-121.3243597	Monterey County
240564	Fee-for-Service	1134316110	1134316110	1	1	GRECO, ROBERT	7/1/1996	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	7575 N DEL MAR AVE	STE 101	FRESNO	CA	93711	6857	10	06019	36.847782	-119.7958885	Fresno County
240575	Fee-for-Service	1912968496	1912968496	1	1	GALLEMORE, RON P MD	9/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78240	18	Ophthalmology	0	In state provider	None	1127 WILSHIRE BLVD	STE 1620	LOS ANGELES	CA	90017	4007	19	06037	34.05270508	-118.2641005	Los Angeles County
240594	Fee-for-Service	1265970511	1265970511	1	1	GARFIELD BEACH CVS LLC	1/2/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	812 SOUTH GRAND AVE	None	LOS ANGELES	CA	90017	4610	19	06037	34.04543884	-118.2582805	Los Angeles County
240597	Fee-for-Service	1790985117	1790985117	1	1	GANDY, SARA L MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76963	36	Psychiatry	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
240605	Fee-for-Service	1528167830	1528167830	1	1	GHANEM, BASSAM MD	6/5/2012	207RH0003X	NA	Oncology	026	PHYSICIANS	97459	None	None	0	In state provider	None	1687 ERRINGER RD	#104	SIMI VALLEY	CA	93065	6509	56	06111	34.268886	-118.761426	Ventura County
240606	Fee-for-Service	1144538802	1144538802	1	1	GHODS, LEAH D LCSW	8/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	66433	-	NOT APPLICABLE	0	In state provider	None	11512 B AVE	None	AUBURN	CA	95603	2605	31	06061	38.93969517	-121.1046397	Placer County
240665	Fee-for-Service	1639266216	1639266216	1	2	GEHLAWAT, DILBAGH MD INC	10/15/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	35839	40	Pediatrics	0	In state provider	None	432 LEXINGTON ST	None	DELANO	CA	93215	3697	15	06029	35.762706	-119.2407725	Kern County
240695	Fee-for-Service	1245433549	1245433549	1	1	GUTHMILLER, MUN C CRNA	10/31/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
240712	Fee-for-Service	1821261124	1821261124	1	1	GOLDEN, CHARLES V DO	5/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9908	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
240724	Fee-for-Service	1750326948	1750326948	1	1	GARBEROGLIO, CARLOS A	3/31/1989	208600000X	NA	General Surgery	026	PHYSICIANS	46364	None	None	0	In state provider	None	11370 ANDERSON ST	# 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
240725	Fee-for-Service	1740416767	1740416767	1	1	GRECO, DONALD J MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116326	05	Anesthesiology	0	In state provider	None	81812 DOCTOR CARREON BLV	STE F	INDIO	CA	92201	5594	33	06065	33.70742848	-116.236728	Riverside County
240756	Fee-for-Service	1750351821	1750351821	1	1	GOH, WEI-CHUN MD	6/20/2008	174400000X	NA	Other	026	PHYSICIANS	73083	01	General Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
240764	Fee-for-Service	1164001038	1164001038	1	1	GARRIDO, NALLELI I NP	11/9/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1131 6TH ST	STE 232	ONTARIO	CA	91762	1121	36	06071	34.084404	-117.6717015	San Bernardino County
240862	Fee-for-Service	1346260635	1346260635	1	1	GARBEROGLIO, MARIA C MD	1/1/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46365	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	# 100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
240875	Fee-for-Service	1972705424	1972705424	1	1	GRAHAM, OLIVER Z MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66957	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
240920	Fee-for-Service	1033245816	1033245816	1	1	GUARDINO, JASON M DO	9/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9941	10	Gastroenterology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
240945	Fee-for-Service	1801445481	1801445481	1	1	GLACIER BAY HOLDINGS LLC	10/7/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1601 PETERSEN AVE	None	SAN JOSE	CA	95129	4844	43	06085	37.29414701	-121.9989013	Santa Clara County
240946	Fee-for-Service	1396847299	1396847299	1	1	GILDIN, JOAN S. MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	40268	36	Psychiatry	0	In state provider	None	9400B RUFFIN CT	None	SAN DIEGO	CA	92123	5300	37	06073	32.8287633	-117.1231477	San Diego County
240953	Fee-for-Service	1548716020	1548716020	1	1	GOMEZ, NICOLE G MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136960	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
240956	Fee-for-Service	1801162623	1801162623	1	1	GOUSSOUS, NAEEM MD	10/7/2020	390200000X	NA	Other	026	PHYSICIANS	170464	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
240966	Fee-for-Service	1386754299	1386754299	1	1	GALLAND, JEFFREY D MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	62222	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
241066	Fee-for-Service	1013483569	1013483569	1	1	GOLDEN COAST HOSPICE AND	11/23/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	2522 CHAMBERS ROAD	STE 112	TUSTIN	CA	92780	6962	30	06059	33.71785088	-117.8076329	Orange County
241088	Fee-for-Service	1518142462	1518142462	1	1	GHIASI, ZAHRA MD	5/1/2002	193400000X	NA	Other	026	PHYSICIANS	78525	18	Ophthalmology	0	In state provider	None	113 WATERWORKS WY	STE 245	IRVINE	CA	92618	3175	30	06059	33.66497942	-117.7635578	Orange County
241123	Fee-for-Service	1982329934	1982329934	1	1	GREINKE, STEPHANIE A PT	1/9/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4960 VERDUGO	None	CAMARILLO	CA	93012	8632	56	06111	34.21547303	-119.0040356	Ventura County
241139	Fee-for-Service	1689072993	1689072993	1	1	GOLRIZ, MITRA LMFT	8/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
241191	Fee-for-Service	1487812921	1487812921	1	1	GHIASSI, SABER MD	11/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109928	02	General Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
241205	Fee-for-Service	1619583226	1619583226	1	1	GEORGEVITCH, TANYA LMFT	11/15/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1350 HAYES ST	B-9	BENICIA	CA	94510	2933	48	06095	38.04764833	-122.139033	Solano County
241253	Fee-for-Service	1902250855	1902250855	1	1	GITZ, KATHERINE MD	7/1/2019	207PP0204X	NA	Other	026	PHYSICIANS	159617	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
241304	Fee-for-Service	1578071627	1578071627	1	1	GIBBS, LAPHONSA LCSW	9/29/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20200 REDWOOD RD	7	CASTRO VALLEY	CA	94546	4312	01	06001	37.698075	-122.0739205	Alameda County
241335	Fee-for-Service	1871941054	1871941054	1	1	GOLDTHORPE, CLIFFORD S DO	1/6/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	19072	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
241351	Fee-for-Service	1013483569	1013483569	1	1	GOLDEN COAST HOSPICE AND	11/23/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	2522 CHAMBERS ROAD	STE 112	TUSTIN	CA	92780	6962	30	06059	33.71785088	-117.8076329	Orange County
241367	Fee-for-Service	1255423141	1255423141	1	1	GARCIA, FIRMO JR MD	8/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70469	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
241386	Fee-for-Service	1962836635	1962836635	1	1	GONZALEZ, JOSE LMFT	1/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
241413	Fee-for-Service	1336102359	1336102359	1	1	GRISOLIA JAMES S MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42884	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4033 3RD AVE	STE 410	SAN DIEGO	CA	92103	2140	37	06073	32.75053781	-117.1627168	San Diego County
241434	Fee-for-Service	1770564114	1770564114	1	1	GR8 CARE, INC	3/16/2004	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	14518 LOS ANGELES ST	None	BALDWIN PARK	CA	91706	2636	19	06037	34.09225304	-117.9585339	Los Angeles County
241451	Fee-for-Service	1023484268	1023484268	1	1	GUO, WENCHANG MD	6/13/2019	390200000X	NA	Other	026	PHYSICIANS	146608	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
241465	Fee-for-Service	1336197730	1336197730	1	1	GALASKO, DOUGLAS R MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	45023	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
241472	Fee-for-Service	1053508499	1053508499	1	1	GARCIA, MARIA LMFT	10/8/2024	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
241479	Fee-for-Service	1619974334	1619974334	1	1	GARFINKEL, ARTHUR I MD	4/1/1975	204C00000X	NA	Other	026	PHYSICIANS	29201	None	None	0	In state provider	None	23861 MCBEAN PARKWAY	D6	SANTA CLARITA	CA	91355	2077	19	06037	34.39567343	-118.5542698	Los Angeles County
241499	Fee-for-Service	1013202332	1013202332	1	1	GRAVES, STEPHEN J LMFT	11/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1740 PLUM LN	STE B	REDLANDS	CA	92374	0109	36	06071	34.06899169	-117.2145582	San Bernardino County
241523	Fee-for-Service	1932203825	1932203825	1	1	GERMAN DOBSON CVS LLC	11/14/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	3210 UNION HILLS DR	None	PHOENIX	AZ	85050	3223	00	None	33.655716	-112.0128615	Maricopa County
241537	Fee-for-Service	1881033470	1881033470	1	1	GARFIELD BEACH CVS LLC	8/21/2014	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	499 HAIGHT ST	None	SAN FRANCISCO	CA	94117	3505	38	06075	37.77212405	-122.4301754	San Francisco County
241570	Fee-for-Service	1578507828	1578507828	1	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4707 WEST VENICE BLVD	None	LOS ANGELES	CA	90019	5832	19	06037	34.04696566	-118.3392247	Los Angeles County
241604	Fee-for-Service	1679729115	1679729115	1	1	GUTIERREZ-MENDOZA, MICHELLE	4/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	90028	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	R MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
241646	Fee-for-Service	1952586067	1952586067	1	1	GALANG, JACQUELINE M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69426	41	Internal Medicine	0	In state provider	None	165 SAINT DOMINICS DR	STE 201	MANTECA	CA	95337	7802	39	06077	37.79882972	-121.2447835	San Joaquin County
241655	Fee-for-Service	1366520488	1366520488	1	1	GHANI, SHAREH O MD	8/30/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	133769	None	None	0	In state provider	None	39180 LIBERTY ST	205	FREMONT	CA	94538	2586	01	06001	37.55089505	-121.982082	Alameda County
241689	Fee-for-Service	1609989649	1609989649	1	1	GERSTEIN, JEFFREY M MD	11/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63699	36	Psychiatry	0	In state provider	None	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
241701	Fee-for-Service	1013106897	1013106897	1	1	GHALY, MICHAEL A MD	7/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95429	36	Psychiatry	0	In state provider	None	1111 MARKET ST	FL 3	SAN FRANCISCO	CA	94103	1513	38	06075	37.78018987	-122.4128297	San Francisco County
241702	Fee-for-Service	1336102359	1336102359	1	1	GRISOLIA JAMES S MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42884	14	Neurological Surgery	0	In state provider	None	4033 3RD AVE	STE 410	SAN DIEGO	CA	92103	2140	37	06073	32.75053781	-117.1627168	San Diego County
241713	Fee-for-Service	1801328786	1801328786	1	1	GERMANO, NICHOLAS DO	5/16/2023	207RC0200X	NA	Other	026	PHYSICIANS	20799	41	Internal Medicine	0	In state provider	None	1625 PINE STREET	SUITE 102	REDDING	CA	96001	1018	45	06089	40.58321511	-122.388937	Shasta County
241718	Fee-for-Service	1659850832	1659850832	1	1	GUARDIAN FLIGHT LLC	9/7/2021	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	212 WEST FREEDOM WAY	None	BLANDING	UT	84511	3216	00	None	37.58328	-109.4826465	San Juan County
241746	Fee-for-Service	1326453028	1326453028	1	1	GALLUP, MARY A C MD	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139409	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12401 E WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
241775	Fee-for-Service	1578583878	1578583878	1	1	GUGAN, AGNES S MD	6/8/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35900	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
241784	Fee-for-Service	1053448977	1053448977	1	1	GRAZIAN, ROBERT L OD	4/30/1991	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9727 MISSION GORGE RD	None	SANTEE	CA	92071	3809	37	06073	32.8385667	-116.9854242	San Diego County
241789	Fee-for-Service	1912311069	1912311069	1	1	GUILBEAU, ASHLEIGH M MD	10/19/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	140608	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
241804	Fee-for-Service	1609992171	1609992171	1	1	GHEYSAR, KENNETH K MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	71924	08	Family Practice	0	In state provider	None	840 TOWNSITE DR	None	VISTA	CA	92084	5566	37	06073	33.20923325	-117.2343859	San Diego County
241843	Fee-for-Service	1164402202	1164402202	1	1	GILSOUL, JENNIFER 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	1580 W ANTELOPE DR	STE 100	LAYTON	UT	84041	1153	00	None	41.08922695	-111.9943717	Davis County
241850	Fee-for-Service	1912340159	1912340159	1	1	GUPTA, AMAR MD	10/26/2021	2082S0099X	NA	General Surgery	026	PHYSICIANS	167029	None	None	0	In state provider	None	6850 BROCKTON AVE	SUITE 108	RIVERSIDE	CA	92506	3814	33	06065	33.9493261	-117.3967206	Riverside County
241891	Fee-for-Service	1093809659	1093809659	1	1	GLEGHORN, ELIZABETH E MD	6/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48774	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
241913	Fee-for-Service	1861846693	1861846693	1	1	GATEWAY HOME HEALTH CORP	11/27/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10 CROW CANYON CT	None	SAN RAMON	CA	94583	1980	07	06013	37.77732659	-121.9815171	Contra Costa County
241967	Fee-for-Service	1780638049	1780638049	1	1	GIONIS, THOMAS A MD	9/30/1983	207P00000X	NA	Other	026	PHYSICIANS	39248	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
241973	Fee-for-Service	1801963731	1801963731	1	1	GEER, THEODORE G MD	6/22/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60403	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
241976	Fee-for-Service	1588059299	1588059299	1	1	GUINTO, CHEZ LARCIA 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
241990	Fee-for-Service	1336102359	1336102359	1	1	GRISOLIA JAMES S MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42884	13	Neurology (M.D. only)	0	In state provider	None	4033 3RD AVE	STE 410	SAN DIEGO	CA	92103	2140	37	06073	32.75053781	-117.1627168	San Diego County
242003	Fee-for-Service	1801328786	1801328786	1	1	GERMANO, NICHOLAS DO	5/16/2023	207RC0200X	NA	Other	026	PHYSICIANS	20799	29	Pulmonary Diseases (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
242023	Fee-for-Service	1568406833	1568406833	1	1	GARFIELD BEACH CVS, LLC	6/17/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1050 SUNSET BLVD	None	LOS ANGELES	CA	90012	2102	19	06037	34.06484887	-118.2489374	Los Angeles County
242093	Fee-for-Service	1013172535	1013172535	1	1	GILMER, BRIAN B MD	2/8/2022	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	131091	None	None	0	In state provider	None	85 SIERRA PARK RD.	None	MAMMOTH LAKES	CA	93546	0085	26	06051	37.64575895	-118.9638914	Mono County
242129	Fee-for-Service	1144780719	1144780719	1	1	GIDEON, SOHEIL D MD	5/31/2023	207R00000X	NA	Other	026	PHYSICIANS	184590	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
242141	Fee-for-Service	1235114760	1235114760	1	1	GONI, MICHELLE MD	10/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	93877	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
242142	Fee-for-Service	1245594449	1245594449	1	1	GUARDIAN HOME HEALTH CARE	9/12/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AND HOSPICE INC	6601 OWENS DR	STE 135 OFFICE A	PLEASANTON	CA	94588	3356	01	06001	37.69732482	-121.9081031	Alameda County
242144	Fee-for-Service	1700089414	1700089414	1	1	GYAMFI, RICHMOND MD	6/28/2023	207R00000X	NA	Other	026	PHYSICIANS	186725	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
242171	Fee-for-Service	1053929075	1053929075	1	1	GARAY, CYNTHIA E NP	10/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
242174	Fee-for-Service	1205924339	1205924339	1	1	GREYBER, ELIZABETH R MD	12/1/1998	207R00000X	NA	Other	026	PHYSICIANS	80290	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
242178	Fee-for-Service	1093809659	1093809659	1	1	GLEGHORN, ELIZABETH E MD	6/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48774	10	Gastroenterology (M.D. only)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
242210	Fee-for-Service	1922162445	1922162445	1	1	GARCIA, SONYA E MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78022	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
242235	Fee-for-Service	1649335647	1649335647	1	1	GOLETA UNION ELEM SD	10/12/2003	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	401 N FAIRVIEW AVE	None	GOLETA	CA	93117	1732	42	06083	34.44743077	-119.8307072	Santa Barbara County
242244	Fee-for-Service	1780460600	1780460600	1	1	GONZALEZ, VICTORIA XOCHITL	9/26/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4500 TRUXEL RD	APT 1533	SACRAMENTO	CA	95834	3748	34	06067	38.653578	-121.5095265	Sacramento County
242256	Fee-for-Service	1780638049	1780638049	1	1	GIONIS, THOMAS A MD	9/30/1983	207P00000X	NA	Other	026	PHYSICIANS	39248	08	Family Practice	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
242263	Fee-for-Service	1871121319	1871121319	1	1	GONZALEZ, GABRIELA MD	4/2/2025	208800000X	NA	Other	026	PHYSICIANS	181848	34	Urology and Urological Surgery	0	In state provider	None	2625 W ALAMEDA AVE	300, 322	BURBANK	CA	91505	4819	19	06037	34.1577056	-118.329779	Los Angeles County
242324	Fee-for-Service	1124214028	1124214028	1	1	GHANOUNI, PEJMAN MD	6/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96873	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
242365	Fee-for-Service	1801104831	1801104831	1	1	GOLDWASER, GAL PHD	6/21/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5893 COPLEY DR	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
242438	Fee-for-Service	1457498339	1457498339	1	1	GHEI, SONIA K MD	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95837	30	Radiology	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
242448	Fee-for-Service	1992702088	1992702088	1	1	GOLLER, DAVID S MD	11/5/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	21747	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
242454	Fee-for-Service	1942414990	1942414990	1	1	GRAND ADULT DAY HEALTH CARE	3/2/2004	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	6752 WHITE OAK AVE	None	VAN NUYS	CA	91406	5359	19	06037	34.19357831	-118.5185436	Los Angeles County
242465	Fee-for-Service	1255526042	1255526042	1	1	GRANITE WELLNESS CENTERS	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	406 SUNRISE AVE	100	ROSEVILLE	CA	95661	4106	31	06061	38.73944898	-121.2720559	Placer County
242493	Fee-for-Service	1285666735	1285666735	1	1	GOSSELIN-CHASE, LINDA M	3/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	MD	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
242526	Fee-for-Service	1619471174	1619471174	1	1	GOMES, JOSEPH M MD	9/22/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173477	None	None	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
242532	Fee-for-Service	1780460600	1780460600	1	1	GONZALEZ, VICTORIA XOCHITL	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	4500 TRUXEL RD	APT 1533	SACRAMENTO	CA	95834	3748	34	06067	38.653578	-121.5095265	Sacramento County
242539	Fee-for-Service	1477880961	1477880961	1	1	GONZALEZ, VERONICA S NP	10/12/2016	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
242640	Fee-for-Service	1245261551	1245261551	1	1	GOLDWAG, DAVID A DO	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	5356	66	Emergency Medicine (Urgent Care)	0	In state provider	None	675 E SANTA CLARA ST	None	SAN JOSE	CA	95112	1392	43	06085	37.34275712	-121.8768207	Santa Clara County
242697	Fee-for-Service	1508093543	1508093543	1	1	GRAWERT, LAUREN H	5/30/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177679	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
242792	Fee-for-Service	1538317706	1538317706	1	1	GU, DENA J MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102485	02	General Surgery	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
242806	Fee-for-Service	1073357703	1073357703	1	1	GUARDADO, DAMARIS NP	8/23/2024	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
242876	Fee-for-Service	1578166310	1578166310	1	1	GUTIERREZ, JOHAN OT	12/10/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	414 E SAN BERNARDINO RD	None	COVINA	CA	91723	1704	19	06037	34.09060121	-117.8831282	Los Angeles County
242882	Fee-for-Service	1871936245	1871936245	1	1	GUTIERREZ, ALLISON E 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
242885	Fee-for-Service	1215173406	1215173406	1	1	GABRIELIAN, SONYA E MD	12/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106284	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
242898	Fee-for-Service	1972500577	1972500577	1	1	GILBERT SUNIO, GILBERT C MD	3/1/2002	207R00000X	NA	Other	026	PHYSICIANS	73666	None	None	0	In state provider	None	1451 E EL MONTE WAY	None	DINUBA	CA	93618	1812	54	06107	36.54552557	-119.3797841	Tulare County
242907	Fee-for-Service	1851323273	1851323273	1	1	GLANTZ, DANIEL S MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53507	18	Ophthalmology	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
242910	Fee-for-Service	1922160126	1922160126	1	1	GIUDICI, MARY K	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
243103	Fee-for-Service	1013101153	1013101153	2	1	GARFIELD BEACH CVS LLC	9/27/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25601 JERONIMO RD	None	MISSION VIEJO	CA	92691	2794	30	06059	33.6217997	-117.68297	Orange County
243159	Fee-for-Service	1770147332	1770147332	1	1	GENTRY, NATHAN L DO	10/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19841	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
243175	Fee-for-Service	1477327674	1477327674	1	1	GENSOURCERX, INC.	12/8/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6117 RESEDA BLVD	STE D	TARZANA	CA	91335	7368	19	06037	34.181208	-118.536059	Los Angeles County
243190	Fee-for-Service	1073672663	1073672663	1	1	GOLD, SIDNEY MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24875	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
243217	Fee-for-Service	1700459500	1700459500	1	1	GREEN, FREDERICK W LMFT	8/14/2023	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
243224	Fee-for-Service	1730611559	1730611559	1	2	GOOD LIFE PHARMACY INC	3/19/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2633 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805107	-118.185058	Los Angeles County
243228	Fee-for-Service	1376121343	1376121343	1	1	GORJIKIA, NIYAYESH DPM	7/29/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
243249	Fee-for-Service	1932197381	1932197381	1	1	GREGORY C. ELKINS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1625 MEDICAL CTR DR	None	EL PASO	TX	79902	5005	00	None	31.777668	-106.4796975	El Paso County
243257	Fee-for-Service	1740607126	1740607126	1	1	GUSTAFSON, SARAH M MD	12/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141074	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
243263	Fee-for-Service	1902860802	1902860802	1	1	GARCIA-YOUNG III, JORGE A MD	8/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91654	30	Radiology	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
243312	Fee-for-Service	1902284904	1902284904	1	2	GALTRESS, THOMAS LCSW	9/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4 WILLIAMSBURG LN	SUITE E	CHICO	CA	95926	2263	04	06007	39.7522683	-121.8557765	Butte County
243358	Fee-for-Service	1558302406	1558302406	1	1	GARCIA, JOHN R INC	1/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86774	None	None	0	In state provider	None	5959 TRUXTUN AVE	STE 100	BAKERSFIELD	CA	93309	0436	15	06029	35.36306164	-119.0711264	Kern County
243371	Fee-for-Service	1417957887	1417957887	1	1	GILL, PARAMPAL K MD	10/25/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	37279	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2415 W VINE ST	STE 103	LODI	CA	95242	3731	39	06077	38.1228953	-121.3052826	San Joaquin County
243445	Fee-for-Service	1619075108	1619075108	2	1	GARFIELD BEACH CVS, LLC	5/27/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7065 LA PALMA AVE	None	BUENA PARK	CA	90620	2424	30	06059	33.84659052	-118.010169	Orange County
243469	Fee-for-Service	1740290873	1740290873	1	1	GILLESPIE, ROBERT L MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	66094	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
243494	Fee-for-Service	1295182061	1295182061	1	1	GARFIELD BEACH CVS LLC	12/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	632 LINDERO CANYON RD	None	OAK PARK	CA	91377	5457	56	06111	34.18350437	-118.7860707	Ventura County
243526	Fee-for-Service	1629508460	1629508460	1	1	GIANG, BEVERLY MD	9/1/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	159986	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
243546	Fee-for-Service	1013172535	1013172535	1	2	GILMER, BRIAN B MD	2/8/2022	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	131091	None	None	0	In state provider	None	85 SIERRA PARK RD.	None	MAMMOTH LAKES	CA	89503	4723	26	06051	37.64575895	-118.9638914	Mono County
243568	Fee-for-Service	1770016560	1770016560	1	1	GIGLIOTTI, LAUREN M DO	7/1/2020	208M00000X	NA	Other	026	PHYSICIANS	17267	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
243612	Fee-for-Service	1649292715	1649292715	1	1	GALSTYAN, KEVIN G MD INC	1/24/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	87568	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
243626	Fee-for-Service	1285901942	1285901942	1	2	GERSHELIS, ANNA LCSW	1/15/2025	1041C0700X	NA	Mental Health Outpatient Services	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
243634	Fee-for-Service	1497725618	1497725618	1	1	GEX, RODERICK A MD	7/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
243651	Fee-for-Service	1578643623	1578643623	1	1	GIBBS, LISA M MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63894	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
243660	Fee-for-Service	1932234887	1932234887	1	1	GUINN, JACQUELINE J MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	77734	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
243666	Fee-for-Service	1457069155	1457069155	1	1	GHC 0F FRESNO LLC	4/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER	3034 EAST HERNDON AVE	None	FRESNO	CA	93720	0300	10	06019	36.83771847	-119.7350415	Fresno County
243673	Fee-for-Service	1831331834	1831331834	1	1	GHODS, MARYAM MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	106175	05	Anesthesiology	0	In state provider	None	1300 NORTH VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
243691	Fee-for-Service	1003850371	1003850371	1	1	GARFIELD BEACH CVS, LLC	2/6/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6510 SOUTH ST	None	LAKEWOOD	CA	90713	1714	19	06037	33.8582705	-118.1062575	Los Angeles County
243696	Fee-for-Service	1306892187	1306892187	1	1	GERST, CHRISTOPHER 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
243708	Fee-for-Service	1770639189	1770639189	1	1	GARNER, KAREN G MD	11/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55219	41	Internal Medicine	0	In state provider	None	831 VIA SUERTE	STE 102	SAN CLEMENTE	CA	92673	6531	30	06059	33.4630839	-117.5988297	Orange County
243722	Fee-for-Service	1467788257	1467788257	1	1	GARCIA-SANCHEZ, ALISSA M PT	12/16/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
243752	Fee-for-Service	1487881066	1487881066	1	1	GORDAN, JOHN D MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116078	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
243777	Fee-for-Service	1801079892	1801079892	1	1	GK URGI CARE INC	2/21/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1695 S SAN JACINTO AVE	STE A	SAN JACINTO	CA	92583	5181	33	06065	33.770961	-116.954649	Riverside County
243818	Fee-for-Service	1043251929	1043251929	1	1	GARFIELD BEACH CVS, LLC	9/21/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15421 BROOKHURST ST	None	WESTMINSTER	CA	92683	7051	30	06059	33.738849	-117.954816	Orange County
243820	Fee-for-Service	1134759517	1134759517	1	1	GUARDIAN ANGEL HOME CARE OF	4/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PALM DESERT LLC	41865 BOARDWALK	SUITE 215	PALM DESERT	CA	92211	9026	33	06065	33.74625125	-116.3549824	Riverside County
243856	Fee-for-Service	1669781282	1669781282	1	1	GUDAL, JANHAVI R MD	11/12/2010	207R00000X	NA	Other	026	PHYSICIANS	114100	41	Internal Medicine	0	In state provider	None	2235 HAYES ST	None	SAN FRANCISCO	CA	94117	1082	38	06075	37.77302045	-122.4529717	San Francisco County
243883	Fee-for-Service	1346408622	1346408622	1	1	GOH, CAROLYN MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112643	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	STE 450	LOS ANGELES	CA	90095	6957	19	06037	34.06527974	-118.4462792	Los Angeles County
243902	Fee-for-Service	1669661948	1669661948	1	1	GOLD, JULIA MD	3/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	116077	01	General Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
243925	Fee-for-Service	1770087744	1770087744	1	1	GIBNEY, RYAN P MD	5/10/2021	390200000X	NA	Other	026	PHYSICIANS	165740	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
243948	Fee-for-Service	1861602021	1861602021	1	1	GHAZAL, RICHELLE K M MD	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67463	01	General Practice	0	In state provider	None	5500 UNIVERSITY PARKWAY	None	SAN BERNARDINO	CA	92407	2397	36	06071	34.17917599	-117.3266088	San Bernardino County
243957	Fee-for-Service	1851463608	1851463608	1	1	GRANZELLA, JANICE A MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	60565	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
243958	Fee-for-Service	1417370255	1417370255	1	1	GOODMAN, TRAVIS M 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
244009	Fee-for-Service	1346267432	1346267432	1	1	GALLIK, DONNA M MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	80598	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8631 W 3RD STREET	#1017 E	LOS ANGELES	CA	90048	5913	19	06037	34.07361928	-118.3803143	Los Angeles County
244019	Fee-for-Service	1346419942	1346419942	1	1	GERSHMAN, GEORGE MD AMC	6/21/1997	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	62846	10	Gastroenterology (M.D. only)	0	In state provider	None	9735 WILSHIRE BLVD	SUITE 323	BEVERLY HILLS	CA	90212	2108	19	06037	34.06711051	-118.4074605	Los Angeles County
244041	Fee-for-Service	1487881066	1487881066	1	1	GORDAN, JOHN D MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116078	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
244051	Fee-for-Service	1174876163	1174876163	1	1	GALVAN, JOE A LMFT	5/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1617 W. SHAW AVE	STE E	FRESNO	CA	93711	3507	10	06019	36.80819154	-119.8224225	Fresno County
244068	Fee-for-Service	1801079892	1801079892	1	1	GK URGI CARE INC	2/21/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1695 S SAN JACINTO AVE	STE A	SAN JACINTO	CA	92583	5181	33	06065	33.770961	-116.954649	Riverside County
244073	Fee-for-Service	1912071507	1912071507	1	1	GRIFFIN, LISA D MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53692	79	Neurology-Child	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
244109	Fee-for-Service	1366859449	1366859449	1	9	GOLDEN STATE PROVIDERS, A ME	1/14/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	227 WEST JANSS ROAD	SUITE 340	THOUSAND OAKS	CA	91360	1879	56	06111	34.20611691	-118.883861	Ventura County
244150	Fee-for-Service	1053902734	1053902734	1	1	GUADALUPE MEDICAL GROUP	3/1/2020	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4525 EAGLE ROCK	None	EAGLE ROCK	CA	90041	3214	19	06037	34.12685986	-118.2185809	Los Angeles County
244192	Fee-for-Service	1336163807	1336163807	1	1	GOODMAN, CHARLES MD INC	12/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	58389	40	Pediatrics	0	In state provider	None	18350 ROSCOE BLVD	STE 706	NORTHRIDGE	CA	91325	5602	19	06037	34.22071855	-118.5341175	Los Angeles County
244193	Fee-for-Service	1033299250	1033299250	1	1	GREEN, ABE MD APMC	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48234	45	Nephrology (Renal-Kidney)	0	In state provider	None	2080 CENTURY PARK E	SUITE 1410	LOS ANGELES	CA	90067	2017	19	06037	34.05887194	-118.4122914	Los Angeles County
244226	Fee-for-Service	1871664797	1871664797	1	1	GELMAN, ALAN I MD	12/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	51802	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
244301	Fee-for-Service	1588027742	1588027742	1	1	GILLESPIE, MAE R MD	5/26/2020	207L00000X	NA	Other	026	PHYSICIANS	151034	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
244306	Fee-for-Service	1659303352	1659303352	1	1	GOMEZ, ARTHUR G MD	1/1/1995	207R00000X	NA	Other	026	PHYSICIANS	61649	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
244332	Fee-for-Service	1659431120	1659431120	1	1	GORDON, ARTHUR L MD	4/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	38404	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
244345	Fee-for-Service	1891114898	1891114898	1	1	GARBER, KENT MD	7/25/2022	208600000X	NA	General Surgery	026	PHYSICIANS	142995	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
244353	Fee-for-Service	1801079892	1801079892	1	1	GK URGI CARE INC	2/21/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1695 S SAN JACINTO AVE	STE A	SAN JACINTO	CA	92583	5181	33	06065	33.770961	-116.954649	Riverside County
244362	Fee-for-Service	1912071507	1912071507	1	1	GRIFFIN, LISA D MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53692	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
244382	Fee-for-Service	1194011791	1194011791	1	1	GSL PHARMACY INC.	7/18/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8540 SEPULVEDA BOULEVARD	#102	LOS ANGELES	CA	90045	3810	19	06037	33.96022076	-118.3961982	Los Angeles County
244385	Fee-for-Service	1184388332	1184388332	1	1	GESSEL, SUNNI E NP	1/25/2022	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
244400	Fee-for-Service	1972531788	1972531788	1	1	GERSTENFELD, EDWARD P MD	6/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	85435	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
244404	Fee-for-Service	1326129685	1326129685	1	1	GHASSAN WAHBEH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
244421	Fee-for-Service	1811084676	1811084676	1	22	GOLDEN BEAR PHYSICAL THERAPY	2/3/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPORTS INJURY CENTER, I	2339 W HAMMER LN	STE K	STOCKTON	CA	95209	2368	39	06077	38.02138826	-121.344545	San Joaquin County
244437	Fee-for-Service	1053902734	1053902734	1	1	GUADALUPE MEDICAL GROUP	3/1/2020	104100000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4525 EAGLE ROCK	None	EAGLE ROCK	CA	90041	3214	19	06037	34.12685986	-118.2185809	Los Angeles County
244521	Fee-for-Service	1043071277	1043071277	1	1	GILHOOLEY, MICHAEL J MD	2/26/2025	207WX0109X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
244524	Fee-for-Service	1225242332	1225242332	1	1	GROSSMAN, JONATHAN D MD	3/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	98906	25	Physical Medicine and Rehabilitation	0	In state provider	None	45 RIVER PARK PLACE WEST	SUITE 104	FRESNO	CA	93720	1565	10	06019	36.85901695	-119.7893872	Fresno County
244554	Fee-for-Service	1689917080	1689917080	1	1	GONG, LUCY MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133449	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
244577	Fee-for-Service	1992797070	1992797070	1	2	GLENDORA RADIOLOGICAL	8/31/1990	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ASSOC INC	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
244581	Fee-for-Service	1467703769	1467703769	1	1	GAUDIN, JEREMY P. CRNA	12/20/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
244637	Fee-for-Service	1447239744	1447239744	1	1	GHAVAMI, MOBIN P MD	1/9/2006	207R00000X	NA	Other	026	PHYSICIANS	54317	41	Internal Medicine	0	In state provider	None	900 S FAIRMONT AVE	STE A	LODI	CA	95240	5119	39	06077	38.122551	-121.285822	San Joaquin County
244647	Fee-for-Service	1598938193	1598938193	1	1	GARCIA, MEGAN MD	10/30/2023	208600000X	NA	General Surgery	026	PHYSICIANS	181253	None	None	0	In state provider	None	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	4108	19	06037	34.20369349	-118.629837	Los Angeles County
244709	Fee-for-Service	1598096067	1598096067	1	1	GHAVAMI-MAIBODI, MARYAM M MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116322	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
244711	Fee-for-Service	1255596128	1255596128	1	1	GOOCH, REBECCA A MD	1/17/2020	207RC0200X	NA	Other	026	PHYSICIANS	165404	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
244726	Fee-for-Service	1902845597	1902845597	1	1	GRUNDY, DAVID A MD	8/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55843	None	None	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
244751	Fee-for-Service	1194978338	1194978338	1	1	GADOWSKI, DOUGLAS MD INC	7/1/1966	193400000X	NA	Other	026	PHYSICIANS	22057	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	25775 MCBEAN PKWY	STE 105	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
244794	Fee-for-Service	1295828259	1295828259	1	1	GERAYLI, AFROUZ S MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70360	41	Internal Medicine	0	In state provider	None	3901 LAS POSAS RD	STE 103	CAMARILLO	CA	93010	1505	56	06111	34.2415821	-119.0183756	Ventura County
244827	Fee-for-Service	1356452486	1356452486	1	1	GOVINDARAJAN, SUGANTHA MD	10/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	31250	22	Pathology (M.D. only)	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
244833	Fee-for-Service	1285215947	1285215947	1	1	GANNAGE, CATHERINE A MD	10/15/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
244887	Fee-for-Service	1427686930	1427686930	1	1	GREINER, KAREN	5/7/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	185518	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
244931	Fee-for-Service	1700860871	1700860871	1	9	GOLDEN STATE DERMATOLOGY ASS	1/20/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	801 S HAM LN	STE A	LODI	CA	95242	2317	39	06077	38.124495	-121.2882875	San Joaquin County
244941	Fee-for-Service	1508814138	1508814138	1	1	GLEN-WHITE UROLOGICAL	3/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC.	1560 E CHEVY CHASE DR	STE 325	GLENDALE	CA	91206	4180	19	06037	34.15290734	-118.2302295	Los Angeles County
245046	Fee-for-Service	1538108261	1538108261	1	1	GORDON, GEOFFREY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SACRED HEART MED CTR	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
245049	Fee-for-Service	1962608356	1962608356	1	1	GASKINS, HAMPTON T MD INC	12/15/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2671 IOWA AVE	None	RIVERSIDE	CA	92507	2804	33	06065	33.98813685	-117.3398909	Riverside County
245055	Fee-for-Service	1427010982	1427010982	1	1	GRATTON, MATHEW 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	2640	00	None	39.08455286	-94.57578107	Jackson County
245064	Fee-for-Service	1790504702	1790504702	1	1	GALEN INPATIENT PHYSICIANS P	11/22/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	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
245119	Fee-for-Service	1548990062	1548990062	1	1	GHARIBIAN, ELENA LMFT	9/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
245127	Fee-for-Service	1598979304	1598979304	1	1	GEE, LEELIND K LMFT	8/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39159 PASEO PADRE	121	FREMONT	CA	94538	1608	01	06001	37.5531875	-121.9805141	Alameda County
245151	Fee-for-Service	1487300844	1487300844	1	1	GONZALEZ, BLANCA E LCSW	3/9/2022	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
245160	Fee-for-Service	1033282660	1033282660	1	1	GE, MEI MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78712	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
245170	Fee-for-Service	1871852921	1871852921	1	1	GRIFFIN, CHARLES E MD	7/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128675	None	None	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
245222	Fee-for-Service	1174576599	1174576599	1	1	GOMEZ, JULIA E MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66397	08	Family Practice	0	In state provider	None	1140 W LA VETA AVE	STE 700	ORANGE	CA	92868	4229	30	06059	33.7802984	-117.8651669	Orange County
245240	Fee-for-Service	1659639060	1659639060	1	1	GRABIC, IVA MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140319	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
245247	Fee-for-Service	1083639108	1083639108	1	1	GONIAS, STEVEN L MD	12/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87302	22	Pathology (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
245314	Fee-for-Service	1598133829	1598133829	1	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3030 GRAPE ST	None	SAN DIEGO	CA	92102	1134	37	06073	32.7265905	-117.128835	San Diego County
245320	Fee-for-Service	1841633575	1841633575	1	1	GURBANI, AJAY MD	8/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	136215	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
245337	Fee-for-Service	1962608356	1962608356	1	1	GASKINS, HAMPTON T MD INC	12/15/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2671 IOWA AVE	None	RIVERSIDE	CA	92507	2804	33	06065	33.98813685	-117.3398909	Riverside County
245355	Fee-for-Service	1790504702	1790504702	1	1	GALEN INPATIENT PHYSICIANS P	11/22/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
245363	Fee-for-Service	1679776074	1679776074	1	1	GOFFNEY, WILLIE H MD FACS	8/17/2022	2086X0206X	NA	General Surgery	026	PHYSICIANS	52590	None	None	0	In state provider	None	3300 E SOUTH ST	#201	LONG BEACH	CA	90805	4588	19	06037	33.86018093	-118.1537163	Los Angeles County
245373	Fee-for-Service	1689733347	1689733347	1	1	GLASS, CARY D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38907	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
245379	Fee-for-Service	1942405584	1942405584	1	1	GOMEZ, MICHAEL C MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105390	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
245408	Fee-for-Service	1730213265	1730213265	1	1	GONZALEZ, MARGARET C LCSW	4/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	334 VIA VERA CRUZ	SUITE 208	SAN MARCOS	CA	92078	2635	37	06073	33.13698477	-117.1888034	San Diego County
245419	Fee-for-Service	1518361211	1518361211	1	1	GODBLESS HOSPICE CARE INC	7/1/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	STE 425	ENCINO	CA	91436	4612	19	06037	34.15682212	-118.4871886	Los Angeles County
245450	Fee-for-Service	1831168509	1831168509	1	1	GARY L PETERSEN, MD	2/8/2015	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
245460	Fee-for-Service	1801565551	1801565551	1	1	GILL, AMARPAL NP	2/5/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5531 BUSINESS PARK S	201A	BAKERSFIELD	CA	93309	1668	15	06029	35.35738668	-119.0601246	Kern County
245476	Fee-for-Service	1114229069	1114229069	1	3	GENESIS MANOR I	4/15/2011	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OWNER/ADMINISTRATOR	1691 GENESSEE AVE	None	LA VERNE	CA	91750	2032	19	06037	34.1208663	-117.7724213	Los Angeles County
245481	Fee-for-Service	1093755043	1093755043	1	1	GORDON, BRIAN L MD	6/30/1991	207P00000X	NA	Other	026	PHYSICIANS	56207	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
245499	Fee-for-Service	1770673501	1770673501	1	1	GUICHARD, JOHN A MD	9/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	23865	22	Pathology (M.D. only)	0	In state provider	None	WHIPPLE AND ALAMEDA	None	REDWOOD CITY	CA	94062	0000	41	06081	37.480392	-122.2524405	San Mateo County
245509	Fee-for-Service	1194882407	1194882407	1	1	GEMA ELIZABETH FERNANDEZ, M.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9305 W THOMAS RD	STE 155	PHOENIX	AZ	85037	3360	00	None	33.47802	-112.2604065	Maricopa County
245516	Fee-for-Service	1497045439	1497045439	1	1	GARDNER, RACHELLE C CRNA	1/24/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
245531	Fee-for-Service	1811192487	1811192487	1	1	GLEZER, ANNA MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115241	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
245538	Fee-for-Service	1487999215	1487999215	1	1	GANO, DAWN MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123794	79	Neurology-Child	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94131	2202	38	06075	37.76344756	-122.4581992	San Francisco County
245554	Fee-for-Service	1306080841	1306080841	1	1	GULLO, JENNIFER L MD	7/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121026	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
245634	Fee-for-Service	1215906656	1215906656	1	1	GRANT COUNTY FIRE DISTRICT	10/22/2014	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
245642	Fee-for-Service	1154853265	1154853265	1	1	GUICHET, PHILLIP L MD	7/28/2023	2085R0204X	NA	Other	026	PHYSICIANS	183687	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
245656	Fee-for-Service	1447542089	1447542089	1	1	GUANIO, HELEN H LMFT	1/3/2022	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
245670	Fee-for-Service	1285780296	1285780296	1	1	GEVERTS, LINDA J NP	3/22/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2030 COFFEE RD	STE A1	MODESTO	CA	95355	2498	50	06099	37.672569	-120.9757125	Stanislaus County
245709	Fee-for-Service	1518361211	1518361211	1	1	GODBLESS HOSPICE CARE INC	7/1/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	STE 425	ENCINO	CA	91436	4612	19	06037	34.15682212	-118.4871886	Los Angeles County
245724	Fee-for-Service	1750470092	1750470092	1	1	GROSS,JAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 E 210TH ST	None	BRONX	NY	10469	0000	00	None	40.879872	-73.8798975	Bronx County
245827	Fee-for-Service	1063694917	1063694917	1	1	GURUSWAMY, RAVINDRAKUMAR G	7/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55765	41	Internal Medicine	0	In state provider	MD	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
245847	Fee-for-Service	1114059359	1114059359	1	1	GURESKY, BRANDON K LMFT	8/28/2018	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
245874	Fee-for-Service	1083980486	1083980486	1	1	GARG, VINISHA MD	7/31/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	127302	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
245892	Fee-for-Service	1508840877	1508840877	1	1	GALERA, RHONA BETH I	11/8/2019	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
245901	Fee-for-Service	1194207704	1194207704	1	1	GOMEZ, VANESSA C RCP	9/18/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	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
245917	Fee-for-Service	1114229069	1114229069	1	2	GENESIS MANOR I	4/15/2011	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OWNER/ADMINISTRATOR	2123 AQUINAS AVE	None	CLAREMONT	CA	93711	2230	19	06037	34.12201636	-117.7054854	Los Angeles County
245940	Fee-for-Service	1659348431	1659348431	1	1	GUNDRY, COOPER R MD	6/17/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87810	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
245954	Fee-for-Service	1477199834	1477199834	1	1	GUIHAMA, KEVIN PT	2/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	500 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2813	19	06037	34.15937082	-118.2644042	Los Angeles County
245962	Fee-for-Service	1235728494	1235728494	1	1	GOZUN, MAAN KATHRYN MD	5/7/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
245964	Fee-for-Service	1063452225	1063452225	1	1	GREEN, CHERYL MD	2/8/2015	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
245976	Fee-for-Service	1093377707	1093377707	1	1	GUIDE THERAPY SERVICES LICEN	3/30/2020	261QM0801X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SED CLINICAL SOCIAL WORK	2600 WEST OLIVE AVE	5TH FLOOR	BURBANK	CA	91505	4549	19	06037	34.15993924	-118.3307814	Los Angeles County
245992	Fee-for-Service	1669820569	1669820569	1	1	GARCIA, GLORIA MD	10/14/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154734	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
246006	Fee-for-Service	1285165720	1285165720	1	1	GOSLINGA, JILL A MD	7/5/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	160327	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
246026	Fee-for-Service	1619942992	1619942992	1	1	GOLDSCHMIDT, LEONARD MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	43987	18	Ophthalmology	0	In state provider	None	1439 CEDARWOOD LN	None	PLEASANTON	CA	94566	6151	01	06001	37.67106858	-121.8747076	Alameda County
246051	Fee-for-Service	1952534927	1952534927	1	1	GERIATRICS LONG TERM CARE	11/19/2010	207R00000X	NA	Other	026	PHYSICIANS	92725	08	Family Practice	0	In state provider	MEDICAL CORPORATION	6940 PACIFIC AVE	None	STOCKTON	CA	95207	2602	39	06077	38.01336589	-121.3212507	San Joaquin County
246058	Fee-for-Service	1144427725	1144427725	1	1	GATES, RENEE A LCSW	10/14/2011	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	24425 WOOLSEY CYN RD	STE 132	WEST HILLS	CA	91304	6857	19	06037	34.23703694	-118.6592793	Los Angeles County
246078	Fee-for-Service	1861758823	1861758823	1	1	GODBOLE, ROHIT H MD	8/3/2018	390200000X	NA	Other	026	PHYSICIANS	129404	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
246089	Fee-for-Service	1710900998	1710900998	1	1	GALDAMEZ, JORGE M MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81832	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
246101	Fee-for-Service	1073691887	1073691887	1	1	GRONDAHL, JOSEPH MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66118	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
246103	Fee-for-Service	1891791703	1891791703	1	1	GAUTAM, RAVINDRA M	1/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56418	None	None	0	In state provider	None	820 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
246157	Fee-for-Service	1750338042	1750338042	1	1	GAY, JAMES P MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51718	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
246163	Fee-for-Service	1083980486	1083980486	1	1	GARG, VINISHA MD	7/31/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	127302	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
246183	Fee-for-Service	1053680298	1053680298	1	1	GOLDEN WEST EMERGENCY	1/1/2012	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL ASSOCIATES INC	900 SOUTH ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4716	19	06037	34.049623	-118.1388014	Los Angeles County
246203	Fee-for-Service	1932886892	1932886892	1	1	G4 ALL ACCESS TRANSPORT, LLC	2/21/2024	2278P4000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8218 WINTERHEAD LN	None	SACRAMENTO	CA	95823	5558	34	06067	38.460006	-121.444443	Sacramento County
246248	Fee-for-Service	1689661720	1689661720	1	1	GRIFFITHS, WILLIAM J MD	5/31/1991	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	38621	10	Gastroenterology (M.D. only)	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
246265	Fee-for-Service	1194767921	1194767921	1	1	GROOTEGOED RUSSELL AD	7/1/1996	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	305 ORANGE AVE	STE D	HUNTINGTON BEACH	CA	92648	8128	30	06059	33.65940002	-117.9987779	Orange County
246329	Fee-for-Service	1750365052	1750365052	1	1	GRAHAM, ROBERT J OD, INC	1/1/2001	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	216 E MATILIJA ST	None	OJAI	CA	93023	2722	56	06111	34.44887248	-119.244724	Ventura County
246337	Fee-for-Service	1952534927	1952534927	1	1	GERIATRICS LONG TERM CARE	11/19/2010	207R00000X	NA	Other	026	PHYSICIANS	92725	38	Geriatrics	0	In state provider	MEDICAL CORPORATION	6940 PACIFIC AVE	None	STOCKTON	CA	95207	2602	39	06077	38.01336589	-121.3212507	San Joaquin County
246347	Fee-for-Service	1356874929	1356874929	1	1	GOLSHTEYN, GAN DPM	7/30/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
246349	Fee-for-Service	1679035638	1679035638	1	1	GULDE, CHRISTIAN H	3/28/2023	207L00000X	NA	Other	026	PHYSICIANS	184526	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
246351	Fee-for-Service	1164954319	1164954319	1	1	GOBENCIONG, ANTONIO MD	11/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169455	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
246451	Fee-for-Service	1811262009	1811262009	1	1	GUAN, JIAN MD	9/13/2021	207T00000X	NA	General Surgery	026	PHYSICIANS	161397	None	None	0	In state provider	None	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
246557	Fee-for-Service	1568179216	1568179216	1	1	GONZALEZ TELLEZ, MARITZA MS	9/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W LCSW	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
246568	Fee-for-Service	1184700619	1184700619	1	1	GO, ALAN S MD	10/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81204	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
246585	Fee-for-Service	1174532543	1174532543	1	1	GUPTA, BRIJ MD	8/24/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43950	41	Internal Medicine	0	In state provider	None	1401 SPANOS CT	STE 111	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
246603	Fee-for-Service	1023183829	1023183829	2	2	GARDNER, ROBERT W MD	5/22/2024	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	None	-	NOT APPLICABLE	0	In state provider	None	6316 E HIGHWAY 20	None	LUCERNE	CA	95458	7801	17	06033	39.08608009	-122.7921592	Lake County
246614	Fee-for-Service	1770635690	1770635690	1	1	GARCIA-PACHECO, IGOR MD	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114289	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4550 CALIFORNIA AVE	SUITE 500	BAKERSFIELD	CA	93309	7020	15	06029	35.367903	-119.0537145	Kern County
246618	Fee-for-Service	1790264588	1790264588	1	1	GUERRERO, BEN	10/15/2019	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
246646	Fee-for-Service	1164439667	1164439667	1	1	GALEF, FRANKLIN MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36816	41	Internal Medicine	0	In state provider	None	105 DURIAN ST	None	VISTA	CA	92083	6205	37	06073	33.192558	-117.272973	San Diego County
246664	Fee-for-Service	1427823848	1427823848	1	1	GRAY, TAMIKA	4/9/2025	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	628 E LA VERNE AVE	None	POMONA	CA	91767	0001	19	06037	34.0801589	-117.7401256	Los Angeles County
246713	Fee-for-Service	1720579642	1720579642	1	1	GODDARD, STEPHANIE A MD	7/8/2024	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
246728	Fee-for-Service	1457403149	1457403149	1	1	GREENBERG, SETH CRNA	8/27/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
246805	Fee-for-Service	1598729824	1598729824	1	1	GIES,FLORIAN 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	1120 MONTANA	None	GOODING	ID	83330	0000	00	None	42.93362669	-114.710338	Gooding County
246855	Fee-for-Service	1194107169	1194107169	1	1	GUESS, MATTHEW A MD	2/20/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	144547	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13100 STUDEBAKER RD	None	NORWALK	CA	90650	2531	19	06037	33.912594	-118.099152	Los Angeles County
246880	Fee-for-Service	1801256789	1801256789	1	1	GROSSMONT HOSPITAL	6/23/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	5555 GROSSMONT CENTER DR	A217	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
246892	Fee-for-Service	1528623444	1528623444	1	1	GARCHA, JASMINE K DO	9/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20204	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
246900	Fee-for-Service	1770635690	1770635690	1	1	GARCIA-PACHECO, IGOR MD	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114289	41	Internal Medicine	0	In state provider	None	4550 CALIFORNIA AVE	SUITE 500	BAKERSFIELD	CA	93309	7020	15	06029	35.367903	-119.0537145	Kern County
246936	Fee-for-Service	1619266228	1619266228	1	1	GHANI, UMAIR U MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129477	41	Internal Medicine	0	In state provider	None	1818 N ORANGE GROVE AVE	SUITE 204	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
246945	Fee-for-Service	1902886500	1902886500	2	1	GOHL, MARK R CRNA	5/26/2023	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
246953	Fee-for-Service	1427823848	1427823848	1	1	GRAY, TAMIKA	4/9/2025	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	628 E LA VERNE AVE	None	POMONA	CA	91767	0001	19	06037	34.0801589	-117.7401256	Los Angeles County
246959	Fee-for-Service	1891311015	1891311015	1	1	GUTIERREZ, GABRIEL MD	8/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185359	None	None	0	In state provider	None	4053 LONE TREE WAY	101	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
246970	Fee-for-Service	1821016551	1821016551	1	1	GARMAN, JON K MD	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	14948	05	Anesthesiology	0	In state provider	None	170 ALAMEDA	# DE	REDWOOD CITY	CA	94062	2751	41	06081	37.48095011	-122.2532536	San Mateo County
247078	Fee-for-Service	1174989594	1174989594	1	1	GETTYSBURG MEDICAL CLINIC IN	11/15/2019	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	C	1834 BELLEVUE	None	ATWATER	CA	95301	2670	24	06047	37.36036895	-120.6125201	Merced County
247090	Fee-for-Service	1285713701	1285713701	1	1	GONZALES, ANTHONY M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60280	05	Anesthesiology	0	In state provider	None	3033 W ORANGE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
247100	Fee-for-Service	1063709962	1063709962	1	1	GUAN, HENRY F MD	5/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	124043	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
247103	Fee-for-Service	1215189014	1215189014	1	1	GRGUREVIC, MIROSLAV MD	10/16/2008	207L00000X	NA	Other	026	PHYSICIANS	40300	05	Anesthesiology	0	In state provider	INC	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
247150	Fee-for-Service	1497015192	1497015192	1	1	GUL, MARYAM MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149391	41	Internal Medicine	0	In state provider	None	43112 W 15TH ST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
247179	Fee-for-Service	1659313534	1659313534	1	1	GONZALES, ANDREA T MD	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91755	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
247186	Fee-for-Service	1316984958	1316984958	1	1	GOLDMAN, RICHARD L MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	37954	30	Radiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
247197	Fee-for-Service	1548588049	1548588049	1	1	GARVIN, EUGENE J MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124369	05	Anesthesiology	0	In state provider	None	450 E ROMIE LANE	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
247198	Fee-for-Service	1750456091	1750456091	1	1	GREENFIELD, ELLEN M PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9663 TIERRA GRANDE ST	STE 104	SAN DIEGO	CA	92126	4569	37	06073	32.89501952	-117.1213425	San Diego County
247203	Fee-for-Service	1285656884	1285656884	2	1	GARFIELD BEACH CVS LLC	10/9/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2270 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	2017	19	06037	33.798087	-118.122714	Los Angeles County
247227	Fee-for-Service	1780600528	1780600528	1	1	GUTIERREZ, CECILIA A MD	1/23/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78303	01	General Practice	0	In state provider	None	12509 POWAY RD	None	POWAY	CA	92064	4304	37	06073	32.95198061	-117.0600875	San Diego County
247244	Fee-for-Service	1316968076	1316968076	1	1	GHAFFARIAN, SHIREEN PHD	4/4/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9300 WILSHIRE BLVD	SUITE 320	BEVERLY HILLS	CA	90212	3213	19	06037	34.06702622	-118.3941274	Los Angeles County
247277	Fee-for-Service	1790298859	1790298859	1	1	GL&SON LLC	12/22/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8010 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	1533	34	06067	38.711547	-121.2711255	Sacramento County
247289	Fee-for-Service	1538633458	1538633458	1	1	GIOVANI, SCOTT M RCP	9/27/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
247304	Fee-for-Service	1750325023	1750325023	1	1	GARFIELD BEACH CVS, LLC	10/10/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	610 W. TEFFT ST.	None	NIPOMO	CA	93444	9187	40	06079	35.03544194	-120.4872246	San Luis Obispo County
247331	Fee-for-Service	1518166073	1518166073	1	1	GORBACHOVA, TETYANA A MD	12/21/2007	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	94657	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
247336	Fee-for-Service	1205984093	1205984093	1	1	GONZALEZ, MARIA C MD	4/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78731	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
247342	Fee-for-Service	1316051451	1316051451	1	1	GANDHI, SHOBHANA A MD	12/8/2003	174400000X	NA	Other	026	PHYSICIANS	29540	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3968 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2443	19	06037	34.02389048	-118.186929	Los Angeles County
247345	Fee-for-Service	1700502986	1700502986	1	1	GENAHEALTH PHARMACY INC	5/9/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18107 SHERMAN WAY	STE 202	RESEDA	CA	91335	8802	19	06037	34.20122046	-118.527669	Los Angeles County
247383	Fee-for-Service	1821356288	1821356288	1	1	GANESAN, LAKSHMI L MD	9/1/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	127348	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
247399	Fee-for-Service	1578774899	1578774899	1	1	GOLCHET, PAMELA R MD	10/20/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	100521	18	Ophthalmology	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
247444	Fee-for-Service	1891729745	1891729745	1	4	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1035 SOUTH MAIN ST	None	FALLBROOK	CA	92028	3338	37	06073	33.373188	-117.2515065	San Diego County
247480	Fee-for-Service	1003895137	1003895137	1	1	GRANT, SHANNON MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81040	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
247503	Fee-for-Service	1679894752	1679894752	1	1	GIR, AMIT S MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137968	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
247516	Fee-for-Service	1780600528	1780600528	1	1	GUTIERREZ, CECILIA A MD	1/23/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78303	08	Family Practice	0	In state provider	None	12509 POWAY RD	None	POWAY	CA	92064	4304	37	06073	32.95198061	-117.0600875	San Diego County
247628	Fee-for-Service	1285675199	1285675199	1	1	GARFIELD BEACH CVS, LLC	2/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	683 LOMAS SANTA FE	None	SOLANA BEACH	CA	92075	1412	37	06073	32.99596006	-117.2594441	San Diego County
247629	Fee-for-Service	1013311620	1013311620	1	1	GIN, LUCY NP	1/30/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	328 S. FIRST ST	F	ALHAMBRA	CA	91801	3790	19	06037	34.09104553	-118.1252904	Los Angeles County
247634	Fee-for-Service	1811084676	1811084676	1	8	GOLDEN BEAR PHYSICAL THERAPY	12/28/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	855 S TRACY BLVD	None	TRACY	CA	95376	4744	39	06077	37.72411856	-121.4349148	San Joaquin County
247657	Fee-for-Service	1164495750	1164495750	1	1	GRAMINS, DANIEL L MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79711	01	General Practice	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
247669	Fee-for-Service	1821356288	1821356288	1	1	GANESAN, LAKSHMI L MD	9/1/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	127348	45	Nephrology (Renal-Kidney)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
247688	Fee-for-Service	1558039438	1558039438	1	1	GIFTED HOMES INC	12/2/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13339 MEDICINE BOW COURT	None	VICTORVILLE	CA	92394	0522	36	06071	34.52715455	-117.3721635	San Bernardino County
247728	Fee-for-Service	1891729745	1891729745	1	4	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1035 SOUTH MAIN ST	None	FALLBROOK	CA	92028	3338	37	06073	33.373188	-117.2515065	San Diego County
247732	Fee-for-Service	1942419544	1942419544	1	2	GRINBERG, JESSICA B CPO	8/9/2010	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	84 MADRONE ST	None	WILLITS	CA	95490	4249	23	06045	39.40096275	-123.3520916	Mendocino County
247770	Fee-for-Service	1821511965	1821511965	1	1	GRANT, CONNOR J DO	12/6/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	19253	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
247790	Fee-for-Service	1235356254	1235356254	1	1	GOLDBERG,JARED MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4320 SEMINARY RD	None	ALEXANDRA	VA	22304	0000	00	None	38.82433448	-77.10522437	Alexandria
247794	Fee-for-Service	1922432392	1922432392	1	1	GHIGLIERI, MICHELLE L PT	7/12/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
247807	Fee-for-Service	1144530205	1144530205	1	1	GIVEN, DANIEL MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121110	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
247826	Fee-for-Service	1114992203	1114992203	1	1	GADOMSKI, CHRISTOPHER J	5/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8631	40	Pediatrics	0	In state provider	DO	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
247831	Fee-for-Service	1891283214	1891283214	1	1	GUPTA, VARSHA MD	7/28/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164889	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
247853	Fee-for-Service	1659394971	1659394971	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	695 W HERNDON AVE	None	CLOVIS	CA	93612	0104	10	06019	36.840321	-119.728314	Fresno County
247859	Fee-for-Service	1689930455	1689930455	1	1	GUTIERREZ, JONATHAN M MD	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139105	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA STREET	None	SAN JOAQUIN	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin
247867	Fee-for-Service	1851410633	1851410633	1	1	GARCIA, KARA MD	11/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93774	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
247872	Fee-for-Service	1790727493	1790727493	1	1	GARRIDO, MANUEL R MD	2/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84460	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
247899	Fee-for-Service	1659371102	1659371102	1	1	GRIGORE, ALINA M MD	10/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1180 N TOWN CENTER DRIVE	SUITE 200	LAS VEGAS	NV	89144	6363	00	None	36.18265175	-115.3112105	Clark County
247924	Fee-for-Service	1972766582	1972766582	1	1	GILES, GARREN R DO	10/9/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2375 E PRATER WAY	None	SPARKS	NV	89434	9641	00	None	39.54247495	-119.6975356	Washoe County
247943	Fee-for-Service	1316109333	1316109333	1	1	GOYAL, ANURAG MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111132	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
248019	Fee-for-Service	1891729745	1891729745	1	4	GRAYBILL MEDICAL GROUP INC	7/26/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1035 SOUTH MAIN ST	None	FALLBROOK	CA	92028	3338	37	06073	33.373188	-117.2515065	San Diego County
248055	Fee-for-Service	1194790972	1194790972	1	1	GENES, DEAN M MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	53351	30	Radiology	0	In state provider	None	3230 BEARD RD	None	NAPA	CA	94558	3673	28	06055	38.3216968	-122.2953847	Napa County
248063	Fee-for-Service	1417043191	1417043191	1	1	GERARD, STEPHEN K MD	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50781	22	Pathology (M.D. only)	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
248068	Fee-for-Service	1407835952	1407835952	1	1	GLOBERMAN, LINDA M MD	8/24/2004	207N00000X	NA	Dermatology	026	PHYSICIANS	34628	07	Dermatology	0	In state provider	None	4902 IRVINE CENTER DR	STE 105	IRVINE	CA	92604	3334	30	06059	33.68521738	-117.786657	Orange County
248096	Fee-for-Service	1144530205	1144530205	1	1	GIVEN, DANIEL MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121110	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
248179	Fee-for-Service	1609087386	1609087386	1	1	GEOFFREY B TAYLOR, 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	1101 26TH ST S	None	GREAT FALLS	MT	59405	5161	00	None	47.491965	-111.2617215	Cascade County
248225	Fee-for-Service	1477915601	1477915601	1	1	GUO, XIAOYUE M MD	9/28/2023	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167916	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
248233	Fee-for-Service	1417176165	1417176165	1	1	GRIDLEY UNIFIED SCHOOL DIST	3/28/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	429 MAGNOLIA ST	None	GRIDLEY	CA	95948	2599	04	06007	39.3631437	-121.6916173	Butte County
248240	Fee-for-Service	1114658267	1114658267	1	1	GAUTAM, PRATIMA OD	5/31/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 N VERMONT AVE	SUITE 101	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
248255	Fee-for-Service	1548361587	1548361587	1	1	GIL, GABRIEL MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85252	08	Family Practice	0	In state provider	LOMITA FAMILY MEDICAL GR	909 CARDIFF ST	None	SAN DIEGO	CA	92114	5019	37	06073	32.71576625	-117.0252947	San Diego County
248284	Fee-for-Service	1649225632	1649225632	1	1	GENETICS CENTER INC	5/25/2004	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ZADEH, TOURAN M MD	211 S MAIN ST	STE E	ORANGE	CA	92868	3840	30	06059	33.785271	-117.8672615	Orange County
248299	Fee-for-Service	1235431602	1235431602	1	1	GOMES, STEPHEN M LCSW	1/4/2022	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
248352	Fee-for-Service	1417043191	1417043191	1	1	GERARD, STEPHEN K MD	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50781	42	Nuclear Medicine	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
248370	Fee-for-Service	1033118500	1033118500	1	1	GERMAN, JOHN C MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	22900	40	Pediatrics	0	In state provider	None	1140 W LA VETA AVE	STE 540	ORANGE	CA	92868	4221	30	06059	33.7802984	-117.8651669	Orange County
248384	Fee-for-Service	1477080992	1477080992	1	1	GAERTNER, MARK L MD	9/29/2022	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	163132	None	None	0	In state provider	None	100 MED PLAZA	100, 755	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
248402	Fee-for-Service	1215003330	1215003330	1	2	GARNER, BRANDI S	5/14/2024	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
248436	Fee-for-Service	1164863858	1164863858	1	1	GUTIERREZ, BARBARA D CCC-SLP	7/16/2020	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
248445	Fee-for-Service	1194398354	1194398354	1	1	GARFIELD HEALTH CENTER	10/25/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	7740 GARVEY AVE	STE B100-B102	ROSEMEAD	CA	91770	3061	19	06037	34.06259448	-118.10061	Los Angeles County
248450	Fee-for-Service	1710176730	1710176730	1	1	GORDON, STRACEY NP	8/28/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
248488	Fee-for-Service	1952317042	1952317042	1	1	GREENBERG, CINDY J MD	11/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80877	40	Pediatrics	0	In state provider	None	750 LAS GALLINAS AVE	STE 210	SAN RAFAEL	CA	94903	3432	21	06041	38.00688138	-122.5463961	Marin County
248524	Fee-for-Service	1174309439	1174309439	1	1	GALLAHER, ALLISON CCC-SLP	12/11/2023	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
248544	Fee-for-Service	1376617803	1376617803	2	1	GONG PHARMACIST PROFESSIONAL	1/10/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ARMACY	315 S DIAMOND BAR BLVD	D	DIAMOND BAR	CA	91765	1616	19	06037	34.01986873	-117.8093511	Los Angeles County
248566	Fee-for-Service	1356352595	1356352595	1	1	GILLETT, JENNIFER R MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90809	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
248579	Fee-for-Service	1467799502	1467799502	1	1	GREIG, CHRISTINA K MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138223	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	SUITE 230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
248610	Fee-for-Service	1710560594	1710560594	1	1	GUBRAN, AHMED N MD	12/13/2024	207R00000X	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
248631	Fee-for-Service	1871932525	1871932525	2	1	GBA HOSPICE CARE, INC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8280 UTICA AVE	SUITE 210	RANCHO CUCAMONGA	CA	91730	3851	36	06071	34.10304122	-117.5707984	San Bernardino County
248661	Fee-for-Service	1760489371	1760489371	1	1	GOLAND, JAY H MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37670	04	Otology, Laryngology, Rhinology	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
248669	Fee-for-Service	1679651475	1679651475	1	1	GUERRA, JUAN J MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81724	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
248705	Fee-for-Service	1942767231	1942767231	1	1	GARBER-TALAMO, MICHELLE M DO	10/1/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	20264	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
248720	Fee-for-Service	1245400670	1245400670	1	1	GREAT EXPECTATIONS SERVICES	2/5/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	822 GRANADA DR	None	VISTA	CA	92083	4733	37	06073	33.20739126	-117.2703332	San Diego County
248729	Fee-for-Service	1194157743	1194157743	1	1	GRAZER, SAGE A 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
248734	Fee-for-Service	1194398354	1194398354	1	1	GARFIELD HEALTH CENTER	6/30/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	7740 GARVEY AVE	STE B100-B102	ROSEMEAD	CA	91770	3061	19	06037	34.06259448	-118.10061	Los Angeles County
248740	Fee-for-Service	1285901942	1285901942	1	1	GERSHELIS, ANNA LCSW	2/13/2015	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1314 WESTWOOD BLVD	STE 201	LOS ANGELES	CA	90024	4928	19	06037	34.05653136	-118.4424884	Los Angeles County
248763	Fee-for-Service	1396990560	1396990560	1	1	GUPTA, ANKUR V MD	8/21/2017	207R00000X	NA	Other	026	PHYSICIANS	108509	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
248788	Fee-for-Service	1316792344	1316792344	1	1	GOUGH, ELIZABETH B CD	6/6/2024	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
248795	Fee-for-Service	1205900362	1205900362	1	1	GOLDMAN, STEVEN L MD	1/1/1982	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	31919	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
248798	Fee-for-Service	1639336134	1639336134	1	1	GAMINI, ALI A MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105204	41	Internal Medicine	0	In state provider	None	2280 HARRISON AVE	STE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
248918	Fee-for-Service	1871932525	1871932525	2	1	GBA HOSPICE CARE, INC	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8280 UTICA AVE	SUITE 210	RANCHO CUCAMONGA	CA	91730	3851	36	06071	34.10304122	-117.5707984	San Bernardino County
248933	Fee-for-Service	1326448143	1326448143	1	1	GONZALEZ GONZALEZ, ILSE G LC	6/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
248960	Fee-for-Service	1285736256	1285736256	1	1	GABRIELSON, KATHRYN W MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74794	41	Internal Medicine	0	In state provider	None	3030 CHILDREN WAY	None	SAN DIEGO	CA	92123	0000	37	06073	32.798889	-117.150826	San Diego County
248970	Fee-for-Service	1427154533	1427154533	1	1	GROWDON, WILLIAM A MD	3/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	30280	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
248991	Fee-for-Service	1942767231	1942767231	1	1	GARBER-TALAMO, MICHELLE M DO	10/1/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	20264	36	Psychiatry	0	In state provider	None	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	36	06071	34.04833901	-117.2120103	San Bernardino County
249021	Fee-for-Service	1194398354	1194398354	1	1	GARFIELD HEALTH CENTER	10/25/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	7740 GARVEY AVE	STE B100-B102	ROSEMEAD	CA	91770	3061	19	06037	34.06259448	-118.10061	Los Angeles County
249043	Fee-for-Service	1104238104	1104238104	1	1	GALICIA, SAMUEL A MD	11/27/2017	207R00000X	NA	Other	026	PHYSICIANS	145065	41	Internal Medicine	0	In state provider	None	1721 W YOSEMITE AVENUE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
249088	Fee-for-Service	1851398150	1851398150	1	1	GOEBEL, PAUL J MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	47869	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6327 N FRESNO ST	STE 104	FRESNO	CA	93710	5236	10	06019	36.82875536	-119.781417	Fresno County
249098	Fee-for-Service	1255336756	1255336756	1	1	GROSSMAN, PETER H MD	1/31/1995	2086S0122X	NA	General Surgery	026	PHYSICIANS	66484	24	Plastic Surgery	0	In state provider	None	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	1938	19	06037	34.20369349	-118.629837	Los Angeles County
249142	Fee-for-Service	1376864520	1376864520	1	1	GUSENBURG, JEFFREY S MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134625	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
249177	Fee-for-Service	1417965898	1417965898	1	2	GIHAN G GEORGE M D INC	3/2/2022	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
249202	Fee-for-Service	1629251350	1629251350	1	1	GOLSHAN HEDYEH M MD	3/7/2008	207R00000X	NA	Other	026	PHYSICIANS	75923	None	None	0	In state provider	ASSOCIATES INC	1850 N RIVERSIDE AVE	STE 230	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
249223	Fee-for-Service	1891879979	1891879979	1	1	GUPTA, ARVIND K MD	6/21/2016	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
249268	Fee-for-Service	1083922934	1083922934	1	1	GRAHAM, BENJAMIN I OD	12/28/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	SUITE 1-340	LOS ANGELES	CA	90095	7065	19	06037	34.06482757	-118.4443441	Los Angeles County
249283	Fee-for-Service	1225554645	1225554645	1	1	GHC OF CONTRA COSTA, LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1800 ADOBE ST	None	CONCORD	CA	94520	2313	07	06013	37.97700068	-122.0381159	Contra Costa County
249300	Fee-for-Service	1871151829	1871151829	1	1	GRACE HOME HEALTH & HOSPICE	5/4/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1500 STANDIFORD AVE	BLDG C STE 10	MODESTO	CA	95350	0592	50	06099	37.68938848	-121.0175865	Stanislaus County
249361	Fee-for-Service	1881656395	1881656395	1	1	GOLDBERG, RICHARD MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19165	66	Emergency Medicine (Urgent Care)	0	In state provider	None	BUENA VISTA AT ALAMEDA S	None	BURBANK	CA	91505	0000	19	06037	34.158213	-118.328112	Los Angeles County
249409	Fee-for-Service	1578541256	1578541256	1	1	GHOSH, TANUSHREE DO	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13567	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	91188	0001	37	06073	32.79293009	-117.0952438	San Diego County
249427	Fee-for-Service	1699726067	1699726067	1	1	GREGOIRE, EDWARD J MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91378	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
249429	Fee-for-Service	1558999086	1558999086	1	1	GRING, EMMA H NP	10/28/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
249432	Fee-for-Service	1811064728	1811064728	1	1	GUEST, RICHARD A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33685	02	General Surgery	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
249439	Fee-for-Service	1033666391	1033666391	1	1	GUADALUPE GONZALEZ	9/22/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8391 GLENWOOD DRIVE	None	GILROY	CA	95020	4337	43	06085	37.01800314	-121.5805716	Santa Clara County
249445	Fee-for-Service	1578583878	1578583878	1	2	GUGAN, AGNES S 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	C/O FPS OF LLUSM	11175 CAMPUS ST	STE 11120	LOMA LINDA	CA	92350	1700	36	06071	34.049547	-117.2656245	San Bernardino County
249449	Fee-for-Service	1023183829	1023183829	2	1	GARDNER, ROBERT W MD	5/22/2024	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	30366	36	Psychiatry	0	In state provider	None	14895 CATHOLIC CHURCH RD	None	CLEARLAKE OAKS	CA	95423	9601	17	06033	39.01101889	-122.6328626	Lake County
249533	Fee-for-Service	1437211687	1437211687	1	1	GEER, CHERYL H DO	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	6662	15	Obstetrics (D.O. only)	0	In state provider	None	445 ROSEWOOD AVE	STE C	CAMARILLO	CA	93010	5930	56	06111	34.2206084	-119.0616322	Ventura County
249536	Fee-for-Service	1962496653	1962496653	1	1	GREENHOLZ, STEPHEN K MD	8/14/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	65955	02	General Surgery	0	In state provider	None	5301 F ST	STE 216	SACRAMENTO	CA	95819	3221	34	06067	38.571354	-121.4368695	Sacramento County
249567	Fee-for-Service	1891969184	1891969184	1	1	GUSSOUS, YAZEED M MD	7/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130401	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
249600	Fee-for-Service	1730101833	1730101833	1	1	GOLBAHAR, BAHAREH OD	7/5/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	RM 1 340	LOS ANGELES	CA	90024	7002	19	06037	34.06482757	-118.4443441	Los Angeles County
249631	Fee-for-Service	1083631782	1083631782	1	1	GUZE, BARRY MD	12/31/1996	2084N0400X	NA	Neurology	026	PHYSICIANS	40602	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
249655	Fee-for-Service	1588737480	1588737480	1	1	GU, E DI	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1840 N HACIENDA BLVD	STE 9	LA PUENTE	CA	91744	1143	19	06037	34.05164127	-117.9426446	Los Angeles County
249670	Fee-for-Service	1417369158	1417369158	1	1	GOOD SHEPHERD RESIDENTIAL	1/6/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE LLC	238 N RIVERSIDE AVE	SUITE C	RIALTO	CA	92376	5972	36	06071	34.103452	-117.3705748	San Bernardino County
249726	Fee-for-Service	1033666391	1033666391	1	1	GUADALUPE GONZALEZ	10/10/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8391 GLENWOOD DRIVE	None	GILROY	CA	95020	4337	43	06085	37.01800314	-121.5805716	Santa Clara County
249774	Fee-for-Service	1619294907	1619294907	1	1	GOMEZ, CAITLIN L MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120188	78	Neoplastic Diseases/Oncology	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	91346	1207	19	06037	34.27904453	-118.459944	Los Angeles County
249796	Fee-for-Service	1235194176	1235194176	1	1	GROSS, GOLDEE H MD	12/1/2003	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55102	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	365 HAWTHORNE AVE	STE 101	OAKLAND	CA	94609	3115	01	06001	37.82079728	-122.2633226	Alameda County
249822	Fee-for-Service	1437211687	1437211687	1	1	GEER, CHERYL H DO	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	6662	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	445 ROSEWOOD AVE	STE C	CAMARILLO	CA	93010	5930	56	06111	34.2206084	-119.0616322	Ventura County
249824	Fee-for-Service	1962496653	1962496653	1	1	GREENHOLZ, STEPHEN K MD	8/14/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	65955	40	Pediatrics	0	In state provider	None	5301 F ST	STE 216	SACRAMENTO	CA	95819	3221	34	06067	38.571354	-121.4368695	Sacramento County
249833	Fee-for-Service	1528503000	1528503000	1	1	GREENSTEIN, ALEXA R NP	2/4/2019	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
249839	Fee-for-Service	1841826534	1841826534	1	1	GHAI, SANJAY K PT	5/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 N MAIN ST	STE 340	SANTA ANA	CA	92705	6634	30	06059	33.7737545	-117.8687284	Orange County
249866	Fee-for-Service	1043225592	1043225592	1	1	GOADE, DIANE 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
249876	Fee-for-Service	1801206503	1801206503	1	1	GIACONE, HEATHER M MD	6/2/2022	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	155460	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
249896	Fee-for-Service	1598364424	1598364424	1	1	GOOD HEALTH MEDICAL TRANSPOR	4/1/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	T, LLC.	1009 HWY A-12	None	MONTAGUE	CA	96064	9037	47	06093	41.6471939	-122.5161346	Siskiyou County
249900	Fee-for-Service	1457317133	1457317133	1	1	GARTSMAN, ALLA MD	8/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89097	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
249950	Fee-for-Service	1245367507	1245367507	1	1	GLICK, IRA D MD	10/31/1992	2084P0800X	NA	Psychiatry	026	PHYSICIANS	9084	36	Psychiatry	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
249952	Fee-for-Service	1720371347	1720371347	1	1	GADBAW, JACLYN R MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116806	08	Family Practice	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
249966	Fee-for-Service	1477517902	1477517902	1	1	GERTNER, MICHAEL E MD	8/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73501	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
249980	Fee-for-Service	1275567141	1275567141	1	1	GODDARD, MICHAEL DPM	4/26/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	23141 MOULTON PKWY	STE 109	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
250001	Fee-for-Service	1881009751	1881009751	1	1	GONZALEZ, JESSICA LCSW	9/2/2021	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
250012	Fee-for-Service	1629296637	1629296637	1	1	GONZALEZ, TERESITA D J LMFT	8/31/2018	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
250017	Fee-for-Service	1811525231	1811525231	1	1	GHARAKHANIAN, RAFFI A DO	8/19/2024	207R00000X	NA	Other	026	PHYSICIANS	20697	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
250047	Fee-for-Service	1750556940	1750556940	1	1	GREAT WEST MEDICAL ASSOCIATE	10/15/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	1	Border provider	FARIS, LLP	5915 S RAINBOW BLVD	STE 105	LAS VEGAS	NV	89118	2558	00	None	36.08119375	-115.2427495	Clark County
250056	Fee-for-Service	1720287055	1720287055	1	1	GOYAL, LIPIKA MD	3/6/2023	207RX0202X	NA	Oncology	026	PHYSICIANS	184275	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250065	Fee-for-Service	1619294907	1619294907	1	1	GOMEZ, CAITLIN L MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120188	30	Radiology	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	91346	1207	19	06037	34.27904453	-118.459944	Los Angeles County
250164	Fee-for-Service	1609258920	1609258920	1	1	GARFF, KEVIN MD	8/27/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	160988	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
250208	Fee-for-Service	1225226434	1225226434	1	1	GILBERT, JOHN M LMFT	7/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
250225	Fee-for-Service	1033375100	1033375100	1	1	GRACIA, GINA M CCC-A	4/20/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
250259	Fee-for-Service	1811084676	1811084676	1	21	GOLDEN BEAR PHYSICAL THERAPY	10/4/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPORTS INJURY CENTER, I	210 W PINE ST	None	LODI	CA	95240	2020	39	06077	38.13427214	-121.2755342	San Joaquin County
250268	Fee-for-Service	1811938590	1811938590	1	1	GIULIANO, ANNE W MD	10/28/2020	2085R0204X	NA	Other	026	PHYSICIANS	161958	30	Radiology	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
250302	Fee-for-Service	1811261175	1811261175	1	1	GELLER, ANDREW W MD	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111489	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	#8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
250351	Fee-for-Service	1588763437	1588763437	1	1	GARCIA, STEVE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 26TH ST S	None	GREAT FALLS	MT	59405	5161	00	None	47.491965	-111.2617215	Cascade County
250361	Fee-for-Service	1215959093	1215959093	2	1	GARFIELD BEACH CVS LLC	4/26/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4707 PACIFIC AVE	None	STOCKTON	CA	95207	6301	39	06077	37.991781	-121.3153065	San Joaquin County
250403	Fee-for-Service	1255677092	1255677092	1	1	GENERATIONAL CHANGES, INC	5/23/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2409 MERCED STREET	STE 106	FRESNO	CA	93721	1829	10	06019	36.74004418	-119.7890832	Fresno County
250407	Fee-for-Service	1801438841	1801438841	1	1	GOODCHOICE MEDICAL SUPPLIES	3/1/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LLC	4760 MISSION GORGE PL	SUITE D	SAN DIEGO	CA	92120	4220	37	06073	32.78162221	-117.0919293	San Diego County
250428	Fee-for-Service	1487768271	1487768271	1	1	GAMBOA, LUCIE N MD	8/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	41941	40	Pediatrics	0	In state provider	None	1820 41ST AVE	SUITE D	CAPITOLA	CA	95010	2516	44	06087	36.975573	-121.964832	Santa Cruz County
250439	Fee-for-Service	1801932272	1801932272	1	1	GROSS, LAURA A MD	9/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84043	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
250471	Fee-for-Service	1447521737	1447521737	1	1	GARFIELD BEACH CVS LLC	5/31/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7200 BANCROFT AVE	None	OAKLAND	CA	94605	2403	01	06001	37.768221	-122.17608	Alameda County
250480	Fee-for-Service	1942226329	1942226329	1	1	GRASS VALLEY RADIOLOGY	4/30/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP, INC	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
250493	Fee-for-Service	1922797562	1922797562	1	1	GRACE KIM MD ENDOCRINE INC	8/2/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	None	None	0	In state provider	None	1660 SAN CARLOS AVE	None	SAN CARLOS	CA	94070	2022	41	06081	37.50328418	-122.2655795	San Mateo County
250502	Fee-for-Service	1295885770	1295885770	1	1	GUNASEKERA, NISHANI C MD	7/2/2019	207L00000X	NA	Other	026	PHYSICIANS	161651	05	Anesthesiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
250505	Fee-for-Service	1427048792	1427048792	1	1	GRBACH, VINCENT X MD	11/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145555	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
250524	Fee-for-Service	1659041416	1659041416	1	1	GOLDAMMER, EMILY CRNA	1/31/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
250560	Fee-for-Service	1568485605	1568485605	1	1	GLASSNER, SAMUEL H MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68528	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
250562	Fee-for-Service	1538600895	1538600895	1	1	GIEHL, NOLAN M MD	9/27/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	157538	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
250588	Fee-for-Service	1558491043	1558491043	1	1	GARDNER FAMILY HEALTH	1/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	43	06085	37.36514449	-121.8292446	Santa Clara County
250645	Fee-for-Service	1104881457	1104881457	1	1	GREENSTEIN, JOSHUA K MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68100	41	Internal Medicine	0	In state provider	None	631 E GRAND AVENUE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12468152	-117.073451	San Diego County
250649	Fee-for-Service	1326337569	1326337569	1	1	GULIAN, MICHAEL R MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122485	05	Anesthesiology	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
250694	Fee-for-Service	1174657514	1174657514	1	1	GORDON, EURAL E RN	5/7/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7400 DISTRICT BLVD	SUITE C	BAKERSFIELD	CA	93313	4818	15	06029	35.31317675	-119.0831837	Kern County
250754	Fee-for-Service	1427125509	1427125509	1	2	GEVORKIAN, TIGRAN I MD	11/16/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	74704	-	NOT APPLICABLE	0	In state provider	None	3111 WINONA AVENUE	201	BURBANK	CA	91504	2538	19	06037	34.19929449	-118.34496	Los Angeles County
250764	Fee-for-Service	1669873386	1669873386	1	1	GAGNON, ALISON	8/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	38656 MEDICAL CENTER DR	SUITE B	PALMDALE	CA	93551	4483	19	06037	34.58533737	-118.1437927	Los Angeles County
250839	Fee-for-Service	1679757595	1679757595	1	1	GERARDO & EVELYN PASCUAL	9/26/1998	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	617 S SENTOUS AVE	None	WEST COVINA	CA	91792	3126	19	06037	34.00424487	-117.8808461	Los Angeles County
250847	Fee-for-Service	1275640245	1275640245	1	1	GREGORY BOWLING MD	9/23/2015	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
250870	Fee-for-Service	1104241447	1104241447	1	1	GROVES, JUNO LMFT	8/27/2019	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2805 PORTER STREET	None	SOQUEL	CA	95060	2103	44	06087	36.986895	-121.9574085	Santa Cruz County
250875	Fee-for-Service	1558491043	1558491043	1	1	GARDNER FAMILY HEALTH	1/1/1992	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	43	06085	37.36514449	-121.8292446	Santa Clara County
250885	Fee-for-Service	1225181936	1225181936	1	1	GUADALUPE UNION SCHOOL	1/3/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4465 9TH ST	None	GUADALUPE	CA	93434	0788	42	06083	34.96894951	-120.5692705	Santa Barbara County
250905	Fee-for-Service	1285466227	1285466227	1	1	GIBSON, LIANA LMFT	2/25/2025	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
250907	Fee-for-Service	1609403062	1609403062	1	1	GHODRATI, SAHAND MD	5/18/2023	207R00000X	NA	Other	026	PHYSICIANS	177870	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
250915	Fee-for-Service	1083887277	1083887277	1	1	GANDHI, DHRUVIL P MD	5/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10320	02	General Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	B10	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
250925	Fee-for-Service	1699707224	1699707224	1	1	GOLDMAN, HERBERT MD	6/30/1985	174400000X	NA	Other	026	PHYSICIANS	45955	18	Ophthalmology	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
250995	Fee-for-Service	1720024128	1720024128	1	1	GUPTA, NAVEEN MD	12/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	34794	78	Neoplastic Diseases/Oncology	0	In state provider	None	1280 CORONA POINTE CT	STE 112	CORONA	CA	92879	1770	33	06065	33.87039079	-117.5408442	Riverside County
251003	Fee-for-Service	1811084676	1811084676	1	15	GOLDEN BEAR PHYSICAL THERAPY	12/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	1906 VISTA DEL LAGO DR	STE A	VALLEY SPRINGS	CA	95252	9700	05	06009	38.16810805	-120.8383709	Calaveras County
251010	Fee-for-Service	1235493842	1235493842	1	1	GULLAPALLI, YOCHITA MD	8/16/2024	207R00000X	NA	Other	026	PHYSICIANS	173207	41	Internal Medicine	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
251018	Fee-for-Service	1225109085	1225109085	1	1	GROSSFELD, PAUL D MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	52799	35	Pediatric Cardiology (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
251046	Fee-for-Service	1932755964	1932755964	1	1	GODINEZ, ANDREA M LCSW	5/13/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
251049	Fee-for-Service	1922798164	1922798164	1	1	GICHOMO, ROSE WAMBUI	6/20/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3171 HIGHGATE TERRACE	LOOP	FOLSOM	CA	95630	7053	34	06067	38.635641	-121.0935285	Sacramento County
251054	Fee-for-Service	1720868334	1720868334	1	1	GUTIERREZ, PRISCILLA NP	5/1/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	37	06073	33.01539521	-117.0824934	San Diego County
251130	Fee-for-Service	1184824146	1184824146	1	1	GANJIANPOUR, RAMIN MD INC	9/29/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	11550 INDIAN HILLS RD	SUITE 241	MISSION HILLS	CA	91345	1202	19	06037	34.28024575	-118.4588775	Los Angeles County
251136	Fee-for-Service	1619912516	1619912516	1	1	GARFIELD BEACH CVS, LLC	1/29/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16975 BEAR VALLEY DR	None	HESPERIA	CA	92345	1809	36	06071	34.47088647	-117.2934675	San Bernardino County
251145	Fee-for-Service	1659889848	1659889848	1	1	GUTIERREZ, ALBERTO C LMFT	8/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
251147	Fee-for-Service	1770536807	1770536807	1	1	GARY A NEIDICH, 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 22ND ST	None	SIOUX FALLS	SD	57117	0000	00	None	43.534908	-96.7455765	Minnehaha County
251162	Fee-for-Service	1558491043	1558491043	1	1	GARDNER FAMILY HEALTH	3/1/1997	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	43	06085	37.36514449	-121.8292446	Santa Clara County
251174	Fee-for-Service	1225181936	1225181936	1	1	GUADALUPE UNION SCHOOL	4/11/2002	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	4465 9TH ST	None	GUADALUPE	CA	93434	0788	42	06083	34.96894951	-120.5692705	Santa Barbara County
251176	Fee-for-Service	1013106897	1013106897	1	2	GHALY, MICHAEL A MD	11/24/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	95429	-	NOT APPLICABLE	0	In state provider	None	433 TURK STREET	None	SAN FRANCISCO	CA	94102	3329	38	06075	37.78247225	-122.4163506	San Francisco County
251197	Fee-for-Service	1992797070	1992797070	1	1	GLENDORA RADIOLOGICAL	4/1/1983	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOC INC	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
251206	Fee-for-Service	1083887277	1083887277	1	1	GANDHI, DHRUVIL P MD	5/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10320	28	Proctology (colon and rectal)	0	In state provider	None	101 THE CITY DRIVE SOUTH	B10	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
251222	Fee-for-Service	1811395353	1811395353	1	1	GRANDCARE SAN DIEGO LLC	12/17/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2535 CAMINO DEL RIO S	STE 120	SAN DIEGO	CA	92108	3764	37	06073	32.76923898	-117.1376556	San Diego County
251248	Fee-for-Service	1902984727	1902984727	1	1	GEE, CHRISTOPHER W MD	7/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82525	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
251258	Fee-for-Service	1114961463	1114961463	1	1	GARFIELD BEACH CVS, LLC	5/1/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	44430 CHALLENGER WAY	None	LANCASTER	CA	93535	3205	19	06037	34.690419	-118.1126305	Los Angeles County
251260	Fee-for-Service	1811084676	1811084676	1	11	GOLDEN BEAR PHYSICAL THERAPY	1/2/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	1335 COFFEE RD	STE 200	MODESTO	CA	95355	3188	50	06099	37.66291854	-120.9756994	Stanislaus County
251268	Fee-for-Service	1013594308	1013594308	1	1	GRIMES, NICKOLAS P DPM	7/28/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2342 PROFESSIONAL PARKWA	SUITE 100	SANTA MARIA	CA	93455	1660	42	06083	34.91786968	-120.4383001	Santa Barbara County
251306	Fee-for-Service	1225109085	1225109085	1	1	GROSSFELD, PAUL D MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	52799	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
251337	Fee-for-Service	1922798164	1922798164	1	1	GICHOMO, ROSE WAMBUI	6/20/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3171 HIGHGATE TERRACE	LOOP	FOLSOM	CA	95630	7053	34	06067	38.635641	-121.0935285	Sacramento County
251365	Fee-for-Service	1730545666	1730545666	1	1	GOMEZ, EVELYN Y CCC-SLP	8/8/2022	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
251383	Fee-for-Service	1407182579	1407182579	1	1	GRAGLIA, SALLY M S MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129640	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3556	48	06095	38.26109552	-122.0470245	Solano County
251430	Fee-for-Service	1235634924	1235634924	1	1	GARCIA-GROSSMAN, ILANA R MD	8/9/2023	207R00000X	NA	Other	026	PHYSICIANS	166349	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
251432	Fee-for-Service	1295480176	1295480176	1	1	G&E HOME HEALTH	2/29/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	401 N BRAND BLVD	STE 303	GLENDALE	CA	91203	2203	19	06037	34.151958	-118.255149	Los Angeles County
251434	Fee-for-Service	1568456002	1568456002	3	1	GOLD COAST AMBULANCE SERVICE	12/18/2017	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	200 BERNOULLI CIR	None	OXNARD	CA	93030	8012	56	06111	34.20333285	-119.1502984	Ventura County
251444	Fee-for-Service	1063618031	1063618031	1	1	GARFIELD BEACH CVS, LLC	2/19/2008	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	123 N. REINO ROAD	None	NEWBURY PARK	CA	91320	3710	56	06111	34.18001215	-118.9526614	Ventura County
251451	Fee-for-Service	1558491043	1558491043	1	1	GARDNER FAMILY HEALTH	7/1/1994	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	NETWORK INC	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	43	06085	37.36514449	-121.8292446	Santa Clara County
251462	Fee-for-Service	1336450741	1336450741	1	1	GUERRERO, LANCE 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
251464	Fee-for-Service	1194068460	1194068460	1	1	GOROVOY, DAVID S MD	5/28/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160618	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251507	Fee-for-Service	1265589998	1265589998	1	1	GOLDBERG, DANA J MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108705	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
251521	Fee-for-Service	1629090311	1629090311	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1893 W MALVERN AVE	None	FULLERTON	CA	92833	2403	30	06059	33.87987	-117.9611415	Orange County
251525	Fee-for-Service	1295708451	1295708451	1	1	GULLAPALLI, NAGESHWARA	9/13/2005	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
251549	Fee-for-Service	1912240771	1912240771	1	1	GARCIA, DANIELLA E MD	5/9/2019	207P00000X	NA	Other	026	PHYSICIANS	160219	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
251595	Fee-for-Service	1225109085	1225109085	1	1	GROSSFELD, PAUL D MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	52799	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
251638	Fee-for-Service	1679522916	1679522916	1	1	GREGORATOS, GABRIEL MD	12/1/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	20170	06	Cardiovascular Disease (M.D. only)	0	In state provider	DEPT OF MEDICINE	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
251688	Fee-for-Service	1184121899	1184121899	1	1	GORDON, EMILE B MD	8/12/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	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
251745	Fee-for-Service	1154647410	1154647410	1	1	GARCIA, KARLA J MD	10/22/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	120672	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
251768	Fee-for-Service	1952832511	1952832511	1	1	GUPTA, PRERNA MD	9/24/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	160267	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
251795	Fee-for-Service	1619296795	1619296795	1	1	GRIBBEN, WALTER B MD	6/4/2019	208M00000X	NA	Other	026	PHYSICIANS	155367	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
251888	Fee-for-Service	1326042821	1326042821	1	1	GORE, ALVIN I MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	79731	08	Family Practice	0	In state provider	None	500 DOYLE PARK DR	SUITE 100	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
251905	Fee-for-Service	1912180233	1912180233	1	1	GHAZAL, BAHIJ G MD	5/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123097	41	Internal Medicine	0	In state provider	None	6109 W RAMSEY STREET	None	BANNING	CA	92223	3051	33	06065	33.92940576	-116.9437965	Riverside County
251926	Fee-for-Service	1679522916	1679522916	1	1	GREGORATOS, GABRIEL MD	12/1/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	20170	01	General Practice	0	In state provider	DEPT OF MEDICINE	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
251949	Fee-for-Service	1912290107	1912290107	1	1	GARBUZ, ZEV W MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131148	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
251970	Fee-for-Service	1689810020	1689810020	2	1	GARFIELD BEACH CVS LLC	10/19/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19105 GOLDEN VALLEY RD	None	SANTA CLARITA	CA	91387	1428	19	06037	34.39342714	-118.4637271	Los Angeles County
251974	Fee-for-Service	1376746834	1376746834	1	1	GUPTA, ANITA DO	1/5/2022	207L00000X	NA	Other	026	PHYSICIANS	17372	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
252002	Fee-for-Service	1306297155	1306297155	1	1	GHAZIPURA, ANUM A LMFT	6/20/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	133220	-	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
252010	Fee-for-Service	1437223344	1437223344	1	1	GHERMAN, MARIA G MD	3/1/1984	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	39264	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
252016	Fee-for-Service	1508870700	1508870700	1	1	GARG, YOGENDER P MD INC	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66071	18	Ophthalmology	0	In state provider	None	1801 SOLAR DR	STE 231	OXNARD	CA	93030	0193	56	06111	34.21831864	-119.1449657	Ventura County
252034	Fee-for-Service	1427415454	1427415454	1	1	GARFIELD VILLAS LLC	1/10/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1425 N GARFIELD AVE	None	PASADENA	CA	91104	2106	19	06037	34.17048	-118.143936	Los Angeles County
252062	Fee-for-Service	1639333164	1639333164	1	1	GOWDA, AKSHATHA G V MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135632	41	Internal Medicine	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 301	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
252113	Fee-for-Service	1366826950	1366826950	1	1	GOWERN, NATALIE LMFT	4/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
252119	Fee-for-Service	1225193956	1225193956	1	1	GRZYBOWSKI, THERESA L	2/26/2013	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
252123	Fee-for-Service	1457551665	1457551665	1	1	GHARAHBAGHIAN, LALEH MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94604	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
252127	Fee-for-Service	1932745387	1932745387	1	1	GOPINATH CORPORATION	1/3/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1306 MAIN ST	STE 102	RAMONA	CA	92065	2127	37	06073	33.03915422	-116.8736534	San Diego County
252128	Fee-for-Service	1073535761	1073535761	2	1	GARFIELD BEACH CVS LLC	9/28/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2907 COCHRAN ST	None	SIMI VALLEY	CA	93065	2773	56	06111	34.27904047	-118.739799	Ventura County
252154	Fee-for-Service	1710147194	1710147194	1	2	GUERRA, MARIBEL LCSW	7/21/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1875 W REDONDO BEACH BLV	STE 303	GARDENA	CA	90247	3644	19	06037	33.8879044	-118.3111113	Los Angeles County
252161	Fee-for-Service	1922058288	1922058288	1	1	GILLIS, PATRICIA J DO MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73899	None	None	0	In state provider	None	14500 SHERMAN CIR	None	VAN NUYS	CA	91405	3052	19	06037	34.20025916	-118.4500763	Los Angeles County
252177	Fee-for-Service	1003133422	1003133422	1	1	GUPTA, PRITHA MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125113	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
252180	Fee-for-Service	1487787784	1487787784	1	1	GHEDARI, SHARAREH LMFT	1/17/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
252204	Fee-for-Service	1295231603	1295231603	1	1	GOLDSTEIN, JORDAN S MD	5/9/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	174641	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
252212	Fee-for-Service	1811084676	1811084676	1	5	GOLDEN BEAR PHYSICAL THERAPY	12/26/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	1519 W YOSEMITE AVE	None	MANTECA	CA	95337	5159	39	06077	37.79738017	-121.2413628	San Joaquin County
252222	Fee-for-Service	1902073216	1902073216	1	1	GELLER, FELIX A MD	11/16/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	147211	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
252237	Fee-for-Service	1689671828	1689671828	1	1	GLASER, ANNE M MD	7/31/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	56826	30	Radiology	0	In state provider	None	2191 MOWRY AVE	SUITE 500-H	FREMONT	CA	94538	1725	01	06001	37.55710897	-121.9814562	Alameda County
252249	Fee-for-Service	1528268133	1528268133	1	1	GIRSKY, MARC J MD INC	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83112	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1400 S GRAND AVE	STE 615	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
252298	Fee-for-Service	1033479548	1033479548	1	1	GRAHAM, ERIC J MD	10/19/2017	207P00000X	NA	Other	026	PHYSICIANS	130257	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
252301	Fee-for-Service	1538200936	1538200936	1	1	GERALD J FAY, 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 NE LILLY RD	None	OLYMPIA	WA	98506	0000	00	None	47.053944	-122.8444465	Thurston County
252303	Fee-for-Service	1982925046	1982925046	1	2	GONZALEZ, SOPHIA A LMFT	11/25/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	36997	-	NOT APPLICABLE	0	In state provider	None	1207 EAST FRUIT STREET	BUILDING B	SANTA ANA	CA	92701	4206	30	06059	33.75238847	-117.8539245	Orange County
252318	Fee-for-Service	1356366116	1356366116	1	1	GARRAWAY, ISLA P MD	10/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75368	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
252357	Fee-for-Service	1235664301	1235664301	1	1	GUO, MENGYING MD	12/4/2020	207R00000X	NA	Other	026	PHYSICIANS	158952	None	None	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
252359	Fee-for-Service	1720065782	1720065782	1	1	GARRITY DAVID A. MD	8/19/2009	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
252401	Fee-for-Service	1720100316	1720100316	1	1	GUZMAN, ANDREA LMFT	11/9/2023	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
252415	Fee-for-Service	1750016259	1750016259	1	1	GARDEN GROVE POST ACUTE LLC	8/16/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12332 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1804	30	06059	33.77429347	-117.9174015	Orange County
252471	Fee-for-Service	1538784566	1538784566	1	1	GRANDISON, AMBER D MD	2/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185413	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
252486	Fee-for-Service	1881945178	1881945178	1	1	GONZALES, LISA R LPCC	9/24/2021	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
252525	Fee-for-Service	1689671828	1689671828	1	1	GLASER, ANNE M MD	7/31/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	56826	08	Family Practice	0	In state provider	None	2191 MOWRY AVE	SUITE 500-H	FREMONT	CA	94538	1725	01	06001	37.55710897	-121.9814562	Alameda County
252526	Fee-for-Service	1184829442	1184829442	1	1	GARCIA-DIAZ, GABRIEL MD	7/1/2013	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	115417	20	Orthopedic Surgery	0	In state provider	None	123 WEST N BEAR CREEK DR	None	MERCED	CA	95348	3420	24	06047	37.31144034	-120.4716162	Merced County
252530	Fee-for-Service	1295735322	1295735322	1	1	GOTTLIEB, ANNETTE J MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66948	07	Dermatology	0	In state provider	None	8920 WILSHIRE BLVD	STE 545	BEVERLY HILLS	CA	90211	2009	19	06037	34.06703599	-118.3863456	Los Angeles County
252557	Fee-for-Service	1407006406	1407006406	1	1	GORMAN, HEATHER R PSYD	2/3/2023	101YM0800X	NA	Other	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
252580	Fee-for-Service	1184727059	1184727059	1	1	GRIDLEY MEDICAL GROUP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	225 SPRUCE ST	None	GRIDLEY	CA	95948	2215	04	06007	39.36695351	-121.68954	Butte County
252644	Fee-for-Service	1336220433	1336220433	1	1	GARIANO, RAY F	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68701	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
252671	Fee-for-Service	1477856003	1477856003	1	1	GILL, MONA K OD	2/9/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 JAMES WAY	STE 210	PISMO BEACH	CA	93449	2874	40	06079	35.13801548	-120.6270972	San Luis Obispo County
252672	Fee-for-Service	1548544307	1548544307	1	1	GOULD, JESSICA L MD	4/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118447	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
252702	Fee-for-Service	1770607921	1770607921	1	1	GARCIA, ROSE LMFT	8/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
252733	Fee-for-Service	1932270824	1932270824	1	1	GOLDSTEIN, DAVID J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36779	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
252765	Fee-for-Service	1457705642	1457705642	1	1	GILMORE, SCOTT M MD	5/20/2021	207P00000X	NA	Other	026	PHYSICIANS	169082	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	0070	36	06071	34.26577765	-117.1695461	San Bernardino County
252773	Fee-for-Service	1184736225	1184736225	1	1	GRAY, STACY W MD	5/31/2017	207RX0202X	NA	Oncology	026	PHYSICIANS	147699	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
252781	Fee-for-Service	1003246125	1003246125	1	1	GUARDADO, NADIA MD	12/7/2022	208600000X	NA	General Surgery	026	PHYSICIANS	171031	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
252782	Fee-for-Service	1043553795	1043553795	1	1	GASCA, CHRISTIAN LCSW	3/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
252795	Fee-for-Service	1629131677	1629131677	1	1	GLASGOW, RAEWYN J CNM	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
252798	Fee-for-Service	1831109214	1831109214	1	1	GALLO, DEBORAH L PHD	9/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20940 BURBANK BLVD	None	WOODLAND HILLS	CA	91365	6701	19	06037	34.1719401	-118.5881418	Los Angeles County
252799	Fee-for-Service	1871526723	1871526723	1	1	GOLDSMITH, MARK S MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	44890	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
252823	Fee-for-Service	1992981484	1992981484	1	1	GANDINGCO, WINNIE J MD	12/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102158	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
252843	Fee-for-Service	1083688782	1083688782	1	1	GELMAN, CLIFFORD L MD	10/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144049	02	General Surgery	0	In state provider	None	921 OAK PARK BLVD	SUITE 201	PISMO BEACH	CA	93449	3400	40	06079	35.13600697	-120.6045995	San Luis Obispo County
252868	Fee-for-Service	1184727059	1184727059	1	1	GRIDLEY MEDICAL GROUP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	225 SPRUCE ST	None	GRIDLEY	CA	95948	2215	04	06007	39.36695351	-121.68954	Butte County
252879	Fee-for-Service	1386823813	1386823813	1	1	GODETT, NICOLE C	11/4/2016	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1000 N NORMA ST	STE A	RIDGECREST	CA	93555	3151	15	06029	35.638893	-117.6787005	Kern County
252975	Fee-for-Service	1235151028	1235151028	2	1	GARFIELD BEACH CVS LLC	3/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8840 CORBIN AVE	None	NORTHRIDGE	CA	91324	3309	19	06037	34.231023	-118.5622615	Los Angeles County
253038	Fee-for-Service	1700988680	1700988680	1	1	GELLER, KENNETH A MD	12/1/2003	207YP0228X	NA	ENT/Otolaryngology	026	PHYSICIANS	26159	40	Pediatrics	0	In state provider	None	6430 W SUNSET BLVD	STE 600	LOS ANGELES	CA	90028	7909	19	06037	34.09797681	-118.3299393	Los Angeles County
253040	Fee-for-Service	1689123879	1689123879	1	1	GHIAM, LIAM MD	1/10/2020	2085R0001X	NA	Other	026	PHYSICIANS	165739	None	None	0	In state provider	None	1316 NELSON AVE	None	MODESTO	CA	95350	5341	50	06099	37.66206042	-120.9881734	Stanislaus County
253048	Fee-for-Service	1457545949	1457545949	1	1	GATTO, MICHAEL R MD INC	3/18/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	35026	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1100 N PALM CANYON DR	STE 109	PALM SPRINGS	CA	92262	4418	33	06065	33.838182	-116.546744	Riverside County
253062	Fee-for-Service	1841919248	1841919248	1	1	GRACE AND LOVE RESIDENTIAL	9/15/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CARE HOME LLC	43307 PUTTERS LANE	None	HEMET	CA	92544	5227	33	06065	33.74657734	-116.9051014	Riverside County
253072	Fee-for-Service	1639332893	1639332893	1	1	GOEL, SUMINA R MD	8/19/2022	207UN0901X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	176768	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
253083	Fee-for-Service	1528459385	1528459385	1	1	GASTROENTEROLOGY MEDICAL OF	8/28/2017	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF LOS ANGELES	850 S ATLANTIC BLVD	SUITE 101	MONTEREY PARK	CA	91754	6700	19	06037	34.05097684	-118.1379979	Los Angeles County
253087	Fee-for-Service	1033233408	1033233408	1	1	GARCIA, SYLVIA Y LMFT	4/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2627 MISSION ST	None	SAN MARINO	CA	91108	1639	19	06037	34.11619262	-118.1375031	Los Angeles County
253123	Fee-for-Service	1346204153	1346204153	1	1	GRECO, SANDRA J MD	5/17/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	175529	None	None	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
253128	Fee-for-Service	1962676676	1962676676	1	1	GARCIA, JUDITH A MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	103361	01	General Practice	0	In state provider	None	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
253142	Fee-for-Service	1023559937	1023559937	1	1	GRIFFITHS, SARAH A NP	11/14/2024	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
253198	Fee-for-Service	1710918065	1710918065	2	1	GOEL, KRISHAN K MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31232	40	Pediatrics	0	In state provider	None	1100 DELBON AVE	None	TURLOCK	CA	95382	2021	50	06099	37.5106124	-120.8356611	Stanislaus County
253211	Fee-for-Service	1740408947	1740408947	1	1	GOOD SPIRIT HOME HEALTH	8/14/2008	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	4454 VAN NUYS BLVD	SUITE D	SHERMAN OAKS	CA	91403	5750	19	06037	34.152597	-118.448672	Los Angeles County
253241	Fee-for-Service	1346771268	1346771268	1	1	GENZIANO, JUSTIN L MD	8/23/2022	207L00000X	NA	Other	026	PHYSICIANS	179090	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
253256	Fee-for-Service	1184406522	1184406522	1	1	GOMEZ, CRYSTALOREN CNP	3/21/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3327 ROSECRANS ST	None	SAN DIEGO	CA	92110	4223	37	06073	32.74779742	-117.2076448	San Diego County
253270	Fee-for-Service	1033100722	1033100722	1	1	GIRALDO, ELIAS A MD	10/23/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	155069	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
253334	Fee-for-Service	1497800692	1497800692	1	1	GONZALEZ, MANUEL OD INC	2/1/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11552 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3110	19	06037	33.94759111	-118.0869911	Los Angeles County
253338	Fee-for-Service	1811084676	1811084676	1	27	GOLDEN BEAR PHYSICAL THERAPY	10/11/2023	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPORTS INJURY CENTER,	2119 E HATCH RD	STE. A	MODESTO	CA	95351	4814	50	06099	37.60927038	-120.9561263	Stanislaus County
253378	Fee-for-Service	1205878568	1205878568	1	1	GERAYLI, AFSHIN S MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80098	05	Anesthesiology	0	In state provider	INC	27800 MEDICAL CENTER RD	STE 161	MISSION VIEJO	CA	92691	6442	30	06059	33.55952733	-117.6645199	Orange County
253389	Fee-for-Service	1154423788	1154423788	1	1	GOLDBERG, D PETER MD	6/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	46533	05	Anesthesiology	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
253400	Fee-for-Service	1245984855	1245984855	1	1	GLEN WEST HEALTH SERVICES	11/8/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	135 N VICTORY BLVD	STE 3	BURBANK	CA	91502	1837	19	06037	34.17458874	-118.3170539	Los Angeles County
253430	Fee-for-Service	1255621405	1255621405	1	1	GARVEY, ERIN M MD	9/25/2021	2086S0120X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
253457	Fee-for-Service	1841477767	1841477767	1	1	GONZALEZ, BERTHA A DO INC	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6849	08	Family Practice	0	In state provider	None	3106 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02373532	-118.1368368	Los Angeles County
253492	Fee-for-Service	1710173489	1710173489	1	1	GLENDALE FOOT AND ANKLE	7/1/1991	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	PODIATRY CENTER INC	1030 S GLENDALE AVE	STE 403	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
253511	Fee-for-Service	1699823427	1699823427	1	1	GONZALEZ, MARICELA MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75371	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
253643	Fee-for-Service	1871742981	1871742981	1	1	GHAZARYAN, ARMINE MD	9/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115938	36	Psychiatry	0	In state provider	None	1300 N VERNON AVE	SUITE 307	LOS ANGELES	CA	90027	6005	19	06037	34.00386249	-118.251774	Los Angeles County
253651	Fee-for-Service	1659504678	1659504678	1	1	GARFIELD BEACH CVS LLC	3/25/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4987 N FRESNO ST	None	FRESNO	CA	93726	0352	10	06019	36.80811	-119.7814075	Fresno County
253655	Fee-for-Service	1760452965	1760452965	1	1	GHATNEKAR, REVATI J MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	43133	41	Internal Medicine	0	In state provider	None	1180 N INDIAN CANYON DR	STE E205	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
253665	Fee-for-Service	1568933786	1568933786	1	1	GRAY, KAREN E PT	8/19/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
253669	Fee-for-Service	1205878568	1205878568	1	1	GERAYLI, AFSHIN S MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80098	01	General Practice	0	In state provider	INC	27800 MEDICAL CENTER RD	STE 161	MISSION VIEJO	CA	92691	6442	30	06059	33.55952733	-117.6645199	Orange County
253687	Fee-for-Service	1043249196	1043249196	1	1	GENERAL HOME MEDICAL SUPPLY	6/27/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	717 LAKEFIELD ROAD	SUITE D	WESTLAKE VILLAGE	CA	93161	2692	56	06111	34.15709148	-118.831426	Ventura County
253724	Fee-for-Service	1376572727	1376572727	1	1	GRAHAM, THOMAS P MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75583	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4415 S LAKEVIW CYN RD	None	WESTLAKE VILLAGE	CA	91361	0000	19	06037	34.14720238	-118.8195228	Los Angeles County
253729	Fee-for-Service	1306296074	1306296074	1	1	GAZNABI, SAFWAN MD	11/1/2024	1835C0206X	NA	None	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 6100,6300,7200,7300	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
253796	Fee-for-Service	1093020364	1093020364	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	95 HOLGER WAY	None	SAN JOSE	CA	95134	1377	43	06085	37.41734374	-121.9550232	Santa Clara County
253838	Fee-for-Service	1255353942	1255353942	2	1	GARFIELD BEACH CVS LLC	4/17/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	2066	19	06037	34.074144	-118.070397	Los Angeles County
253854	Fee-for-Service	1346844305	1346844305	1	1	GAMMA HOSPICE CARE INC	3/2/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1807 W KATELLA AVE	UNIT 215	ANAHEIM	CA	92804	6691	30	06059	33.80322548	-117.946044	Orange County
253857	Fee-for-Service	1821376062	1821376062	1	1	GOMEZ, WENDY D LCSW	1/26/2024	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
253870	Fee-for-Service	1780021261	1780021261	1	1	GARCIA, MICHAEL MD	1/30/2018	208M00000X	NA	Other	026	PHYSICIANS	131946	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
253878	Fee-for-Service	1437206307	1437206307	1	1	GIANNICO, GIOVANNA A MD	3/30/2023	207ZP0101X	NA	Other	026	PHYSICIANS	185149	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
253898	Fee-for-Service	1396326419	1396326419	1	1	GOUDARZI, ANNA MD	10/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
253918	Fee-for-Service	1699092304	1699092304	1	1	GAO, BILLY S	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130874	None	None	0	In state provider	None	2100 WEBSTER ST	404	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
253925	Fee-for-Service	1730536988	1730536988	1	1	GANNAVARAPU, BHAVANI S MD	8/4/2021	2085R0001X	NA	Other	026	PHYSICIANS	172643	None	None	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
253932	Fee-for-Service	1710942677	1710942677	1	1	GIRGIS, MAGDY H MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	24914	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
253942	Fee-for-Service	1760452965	1760452965	1	1	GHATNEKAR, REVATI J MD	2/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	43133	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1180 N INDIAN CANYON DR	STE E205	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
253965	Fee-for-Service	1841327798	1841327798	1	1	GONZALEZ, SERGIO LCSW	3/22/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
253972	Fee-for-Service	1710147194	1710147194	1	1	GUERRA, MARIBEL LCSW	9/6/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	61039	-	NOT APPLICABLE	0	In state provider	None	2115 N WILMINGTON AVE	None	COMPTON	CA	90222	2030	19	06037	33.91197848	-118.2391821	Los Angeles County
253974	Fee-for-Service	1932922341	1932922341	1	1	GISSENDANER, JENNA	11/4/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
254003	Fee-for-Service	1033343298	1033343298	1	1	GUPTA, MICHELLE MD	12/13/2024	2088P0231X	NA	Other	026	PHYSICIANS	118021	40	Pediatrics	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
254004	Fee-for-Service	1477518454	1477518454	1	1	GIESLER, GREGORY M MD	5/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75160	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	55 E CALIFORNIA BLVD	3RD FLOOR	PASADENA	CA	91105	3944	19	06037	34.13582278	-118.1491634	Los Angeles County
254051	Fee-for-Service	1043254402	1043254402	1	1	GARFIELD BEACH CVS LLC	12/19/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1441 N SANTA FE AVE	None	VISTA	CA	92084	3702	37	06073	33.21964602	-117.2447789	San Diego County
254071	Fee-for-Service	1376837484	1376837484	1	1	GLOBAL PRIMARY MEDICAL	8/1/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP INC	2828 H ST	STE F	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
254086	Fee-for-Service	1417328287	1417328287	1	1	GODES, NATALYA PSYD	8/17/2017	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 CITY DR S	B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
254091	Fee-for-Service	1255054490	1255054490	1	1	GREGG, MELISSA A CNP	1/10/2023	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
254093	Fee-for-Service	1306370150	1306370150	1	1	GREEN, SHANNON MD	10/31/2023	213ER0200X	NA	Other	026	PHYSICIANS	160498	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
254099	Fee-for-Service	1669441606	1669441606	1	1	GARRETT, WILLIAM 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	510 W TIDWELL RD	None	HOUSTON	TX	77091	4339	00	None	29.8472461	-95.40841428	Harris County
254127	Fee-for-Service	1760594170	1760594170	1	1	GE, NORMAN N MD	8/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69763	04	Otology, Laryngology, Rhinology	0	In state provider	RTE 81	101 THE CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
254145	Fee-for-Service	1346844305	1346844305	1	1	GAMMA HOSPICE CARE INC	3/2/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1807 W KATELLA AVE	UNIT 215	ANAHEIM	CA	92804	6691	30	06059	33.80322548	-117.946044	Orange County
254155	Fee-for-Service	1881280295	1881280295	1	1	GUKASYAN, ARMINE CNP	5/13/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	511 N HOLLYWOOD WAY	None	BURBANK	CA	91505	3406	19	06037	34.15985598	-118.3431272	Los Angeles County
254175	Fee-for-Service	1649524687	1649524687	1	1	GELMAN, RACHEL M	3/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
254179	Fee-for-Service	1649409616	1649409616	1	1	GLADSTONE, KENNETH A PHD	1/27/2015	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
254208	Fee-for-Service	1871165084	1871165084	1	1	GOOD HOPE HEALTH SERVICES	6/13/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11755 VICTORY BLVD	STE 203	NORTH HOLLYWOOD	CA	91606	3452	19	06037	34.18670448	-118.389699	Los Angeles County
254264	Fee-for-Service	1558476978	1558476978	1	1	GELBART, SOLOMON S MD	4/25/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	39883	18	Ophthalmology	0	In state provider	None	490 POST ST	STE 640	SAN FRANCISCO	CA	94102	1418	38	06075	37.78812774	-122.4096884	San Francisco County
254282	Fee-for-Service	1336457183	1336457183	1	1	GUINN, REBECCA M PT	10/10/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2230 LYNN RD	STE 250	THOUSAND OAKS	CA	91360	1985	56	06111	34.20894685	-118.885185	Ventura County
254291	Fee-for-Service	1033343298	1033343298	1	1	GUPTA, MICHELLE MD	12/13/2024	2088P0231X	NA	Other	026	PHYSICIANS	118021	34	Urology and Urological Surgery	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
254313	Fee-for-Service	1013911460	1013911460	1	1	GADOWSKI, DOUGLAS MD INC	2/8/2015	193400000X	NA	Other	026	PHYSICIANS	22057	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	25775 MCBEAN PKWY	STE 105	VALENCIA	CA	91355	3702	19	06037	34.40042013	-118.5511416	Los Angeles County
254338	Fee-for-Service	1992728109	1992728109	1	1	GOMPERTS, BRIGITTE N MD	10/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84496	68	Hematology	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
254359	Fee-for-Service	1376837484	1376837484	1	1	GLOBAL PRIMARY MEDICAL	8/1/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	2828 H ST	STE F	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
254440	Fee-for-Service	1205932126	1205932126	1	1	GODRON LANE HEALTHCARE	12/13/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1821 E CHAPMAN AVE	None	FULLERTON	CA	92831	4102	30	06059	33.87421047	-117.897093	Orange County
254446	Fee-for-Service	1306226915	1306226915	1	1	GONZALEZ, RUBY MD	2/11/2019	390200000X	NA	Other	026	PHYSICIANS	149561	08	Family Practice	0	In state provider	None	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
254454	Fee-for-Service	1336575877	1336575877	1	1	GJERDE, CHRISTINE R DO	2/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13346	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
254474	Fee-for-Service	1184924193	1184924193	1	1	GOLDEN STATE RADIATION ONCOL	2/16/2016	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ONCOLOGY INC	8929 WILSHIRE BLVD	STE 100	BEVERLY HILLS	CA	90211	1950	19	06037	34.06709669	-118.386182	Los Angeles County
254488	Fee-for-Service	1366736092	1366736092	1	1	GOWDA, ASHWIN A DO MD	6/15/2018	207RC0200X	NA	Other	026	PHYSICIANS	16078	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
254527	Fee-for-Service	1518230341	1518230341	1	1	GABOT PUHAWAN, KATHRYN E MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119881	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
254552	Fee-for-Service	1174258693	1174258693	1	1	GARFIELD BEACH CVS, L.L.C.	1/19/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5611 STOCKTON BLVD	None	SACRAMENTO	CA	95824	1611	34	06067	38.524518	-121.4414775	Sacramento County
254559	Fee-for-Service	1588631840	1588631840	1	1	GLEASON, RANDY H	4/30/1993	207L00000X	NA	Other	026	PHYSICIANS	50398	05	Anesthesiology	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
254628	Fee-for-Service	1992728109	1992728109	1	1	GOMPERTS, BRIGITTE N MD	10/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84496	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
254657	Fee-for-Service	1326819426	1326819426	1	1	GONZALES, SARINA CNP	2/17/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
254664	Fee-for-Service	1639243231	1639243231	1	1	GIVANT-EASTLICK, L G MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61804	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
254671	Fee-for-Service	1154381341	1154381341	1	1	GUILFOY, GUY P MD	7/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	50096	20	Orthopedic Surgery	0	In state provider	None	1600 CREEKSIDE DR	STE 1400	FOLSOM	CA	95630	3445	34	06067	38.669994	-121.147488	Sacramento County
254729	Fee-for-Service	1669053625	1669053625	1	1	GUTIERREZ, MICHELLE LMFT	8/28/2024	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
254766	Fee-for-Service	1144584756	1144584756	1	1	GUZMAN, MICHAEL X II DO	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14800	41	Internal Medicine	0	In state provider	None	2000 SUTTER PLACE	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
254770	Fee-for-Service	1679057384	1679057384	1	1	GUTIERREZ, CYNTHIA LCSW	5/3/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	121924	-	NOT APPLICABLE	0	In state provider	None	7101 BAIRD AVENUE	None	RESEDA	CA	91335	4150	19	06037	34.1995012	-118.5373824	Los Angeles County
254791	Fee-for-Service	1396823878	1396823878	1	1	GLAZER, MARK MD	5/28/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
254801	Fee-for-Service	1508960840	1508960840	1	1	GARBER, ELAYNE MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32336	41	Internal Medicine	0	In state provider	None	8631 W 3RD ST	STE 700E	LOS ANGELES	CA	90048	5911	19	06037	34.07361928	-118.3803143	Los Angeles County
254811	Fee-for-Service	1578501763	1578501763	1	1	GECHLIK, GARY A MD	4/14/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71339	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
254821	Fee-for-Service	1518230341	1518230341	1	1	GABOT PUHAWAN, KATHRYN E MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119881	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
254822	Fee-for-Service	1295799724	1295799724	1	1	GARRETT, FRANCIS B MD	11/2/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	44163	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
254832	Fee-for-Service	1144301722	1144301722	1	1	GUPTA, ANAMIKA MD	11/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92431	None	None	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
254840	Fee-for-Service	1861892051	1861892051	2	1	GARFIELD BEACH CVS LLC	4/25/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	950 CODDINGTOWN CENTER	None	SANTA ROSA	CA	95401	3512	49	06097	38.45899558	-122.7313732	Sonoma County
254856	Fee-for-Service	1700223799	1700223799	1	1	GHANEM, NATALY A MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133197	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
254866	Fee-for-Service	1891890620	1891890620	1	1	GOPAL,REDDY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 WALTER NE	STE 204	ALBUQUERQUE	NM	87102	0000	00	None	35.08716551	-106.6401923	Bernalillo County
254885	Fee-for-Service	1376679506	1376679506	1	1	GERALD THOMAS MCCULLOUGH 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	415 JEFFERSON ST N	None	WADENA	MN	56482	1264	00	None	46.44658422	-95.13270643	Wadena County
254918	Fee-for-Service	1992728109	1992728109	1	1	GOMPERTS, BRIGITTE N MD	10/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84496	78	Neoplastic Diseases/Oncology	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
254925	Fee-for-Service	1316250814	1316250814	1	1	GARCIA-CORDOVA, KARLA M LMFT	5/20/2021	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
254929	Fee-for-Service	1396732590	1396732590	1	1	GREENFIELD CARE CENTER	5/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	OF FAIRFIELD	1260 TRAVIS BLVD	None	FAIRFIELD	CA	94533	4802	48	06095	38.25819346	-122.049171	Solano County
254943	Fee-for-Service	1619933553	1619933553	1	1	GORDO, MITA R MD	8/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54477	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
254945	Fee-for-Service	1386226272	1386226272	1	1	GUTIERREZ, KARLA G NP	12/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3933 COFFEE RD	STE A	BAKERSFIELD	CA	93308	5024	15	06029	35.395335	-119.092336	Kern County
254948	Fee-for-Service	1326058371	1326058371	1	1	GONZALEZ, DIEGO R MD	1/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91803	41	Internal Medicine	0	In state provider	None	1310 W STEWART DR	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
254955	Fee-for-Service	1750711719	1750711719	1	1	GOSCHA, SHELLY S LCSW	6/13/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3330 HEIGHTS DR	STE 120	CAMERON PARK	CA	95682	7636	09	06017	38.66076236	-120.981666	El Dorado County
254957	Fee-for-Service	1174649610	1174649610	2	1	GUERRA, JOSE L PSYD	6/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9010 CORBIN AVENUE	SUITE 4B	NORTHRIDGE	CA	91324	3344	19	06037	34.23447488	-118.5622843	Los Angeles County
254976	Fee-for-Service	1811084676	1811084676	1	24	GOLDEN BEAR PHYSICAL THERAPY	5/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPORTS INJURY CENTER, I	2222 FRANCISCO DR	STE 120	EL DORADO HILLS	CA	95762	3762	09	06017	38.71039358	-121.08565	El Dorado County
254979	Fee-for-Service	1396277828	1396277828	1	1	GABRA, FADY E	10/1/2024	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	159503	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
255018	Fee-for-Service	1396836011	1396836011	1	1	GOLDEN PHARMACY CORPORATION	9/30/1992	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10301 BOLSA AVE	STE 105	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
255035	Fee-for-Service	1851684708	1851684708	1	1	GUL, KHAWAR MAHMOOD M D INC	11/28/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	89941	41	Internal Medicine	0	In state provider	None	136 N THIRD ST	STE 1	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
255055	Fee-for-Service	1982636965	1982636965	1	1	GOODFRIEND, SCOTT E MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	43716	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
255064	Fee-for-Service	1508125410	1508125410	1	1	GREEN, BRENDA MD	1/20/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	134406	08	Family Practice	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
255082	Fee-for-Service	1508960840	1508960840	1	1	GARBER, ELAYNE MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32336	83	Rheumatology	0	In state provider	None	8631 W 3RD ST	STE 700E	LOS ANGELES	CA	90048	5911	19	06037	34.07361928	-118.3803143	Los Angeles County
255116	Fee-for-Service	1356770564	1356770564	1	1	GARCIA, MARGARITA D LMFT	6/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1341 W ROBINHOOD DRIVE	STE B2	STOCKTON	CA	95207	5517	39	06077	37.99838007	-121.3243901	San Joaquin County
255146	Fee-for-Service	1811084676	1811084676	1	3	GOLDEN BEAR PHYSICAL THERAPY	12/26/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	3800 GEER RD	STE 101	TURLOCK	CA	95382	1146	50	06099	37.52713247	-120.8488664	Stanislaus County
255162	Fee-for-Service	1609089861	1609089861	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	207Q00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	WOMEN'S HEALTH	797 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
255186	Fee-for-Service	1457931222	1457931222	1	1	GUTIERREZ GO, PATRICK	10/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20339	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
255197	Fee-for-Service	1134526908	1134526908	1	1	GALLERANI, CHRISTINA A MD	12/20/2024	207P00000X	NA	Other	026	PHYSICIANS	173378	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
255203	Fee-for-Service	1952790065	1952790065	2	1	GARFIELD BEACH CVS LLC	12/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2187 SHATTUCK AVE	None	BERKELEY	CA	94704	1308	01	06001	37.86964312	-122.2678538	Alameda County
255220	Fee-for-Service	1174570782	1174570782	1	1	GRAINEY, RICHARD J MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52511	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
255236	Fee-for-Service	1386082501	1386082501	1	1	GOODWIN, DEVIN S PT	3/26/2015	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
255243	Fee-for-Service	1033525696	1033525696	1	1	GAMEZ, ANA M	11/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12140 ARTESIA BLVD STE 1	None	ARTESIA	CA	90701	4054	19	06037	33.87301048	-118.073313	Los Angeles County
255289	Fee-for-Service	1619317716	1619317716	1	1	GREGORY M HELBIG MD INC	1/22/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	4016 DALE ROAD	None	MODESTO	CA	95356	9268	50	06099	37.69723812	-121.049967	Stanislaus County
255290	Fee-for-Service	1497774947	1497774947	1	1	GEHRET, DAVID A MD	12/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48231	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
255303	Fee-for-Service	1720109176	1720109176	1	1	GUAN, ZHONGHUI MD	9/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104338	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	0648	SAN FRANCISCO	CA	94143	0648	38	06075	37.7634502	-122.4579779	San Francisco County
255328	Fee-for-Service	1538290929	1538290929	1	1	GOLDENBERG, VIKTORIYA OD	9/21/2007	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6433 FALLBROOK AVENUE	None	WEST HILLS	CA	91307	3543	19	06037	34.187778	-118.62621	Los Angeles County
255367	Fee-for-Service	1619095247	1619095247	1	1	GWARTZ, BRIAN L MD	1/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43746	05	Anesthesiology	0	In state provider	PAIN DIAGNOSIS AND TREAT	210 S GRAND AVE	STE 315	GLENDORA	CA	91741	4284	19	06037	34.133859	-117.872523	Los Angeles County
255389	Fee-for-Service	1558819763	1558819763	1	1	GROVES, JILL E LMFT	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3333 SKY PARK DR	STE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
255416	Fee-for-Service	1831490184	1831490184	1	1	GATEWAY COMPREHENSIVE	9/22/2014	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP APC	1323 3RD AVENUE	None	CHULA VISTA	CA	91911	4302	37	06073	32.60538009	-117.0657621	San Diego County
255435	Fee-for-Service	1811084676	1811084676	1	23	GOLDEN BEAR PHYSICAL THERAPY	3/9/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPORTS INJURY CENTER IN	2603 PATTERSON RD	STE 8	RIVERBANK	CA	95367	3407	50	06099	37.73272653	-120.949119	Stanislaus County
255451	Fee-for-Service	1609089861	1609089861	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	WOMEN'S HEALTH	797 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
255482	Fee-for-Service	1285638205	1285638205	1	1	GARCIA-GALAN, LYNN J MD	12/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	81766	40	Pediatrics	0	In state provider	None	2486 N PONDEROSA DR	STE D211	CAMARILLO	CA	93010	2376	56	06111	34.24266768	-119.0228157	Ventura County
255518	Fee-for-Service	1295815579	1295815579	1	1	GESCUK, BRYAN D MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65762	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
255532	Fee-for-Service	1861727547	1861727547	1	1	GLEASON, NATHANIEL W MD	5/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110528	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
255612	Fee-for-Service	1992849863	1992849863	1	1	GRAVES, JENNIFER S MD	6/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116811	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
255646	Fee-for-Service	1104097286	1104097286	1	1	GIBSON, JENNIFER D LMFT	6/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4750 QUAIL LAKES DR	STE C	STOCKTON	CA	95207	5274	39	06077	37.98582556	-121.3398554	San Joaquin County
255650	Fee-for-Service	1275392292	1275392292	1	1	GRECIA, NEIL I RCP	4/16/2024	2279P3900X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
255654	Fee-for-Service	1619095247	1619095247	1	1	GWARTZ, BRIAN L MD	1/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43746	01	General Practice	0	In state provider	PAIN DIAGNOSIS AND TREAT	210 S GRAND AVE	STE 315	GLENDORA	CA	91741	4284	19	06037	34.133859	-117.872523	Los Angeles County
255658	Fee-for-Service	1528041654	1528041654	1	1	GORDON, ROBERT B MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	34624	36	Psychiatry	0	In state provider	None	13193 CENTRAL AVE	STE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
255700	Fee-for-Service	1700380086	1700380086	1	1	GARFIELD BEACH CVS LLC	10/22/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1850 5TH AVE	None	SAN DIEGO	CA	92101	2713	37	06073	32.72487912	-117.1602864	San Diego County
255718	Fee-for-Service	1659671071	1659671071	1	1	GIRGIS, RAFIK R MD INC	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	39470	40	Pediatrics	0	In state provider	None	415 W ALOSTA AVE	SUITE 201	GLENDORA	CA	91740	4335	19	06037	34.1288673	-117.8699632	Los Angeles County
255727	Fee-for-Service	1871138016	1871138016	1	1	GUARDIAN ANGEL HOME CARE OF	4/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	BAKERSFIELD LLC	5001 E COMMERCECENTER DR	SUITE 240	BAKERSFIELD	CA	93309	1659	15	06029	35.36190719	-119.0577352	Kern County
255745	Fee-for-Service	1134195696	1134195696	1	1	GRENCH, LAWRENCE J MD	2/4/2021	207L00000X	NA	Other	026	PHYSICIANS	163074	None	None	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
255747	Fee-for-Service	1811949993	1811949993	1	1	GIEDT-PAREDES, W REID MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	46831	None	None	0	In state provider	None	260 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65808446	-121.6456618	Monterey County
255748	Fee-for-Service	1013037993	1013037993	1	1	GONZALEZ-HOWARD, MARY A MD	12/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94656	40	Pediatrics	0	In state provider	None	7720 N FRESNO ST	104	FRESNO	CA	93703	3745	10	06019	36.85068226	-119.7836282	Fresno County
255801	Fee-for-Service	1144255217	1144255217	1	1	GIN, GENEEN T DO	9/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9074	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
255807	Fee-for-Service	1295815579	1295815579	1	1	GESCUK, BRYAN D MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65762	83	Rheumatology	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
255826	Fee-for-Service	1275035560	1275035560	1	1	GORMAN, CODEE	7/25/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
255852	Fee-for-Service	1205260072	1205260072	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 5TH ST	None	ALAMEDA	CA	94501	6574	01	06001	37.78919762	-122.2806453	Alameda County
255919	Fee-for-Service	1811084676	1811084676	1	26	GOLDEN BEAR PHYSICAL THERAPY	5/16/2023	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	1916 N MAIN ST.	None	SALINAS	CA	93906	2034	27	06053	36.71995522	-121.655807	Monterey County
255921	Fee-for-Service	1033845706	1033845706	1	1	GACH-KVENILD, AARON MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	189450	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
255930	Fee-for-Service	1649280652	1649280652	1	1	GLOVER, KAREN M MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70211	08	Family Practice	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
255954	Fee-for-Service	1821235375	1821235375	1	1	GOULARTE, YVETTE CRNA	11/5/2012	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
256007	Fee-for-Service	1659671071	1659671071	1	1	GIRGIS, RAFIK R MD INC	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	39470	01	General Practice	0	In state provider	None	415 W ALOSTA AVE	SUITE 201	GLENDORA	CA	91740	4335	19	06037	34.1288673	-117.8699632	Los Angeles County
256018	Fee-for-Service	1316025117	1316025117	1	1	GRIFFIN, GARRETT JAMES	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81507	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
256057	Fee-for-Service	1942554530	1942554530	1	1	GAKS PHARMACY LLC	3/11/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10700 BALBOA BLVD	#101	GRANADA HILLS	CA	91344	5001	19	06037	34.265007	-118.5022345	Los Angeles County
256147	Fee-for-Service	1679099402	1679099402	1	1	GREENE, ROXANNE N PT	4/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
256165	Fee-for-Service	1639489321	1639489321	1	1	GUZMAN, OMAR A MD	11/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119935	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
256200	Fee-for-Service	1679514582	1679514582	1	1	GARFIELD BEACH CVS, LLC	12/19/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	24840 ORCHARD VILLAGE	None	SANTA CLARITA	CA	91355	3054	19	06037	34.38061005	-118.5410615	Los Angeles County
256206	Fee-for-Service	1467543280	1467543280	1	1	GEORGE R BRUNO MD	6/15/2020	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
256213	Fee-for-Service	1649280652	1649280652	1	1	GLOVER, KAREN M MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70211	66	Emergency Medicine (Urgent Care)	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
256244	Fee-for-Service	1689900763	1689900763	1	1	GALVIN, PETER J LCSW	8/8/2013	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	11303 WASHINGTON BLVD	STE 101	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
256293	Fee-for-Service	1083639801	1083639801	1	1	GUO, MING MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69064	13	Neurology (M.D. only)	0	In state provider	None	1245 16TH ST	None	SANTA MONICA	CA	90404	1235	19	06037	34.02726451	-118.4857138	Los Angeles County
256295	Fee-for-Service	1659671071	1659671071	1	1	GIRGIS, RAFIK R MD INC	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	39470	08	Family Practice	0	In state provider	None	415 W ALOSTA AVE	SUITE 201	GLENDORA	CA	91740	4335	19	06037	34.1288673	-117.8699632	Los Angeles County
256318	Fee-for-Service	1598072662	1598072662	1	1	GREEN VALLEY MEDICAL CLINIC	8/23/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	41689 ROAD 128	None	OROSI	CA	93647	2060	54	06107	36.54673795	-119.2869613	Tulare County
256327	Fee-for-Service	1033736038	1033736038	1	1	GENEROUS HOSPICE AND	4/8/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	8700 RESEDA BLVD	STE 202 B	NORTHRIDGE	CA	91324	4189	19	06037	34.229988	-118.536062	Los Angeles County
256342	Fee-for-Service	1982629176	1982629176	1	1	GETZUG, TERRI MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	55241	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
256430	Fee-for-Service	1609842715	1609842715	1	1	GANTWERKER, BRIAN R MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109316	14	Neurological Surgery	0	In state provider	None	25751 MCBEAN PKWY	STE 305	VALENCIA	CA	91355	3701	19	06037	34.39972502	-118.5511766	Los Angeles County
256473	Fee-for-Service	1760440150	1760440150	1	1	GONZALEZ, MARIA N A MD	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95478	13	Neurology (M.D. only)	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
256499	Fee-for-Service	1982718946	1982718946	1	1	GRABER, JENNIFER A MD	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	76892	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
256507	Fee-for-Service	1255531034	1255531034	1	1	GATT, MAUREEN T PHD	6/6/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
256543	Fee-for-Service	1760908578	1760908578	1	1	GUARDIAN FLIGHT LLC	5/3/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	170 DUPONT DR	None	LANDER	WY	82520	3055	00	None	42.83754881	-108.7561021	Fremont County
256573	Fee-for-Service	1972519650	1972519650	1	1	GEHLKE, REBECCA A LMFT	6/16/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
256605	Fee-for-Service	1598072662	1598072662	1	1	GREEN VALLEY MEDICAL CLINIC	8/23/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	41689 ROAD 128	None	OROSI	CA	93647	2060	54	06107	36.54673795	-119.2869613	Tulare County
256613	Fee-for-Service	1033736038	1033736038	1	1	GENEROUS HOSPICE AND	4/8/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	8700 RESEDA BLVD	STE 202 B	NORTHRIDGE	CA	91324	4189	19	06037	34.229988	-118.536062	Los Angeles County
256631	Fee-for-Service	1083015846	1083015846	1	1	GOKALDAS, RESHMA R MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138459	13	Neurology (M.D. only)	0	In state provider	None	6010 HIDDEN VALLEY RD	STE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
256633	Fee-for-Service	1730596818	1730596818	1	1	GASHI, AGIM DPM INC	5/26/2015	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4560 ADMIRALTY WAY	STE 351	MARINA DEL REY	CA	90292	5446	19	06037	33.98364904	-118.4449069	Los Angeles County
256639	Fee-for-Service	1811926280	1811926280	1	1	GRANADOS, GILBERTO MD	8/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80759	08	Family Practice	0	In state provider	None	21840 NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
256660	Fee-for-Service	1942577523	1942577523	1	1	GUTH, RONALD E MD INC	9/4/2013	207L00000X	NA	Other	026	PHYSICIANS	44960	05	Anesthesiology	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
256719	Fee-for-Service	1669759833	1669759833	1	1	GONZALEZ, NANCY LMFT	3/18/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16530 VENTURA BLVD	STE 400	ENCINO	CA	91436	4551	19	06037	34.15766626	-118.4934057	Los Angeles County
256747	Fee-for-Service	1437325289	1437325289	1	1	GUPTA, ASHA MD	9/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110638	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
256766	Fee-for-Service	1063943686	1063943686	1	1	GRISSOM, DANIEL MD	9/7/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	2375 E PRATER WAY	None	SPARKS	NV	89434	9641	00	None	39.54247495	-119.6975356	Washoe County
256769	Fee-for-Service	1881182624	1881182624	1	1	GREACEN, MADELAINE M MD	10/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174845	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
256803	Fee-for-Service	1306399522	1306399522	1	1	GOKHALE, MANJIRI J	11/23/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 WEST PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
256822	Fee-for-Service	1124046776	1124046776	1	1	GARNAAS, KAREN R MD	12/22/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	156702	13	Neurology (M.D. only)	0	In state provider	None	2510 AIRPARK DR	STE 301	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
256841	Fee-for-Service	1376809723	1376809723	1	1	GOLDEN GATE EYE ASSOCIATES I	11/15/2013	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	NC	711 VAN NESS AVE	SUITE 440	SAN FRANCISCO	CA	94102	3242	38	06075	37.78218473	-122.4208156	San Francisco County
256854	Fee-for-Service	1457410524	1457410524	1	1	GOFF, DAVID T 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
256893	Fee-for-Service	1952647851	1952647851	1	1	GUNKLE, CHERYSH K NP	12/7/2023	363LF0000X	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
256924	Fee-for-Service	1114030004	1114030004	1	1	GAYLORD, KENT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W PACIFIC AVE	None	TELLURIDE	CO	81435	0000	00	None	37.93765475	-107.8162593	San Miguel County
256943	Fee-for-Service	1457746554	1457746554	1	1	GHANCHI, HAMMAD DO	6/30/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	15170	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
257006	Fee-for-Service	1194920595	1194920595	1	1	GUPTA, SHIVANI MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137240	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
257015	Fee-for-Service	1659445005	1659445005	1	1	GOSHORN, RORY D LMFT	11/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	69844 HIGHWAY 111	SUITE H	RANCHO MIRAGE	CA	92270	2849	33	06065	33.76988393	-116.4463473	Riverside County
257048	Fee-for-Service	1508891748	1508891748	1	1	GRANT, ROBERT M MD	2/28/1991	207R00000X	NA	Other	026	PHYSICIANS	67576	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
257052	Fee-for-Service	1881778231	1881778231	1	1	GREGORY, JANA M	5/6/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	2619	57	06113	38.55491538	-121.7876886	Yolo County
257085	Fee-for-Service	1164423547	1164423547	1	1	GINSBURG, ELI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	18003	41	Internal Medicine	0	In state provider	None	9001 WILSHIRE BLVD	STE 302	BEVERLY HILLS	CA	90211	1841	19	06037	34.06708548	-118.3880025	Los Angeles County
257129	Fee-for-Service	1376809723	1376809723	1	1	GOLDEN GATE EYE ASSOCIATES I	11/15/2013	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	NC	711 VAN NESS AVE	SUITE 440	SAN FRANCISCO	CA	94102	3242	38	06075	37.78218473	-122.4208156	San Francisco County
257145	Fee-for-Service	1568953487	1568953487	1	1	GILL, TRENIESE NP	2/4/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
257149	Fee-for-Service	1114903192	1114903192	1	1	GRACE, JEANNETTE E	12/2/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
257158	Fee-for-Service	1619915360	1619915360	1	1	GARIMELLA, SREE N MD	9/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84792	41	Internal Medicine	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
257161	Fee-for-Service	1427069277	1427069277	1	1	GOODFARB, ADAM J MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80099	40	Pediatrics	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
257181	Fee-for-Service	1003818642	1003818642	1	1	GRAZIANO, KATHLEEN D MD	11/26/2007	2086S0102X	NA	General Surgery	026	PHYSICIANS	-	85	Surgery-Pediatric	2	Out of state provider	None	1920 E CAMBRIDGE AVE	#201	PHOENIX	AZ	85006	1462	00	None	33.4775733	-112.040141	Maricopa County
257232	Fee-for-Service	1235203753	1235203753	1	1	G & H RAPHA INC	4/1/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5575 MISSION BLVD	None	RIVERSIDE	CA	92509	4503	33	06065	33.99680982	-117.4061635	Riverside County
257268	Fee-for-Service	1427125509	1427125509	1	1	GEVORKIAN, TIGRAN I MD	4/7/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	74704	36	Psychiatry	0	In state provider	None	2900 E DEL MAR BLVD	None	PASADENA	CA	91107	4375	19	06037	34.14213253	-118.090593	Los Angeles County
257305	Fee-for-Service	1568190700	1568190700	1	1	GARCIA, VALENTINA	1/8/2025	363LF0000X	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
257307	Fee-for-Service	1376715573	1376715573	1	1	GRAY, PAULINE J LMFT	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
257379	Fee-for-Service	1124605530	1124605530	1	1	GAMBOA, MARY MD	4/9/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
257387	Fee-for-Service	1790708782	1790708782	1	1	GARG, VIJAY K MD	1/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35932	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1687 ERRINGER RD	STE 211	SIMI VALLEY	CA	93065	6510	56	06111	34.268886	-118.761426	Ventura County
257456	Fee-for-Service	1427069277	1427069277	1	1	GOODFARB, ADAM J MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80099	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
257473	Fee-for-Service	1780900829	1780900829	1	1	GRAHAM, KAYLAN A MD	6/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121550	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
257506	Fee-for-Service	1306869680	1306869680	2	1	GARFIELD BEACH CVS LLC	12/11/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3333 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3252	33	06065	33.94641026	-117.3821866	Riverside County
257567	Fee-for-Service	1649895194	1649895194	1	1	GRASS VALLEY RADIATION ONCOL	6/8/2021	2085R0001X	NA	Other	026	PHYSICIANS	None	32	Radiation Therapy (D.O. only)	0	In state provider	OGY	155 GLASSON WAY # L20	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
257664	Fee-for-Service	1912083726	1912083726	1	1	GREENBERG, DEBORAH 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	4545 ROOSEVELT WAY NE	None	SEATTLE	WA	98105	4721	00	None	47.6625934	-122.3174587	King County
257669	Fee-for-Service	1073074050	1073074050	1	1	GAO, BRADLEY T MD	6/30/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
257735	Fee-for-Service	1093798860	1093798860	1	1	GENERAO, STEFANIE A RN	12/29/2006	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
257766	Fee-for-Service	1407871734	1407871734	1	2	GERARDI, JOSEPH A D0	4/19/2017	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
257768	Fee-for-Service	1396173282	1396173282	1	1	GEE, LOUISA LMFT	8/2/2019	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
257777	Fee-for-Service	1841300670	1841300670	1	1	GOYAL-MCHALE, SUSAN MD	9/11/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	77021	05	Anesthesiology	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
257802	Fee-for-Service	1396410924	1396410924	1	1	GOMEZ, SHARI LCSW	10/3/2024	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
257854	Fee-for-Service	1699721258	1699721258	1	1	GILBERT, MARY A	1/3/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	13121 PHILADELPHIA ST	None	WHITTIER	CA	90601	4302	19	06037	33.97912551	-118.0353645	Los Angeles County
257858	Fee-for-Service	1093966236	1093966236	1	1	GAGNEJA, RITOO MD	8/20/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101849	08	Family Practice	0	In state provider	None	18350 ROSCOE BLVD	STE 600	NORTHRIDGE	CA	91325	4187	19	06037	34.22071855	-118.5341175	Los Angeles County
257859	Fee-for-Service	1912982422	1912982422	1	1	GAY, ANTHONY 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	1108 JUNE ST	None	HOOD RIVER	OR	97031	1513	00	None	45.70318545	-121.522725	Hood River County
257865	Fee-for-Service	1326085671	1326085671	1	1	GRIGOROPOULOS, JERRY MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73614	30	Radiology	0	In state provider	None	101 PARK AVE	None	MODESTO	CA	95354	0556	50	06099	37.64601201	-120.9989475	Stanislaus County
257875	Fee-for-Service	1184899874	1184899874	1	1	GONZALES, KELLY D MD	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	109752	02	General Surgery	0	In state provider	None	150 N JACKSON AVE	STE 100	SAN JOSE	CA	95116	1908	43	06085	37.36190683	-121.8468659	Santa Clara County
257896	Fee-for-Service	1790230886	1790230886	1	1	GARDNER, JONATHAN R CRNA	1/20/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO & R ST	None	FRESNO	CA	93721	1365	10	06019	36.741663	-119.7841005	Fresno County
257921	Fee-for-Service	1356621999	1356621999	1	1	GADDE, LIKHITA MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118194	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
257948	Fee-for-Service	1013917368	1013917368	1	1	GREEN, ELIZABETH E PHD	12/1/1997	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3921 GOLDFINCH ST	None	SAN DIEGO	CA	92103	2926	37	06073	32.74868423	-117.1713463	San Diego County
257963	Fee-for-Service	1396177978	1396177978	1	1	GRIFFITH, MELISSA R PSYD	4/7/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
257982	Fee-for-Service	1326392234	1326392234	1	1	GUSTIN, BENJAMIN J LMFT	11/11/2019	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6741 SEBASTOPOL AVE	160	SEBASTOPOL	CA	95472	3839	49	06097	38.40277333	-122.819659	Sonoma County
258003	Fee-for-Service	1144396359	1144396359	1	1	GUNNARSSON, GUNDI H	9/14/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1902 ROYALTY DRIVE	SUITE 220	POMONA	CA	91767	3056	19	06037	34.07791925	-117.746146	Los Angeles County
258028	Fee-for-Service	1043503873	1043503873	1	1	GARFIELD BEACH CVS, LLC	1/31/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4744 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91602	1833	19	06037	34.15678163	-118.3696832	Los Angeles County
258053	Fee-for-Service	1457871287	1457871287	1	1	GENERATIONS HEALTHCARE	1/15/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY INC	6420 COLDWATER CANYON	STE 200	NORTH HOLLYWOOD	CA	91606	1126	19	06037	34.18745584	-118.4137829	Los Angeles County
258065	Fee-for-Service	1558446229	1558446229	1	1	GALLO, JOHN W DO	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7460	41	Internal Medicine	0	In state provider	None	2220 GLADSTONE DRIVE	SUITE 3	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
258072	Fee-for-Service	1356669865	1356669865	1	1	GOETZ, LINDSEY RAE MD	2/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153781	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
258086	Fee-for-Service	1477548683	1477548683	1	1	GAFF, TERRY 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	401 N SAWYER RD	None	KENDALLVILLE	IN	46755	2568	00	None	41.44839012	-85.29566515	Noble County
258087	Fee-for-Service	1104345453	1104345453	1	1	GARCIA, ROSEMARY J LMFT	10/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST 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
258136	Fee-for-Service	1801818596	1801818596	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1811 HILLSDALE AVE	None	SAN JOSE	CA	95124	3027	43	06085	37.265202	-121.9188375	Santa Clara County
258187	Fee-for-Service	1497778260	1497778260	2	1	GARCIA, BRUNO MD	9/6/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63644	08	Family Practice	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
258191	Fee-for-Service	1700288941	1700288941	2	1	GORDIAN MEDICAL III, INC	8/12/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	617 EAST COLORADO S	None	GLENDALE	CA	91205	1709	19	06037	34.14269752	-118.2474	Los Angeles County
258225	Fee-for-Service	1437266012	1437266012	1	1	GUNTHER-MAHER, MICHAEL G	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62090	41	Internal Medicine	0	In state provider	MD	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
258262	Fee-for-Service	1346097375	1346097375	1	1	GALLE, ARELI K LPCC	5/9/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - 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
258268	Fee-for-Service	1265628473	1265628473	1	1	GUPTA, MADHU MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101257	08	Family Practice	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
258273	Fee-for-Service	1194164905	1194164905	1	1	GIORGI, MARCOANDREA MD	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156575	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
258303	Fee-for-Service	1457373052	1457373052	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4247 S MOONEY BLVD	None	VISALIA	CA	93277	9146	54	06107	36.292239	-119.316789	Tulare County
258315	Fee-for-Service	1598900433	1598900433	1	1	GOLD, ANDREW H	2/23/2015	No Taxonomy Provided	NA	None	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
258340	Fee-for-Service	1235160581	1235160581	1	1	GILMAN, BETH D OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	68 E CENTRAL AVE	STE C	QUINCY	CA	95971	9718	32	06063	39.93638081	-120.9358748	Plumas County
258392	Fee-for-Service	1174546469	1174546469	2	1	GARFIELD BEACH CVS LLC	10/6/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15555 E 14TH ST	STE 400	SAN LEANDRO	CA	94578	1978	01	06001	37.700595	-122.125725	Alameda County
258398	Fee-for-Service	1639289564	1639289564	2	1	GEILING, MICHAEL D DO INC	3/24/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	254 N KESSING ST	None	PORTERVILLE	CA	93257	3424	54	06107	36.07048847	-119.025139	Tulare County
258411	Fee-for-Service	1861589616	1861589616	1	1	GUIROY, BERNADETTE D	4/8/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	53311	84	Surgery-Head and Neck	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
258428	Fee-for-Service	1821176900	1821176900	1	1	GRUBER, AMY L MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66210	40	Pediatrics	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
258445	Fee-for-Service	1073787982	1073787982	1	1	GLAMM CORPORATION	7/2/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	380 BIXBY DRIVE	None	MILPITAS	CA	95035	6007	43	06085	37.43218385	-121.8732142	Santa Clara County
258470	Fee-for-Service	1518459148	1518459148	1	1	GALINDO, PIA DO	5/17/2022	207P00000X	NA	Other	026	PHYSICIANS	17700	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
258540	Fee-for-Service	1467576900	1467576900	1	1	GRIO, MARICOR C MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154783	40	Pediatrics	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91346	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
258574	Fee-for-Service	1164727368	1164727368	1	1	GRACE, MARIAH C DO	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12329	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	321 MIDDLEFIELD RD	MC 5804,1ST FLOOR	MENLO PARK	CA	94025	3500	41	06081	37.45657153	-122.168099	San Mateo County
258581	Fee-for-Service	1447273735	1447273735	2	1	GARFIELD BEACH CVS LLC	11/17/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9052 CENTRAL AVE	None	MONTCLAIR	CA	91763	1621	36	06071	34.090191	-117.689726	San Bernardino County
258599	Fee-for-Service	1497275689	1497275689	1	1	GLASS, SYNDI D OD	2/6/2019	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	STE P25	SAN GABRIEL	CA	91776	1145	19	06037	34.10072807	-118.1066296	Los Angeles County
258604	Fee-for-Service	1831903186	1831903186	1	1	GALLARDO-DIAZ, ERIKA LCSW	2/10/2025	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
258635	Fee-for-Service	1255369757	1255369757	1	1	GRECO, TIMOTHY G MD	5/31/1983	193400000X	NA	Other	026	PHYSICIANS	35541	66	Emergency Medicine (Urgent Care)	0	In state provider	None	21220 WALNUT DR	None	LAKE ELSINORE	CA	92530	9426	33	06065	33.6196833	-117.287361	Riverside County
258657	Fee-for-Service	1437175262	1437175262	1	1	GARCIA, GEORGE H MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	80829	18	Ophthalmology	0	In state provider	None	1031 W CHAPMAN AVE	STE 201	ORANGE	CA	92868	2872	30	06059	33.78791049	-117.8632755	Orange County
258663	Fee-for-Service	1629170998	1629170998	1	2	GASTROENTEROLOGY SPECIAL	6/17/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL GROUP INC APC	27206 CALAROGA AVE	STE 212	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
258697	Fee-for-Service	1215163035	1215163035	1	1	GUNN, DAVID B MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123461	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
258715	Fee-for-Service	1629050943	1629050943	1	1	GHOSH, DIANA BREISTER MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55510	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
258748	Fee-for-Service	1528696465	1528696465	1	1	GUERRERO LARA, MONICA A AU	11/14/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
258806	Fee-for-Service	1548884521	1548884521	1	1	GADDI, LEON ALEXANDRA D	3/24/2021	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
258863	Fee-for-Service	1760455778	1760455778	1	1	GOLDER, MICHAEL G MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141046	36	Psychiatry	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
258927	Fee-for-Service	1124003835	1124003835	1	1	GILL, HARPREET MD	3/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62887	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
258962	Fee-for-Service	1831756030	1831756030	1	1	GARZONA, MARLENE E PHD	7/18/2022	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
258982	Fee-for-Service	1083793111	1083793111	1	1	GALLARDO VILLENA CHERYLL	12/18/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64952	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
259005	Fee-for-Service	1629050943	1629050943	1	1	GHOSH, DIANA BREISTER MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55510	24	Plastic 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
259008	Fee-for-Service	1760579692	1760579692	1	1	GARONA, JUAN E MD	3/31/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38769	40	Pediatrics	0	In state provider	None	596 CARROLL ST	None	SUNNYVALE	CA	94086	6207	43	06085	37.36853041	-122.0305901	Santa Clara County
259009	Fee-for-Service	1255398277	1255398277	1	1	GROSS, MAURICE L MD AMC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69292	05	Anesthesiology	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
259096	Fee-for-Service	1548884521	1548884521	1	1	GADDI, LEON ALEXANDRA D	3/24/2021	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
259113	Fee-for-Service	1609850577	1609850577	1	1	GOODLIN-JONES, BETH L	10/1/1995	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
259122	Fee-for-Service	1073989794	1073989794	1	1	GULKO, BRIAN C MD	8/5/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	144944	None	None	0	In state provider	None	21311 MADRONA AVE	STE 100B	TORRANCE	CA	90503	5970	19	06037	33.835599	-118.3450965	Los Angeles County
259134	Fee-for-Service	1285089029	1285089029	1	1	GLEASON, LISA MD INC	7/27/2016	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	108043	None	None	0	In state provider	None	691 MORRO AVE	None	MORRO BAY	CA	93442	2233	40	06079	35.364654	-120.8511775	San Luis Obispo County
259163	Fee-for-Service	1285782268	1285782268	1	1	GASTELUM, CHRISTIAN J MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74589	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
259195	Fee-for-Service	1649281569	1649281569	1	1	GORMAN, DEITRICK L DO	1/22/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21341	08	Family Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
259208	Fee-for-Service	1669082350	1669082350	1	1	GOOD SAMARITAN HOME HEALTH C	2/9/2024	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	ARE, INC.	3403 E PLAZA BLVD	STE. K	NATIONAL CITY	CA	91950	4140	37	06073	32.68452866	-117.0708631	San Diego County
259212	Fee-for-Service	1750593844	1750593844	1	1	GOLDMAN, JONATHAN W MD	2/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82786	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
259213	Fee-for-Service	1801102850	1801102850	1	1	GONZALEZ, LEANN M LMFT	4/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5055 CANYON CREST DRIVE	207	RIVERSIDE	CA	92507	6015	33	06065	33.95862536	-117.3310726	Riverside County
259214	Fee-for-Service	1104195114	1104195114	1	1	GRUMAN, CATHERINE L MFT	7/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7630 PAINTER AVE	STE C	WHITTIER	CA	90602	2373	19	06037	33.972534	-118.032652	Los Angeles County
259274	Fee-for-Service	1477998995	1477998995	1	1	GUPTA, AAKRITI MD	7/17/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172572	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
259293	Fee-for-Service	1629358734	1629358734	1	1	GOHEEN, KATHARINE C MD	2/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118103	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
259295	Fee-for-Service	1356635478	1356635478	1	1	GONZALEZ QUESADA, CARLOS J	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128997	41	Internal Medicine	0	In state provider	MD	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3103	19	06037	34.06550726	-118.3775199	Los Angeles County
259315	Fee-for-Service	1184647489	1184647489	2	1	GARFIELD BEACH CVS LLC	7/21/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 FITZGERALD DR	None	PINOLE	CA	94564	2250	07	06013	37.98852283	-122.3107537	Contra Costa County
259317	Fee-for-Service	1750369575	1750369575	1	1	GELINO, ERIC A MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91373	30	Radiology	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
259319	Fee-for-Service	1548283187	1548283187	1	1	GARNER, STEVEN L MD	6/30/1993	208200000X	NA	General Surgery	026	PHYSICIANS	68153	24	Plastic Surgery	0	In state provider	None	3311 MISSION DRIVE	None	SANTA CRUZ	CA	95065	1827	44	06087	36.99102829	-121.9802419	Santa Cruz County
259329	Fee-for-Service	1508914573	1508914573	1	1	GOLD, WARREN FREDRICK	10/29/1995	208600000X	NA	General Surgery	026	PHYSICIANS	82237	84	Surgery-Head and Neck	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
259349	Fee-for-Service	1679968887	1679968887	1	1	GANTZ, LISA N MD	2/28/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	145424	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
259382	Fee-for-Service	1710283882	1710283882	1	1	GUTIERREZ, ANITA V LCSW	4/22/2022	1041C0700X	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
259399	Fee-for-Service	1407854599	1407854599	1	1	GERBER, RICHARD S MD	4/1/1996	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	67537	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
259440	Fee-for-Service	1508414137	1508414137	1	1	GRACEFUL HOSPICE CARE INC	9/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	620 W ROUTE 66	219	GLENDORA	CA	91740	4173	19	06037	34.1286087	-117.8755695	Los Angeles County
259459	Fee-for-Service	1609947688	1609947688	1	1	GOY, BARRY W MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77405	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
259487	Fee-for-Service	1528352994	1528352994	1	1	GABRIELYAN, LUSINE PSYD	2/4/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	21600 OXNARD ST.	SUITE 1030	WOODLAND HILLS	CA	91367	4976	19	06037	34.17915728	-118.5992441	Los Angeles County
259509	Fee-for-Service	1164797684	1164797684	1	1	GODOY, LUIS A MD	6/3/2020	390200000X	NA	Other	026	PHYSICIANS	140225	33	Thoracic Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
259511	Fee-for-Service	1619317716	1619317716	1	2	GREGORY M HELBIG MD INC	1/22/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4418	50	06099	37.66508443	-120.9962589	Stanislaus County
259562	Fee-for-Service	1548520133	1548520133	1	1	GARCIA, BOBBY A MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143665	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
259566	Fee-for-Service	1144281528	1144281528	1	1	GOERGEN, THOMAS G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33209	30	Radiology	0	In state provider	None	355 E GRAND AVE	STE 3	ESCONDIDO	CA	92025	3313	37	06073	33.12354429	-117.0775982	San Diego County
259570	Fee-for-Service	1477788750	1477788750	1	1	GURAN, OANA MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116993	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
259579	Fee-for-Service	1780792259	1780792259	1	1	GOVIND, SHOBHA MD INC	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	33851	01	General Practice	0	In state provider	None	3650 SOUTH ST	STE 403	LAKEWOOD	CA	90712	1504	19	06037	33.86019847	-118.149255	Los Angeles County
259598	Fee-for-Service	1942369681	1942369681	1	1	GANEK, CARRIE B MD	1/14/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	95578	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
259627	Fee-for-Service	1053449850	1053449850	1	1	GASTROENTEROLOGY MEDICAL	9/8/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	ASSOC OF SONOMA CTY INC	1210 SONOMA AVE	SUITE B	SANTA ROSA	CA	95405	6648	49	06097	38.440404	-122.6983185	Sonoma County
259652	Fee-for-Service	1518969419	1518969419	1	1	GENERAL CONFERENCE OF 7TH	9/9/2011	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DAY ADVENTIST HACKETTSTO	651 WILLOW GROVE ST	None	HACKETTSTOWN	NJ	07840	1799	00	None	40.86094042	-74.81460371	Warren County
259676	Fee-for-Service	1124150230	1124150230	1	1	GLEASON, JILL E PT	2/4/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
259718	Fee-for-Service	1881745529	1881745529	1	1	GARCIA-HERRON, TRISHA 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
259745	Fee-for-Service	1265063978	1265063978	1	1	GOLDEN STATE HOSPICE	10/7/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20945 DEVONSHIRE ST	SUITE 206	CHATSWORTH	CA	91311	2394	19	06037	34.25727552	-118.5901965	Los Angeles County
259747	Fee-for-Service	1609947688	1609947688	1	1	GOY, BARRY W MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77405	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
259748	Fee-for-Service	1932435765	1932435765	1	1	GRATTON, FINN V LMFT	6/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	725 FRONT ST	STE 200	SANTA CRUZ	CA	95060	4538	44	06087	36.97473119	-122.0252674	Santa Cruz County
259788	Fee-for-Service	1205323136	1205323136	1	1	GAO, CI EN	1/14/2020	390200000X	NA	Other	026	PHYSICIANS	17614	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
259795	Fee-for-Service	1790160042	1790160042	1	1	GONZALEZ, MARIBEL LMFT	3/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	26585 W AGOURA ROAD	330	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
259799	Fee-for-Service	1689752776	1689752776	1	1	GALLAGHER, KATHERINE MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32978	40	Pediatrics	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
259827	Fee-for-Service	1770539140	1770539140	1	1	GOYNE, ARTHUR R	8/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67442	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
259873	Fee-for-Service	1164611570	1164611570	1	1	GILL, KISHWAR R MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52697	08	Family Practice	0	In state provider	None	30979 ROAD 67	None	GOSHEN	CA	93291	9303	54	06107	36.35186208	-119.4241029	Tulare County
259935	Fee-for-Service	1518969419	1518969419	1	1	GENERAL CONFERENCE OF 7TH	9/9/2011	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	DAY ADVENTIST HACKETTSTO	651 WILLOW GROVE ST	None	HACKETTSTOWN	NJ	07840	1799	00	None	40.86094042	-74.81460371	Warren County
259964	Fee-for-Service	1316907736	1316907736	1	1	GABRIEL, JEROME JT MD	4/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53348	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	589 LOS COCHES STREET	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
260033	Fee-for-Service	1265063978	1265063978	1	1	GOLDEN STATE HOSPICE	10/7/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20945 DEVONSHIRE ST	SUITE 206	CHATSWORTH	CA	91311	2394	19	06037	34.25727552	-118.5901965	Los Angeles County
260036	Fee-for-Service	1609947688	1609947688	1	1	GOY, BARRY W MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77405	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
260069	Fee-for-Service	1063785756	1063785756	1	1	GHAZARIAN, ZERON MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145823	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4234 RIVERWALK PKWY	STE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
260088	Fee-for-Service	1780191148	1780191148	1	1	GARFIELD BEACH CVS, LLC	6/15/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 RIVER RD	None	NORCO	CA	92860	2234	33	06065	33.91509099	-117.5886735	Riverside County
260119	Fee-for-Service	1891983581	1891983581	1	1	GANDHI, SHITAL M MD	5/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56219	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
260159	Fee-for-Service	1659337350	1659337350	1	1	GREGORY, WILLIAM B MD	3/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78714	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
260165	Fee-for-Service	1689225955	1689225955	1	1	GOLOZAR BASIRI, PARINAZ LMF	10/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
260181	Fee-for-Service	1811070444	1811070444	2	1	GARFIELD BEACH CVS LLC	5/24/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18287 COLLIER AVE	None	LAKE ELSINORE	CA	92530	2755	33	06065	33.689016	-117.342783	Riverside County
260192	Fee-for-Service	1659496701	1659496701	1	1	GREEN NOVA ENTERPRISE INC	9/21/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	9942 LAKEWOOD BLVD	None	DOWNEY	CA	90240	4009	19	06037	33.94878446	-118.1163619	Los Angeles County
260194	Fee-for-Service	1992970016	1992970016	1	1	GERKE, THOMAS J MD INC	4/1/1998	261Q00000X	NA	Other	026	PHYSICIANS	59290	01	General Practice	0	In state provider	None	10811 S GREVILLEA AVE	None	LENNOX	CA	90304	2325	19	06037	33.937839	-118.3548855	Los Angeles County
260206	Fee-for-Service	1831424597	1831424597	1	1	GARCIA, ROSALIND D NP	6/22/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
260242	Fee-for-Service	1699862169	1699862169	1	1	GOLDMAN, ELLIOT L MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	18522	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	STE 865W	SANTA MONICA	CA	90404	2128	19	06037	34.02891163	-118.4797466	Los Angeles County
260247	Fee-for-Service	1275972481	1275972481	1	1	GREENFIELD CARE CENTER OF	7/1/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FILLMORE LLC	118 B STREET	None	FILLMORE	CA	93015	1763	56	06111	34.39420183	-118.9221812	Ventura County
260254	Fee-for-Service	1457625931	1457625931	1	1	GASTROENTEROLOGY &	8/31/2013	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	99117	10	Gastroenterology (M.D. only)	0	In state provider	HEPATOLOGY SPECIALISTS	1687 ERRINGER RD	#103	SIMI VALLEY	CA	93065	6509	56	06111	34.268886	-118.761426	Ventura County
260289	Fee-for-Service	1447797964	1447797964	1	1	GEE, LORRAINE CCC-SLP	4/15/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
260295	Fee-for-Service	1437368834	1437368834	1	1	GOLLOTTO, MICHAEL R DO	1/21/2022	207L00000X	NA	Other	026	PHYSICIANS	18217	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
260297	Fee-for-Service	1437498276	1437498276	1	1	GIBSON, DAVID J MD	9/16/2021	207RR0500X	NA	Other	026	PHYSICIANS	33504	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
260359	Fee-for-Service	1063785756	1063785756	1	1	GHAZARIAN, ZERON MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145823	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	STE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
260361	Fee-for-Service	1891717401	1891717401	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	879 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	1213	43	06085	37.252287	-121.860513	Santa Clara County
260362	Fee-for-Service	1356414551	1356414551	1	1	GEORGE, BRUCE D OD	1/31/1984	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	931 ANZA AVE	None	VISTA	CA	92084	4531	37	06073	33.21215886	-117.2318869	San Diego County
260377	Fee-for-Service	1336367333	1336367333	1	1	GREEN, ERICA S LCSW	3/18/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	5855 & 5860 STEAMVIEW DR	APT 2 & 3	SAN DIEGO	CA	92105	3910	37	06073	32.74442781	-117.0700954	San Diego County
260434	Fee-for-Service	1376691279	1376691279	1	1	GLASSER, GABRIELLE R MD	5/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73819	79	Neurology-Child	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
260445	Fee-for-Service	1205291697	1205291697	1	1	GARCIA, JARED R LCSW	6/6/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7365 CARNELIAN ST	STE 202	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
260449	Fee-for-Service	1538624739	1538624739	1	1	GARTNER-SCOTT, THERESA A LCS	5/31/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
260465	Fee-for-Service	1952641953	1952641953	1	1	GIBBONS, HOPE R LMFT	6/11/2024	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
260506	Fee-for-Service	1063964260	1063964260	1	1	GARFIELD BEACH CVS LLC	4/24/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8000 W SUNSET BLVD	None	LOS ANGELES	CA	90046	2439	19	06037	34.09796251	-118.365138	Los Angeles County
260523	Fee-for-Service	1962745687	1962745687	1	1	GOODNOUGH, ROBERT T MD	1/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135066	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
260542	Fee-for-Service	1497824569	1497824569	1	1	GEMINI AMBULANCE SERVICE	5/22/2008	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11765 WEST AVE	PMB #243	SAN ANTONIO	TX	78216	2559	00	None	29.54843013	-98.50674438	Bexar County
260550	Fee-for-Service	1558566000	1558566000	1	1	GENONE, SOPHIA PSYD	12/2/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
260552	Fee-for-Service	1558588038	1558588038	1	1	GALOS, KATHERINE J MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	28155	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
260613	Fee-for-Service	1720469208	1720469208	1	1	GUZMAN-GONZALEZ, KAREN J LMF	5/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
260615	Fee-for-Service	1134383839	1134383839	1	1	GENDY, MARY S MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102661	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
260634	Fee-for-Service	1790042497	1790042497	1	1	GHARIBJANIANS, NAREG A MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140673	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
260653	Fee-for-Service	1376617829	1376617829	2	1	GOSWAMI, GAURAV K MD	1/24/2020	2085R0204X	NA	Other	026	PHYSICIANS	97150	30	Radiology	0	In state provider	None	16453 COLORADO AVE	None	PARAMOUNT	CA	90723	5011	19	06037	33.8848803	-118.1614216	Los Angeles County
260666	Fee-for-Service	1770731051	1770731051	1	1	GOVANI, RAHIM S MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112370	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
260699	Fee-for-Service	1770574626	1770574626	1	1	GHATTAS, MAGED L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91620	05	Anesthesiology	0	In state provider	INC	7901 WALKER ST	None	LA PALMA	CA	90623	1722	30	06059	33.84755382	-118.0373024	Orange County
260736	Fee-for-Service	1730607292	1730607292	1	1	GUZNER, ALEX MD	4/14/2024	390200000X	NA	Other	026	PHYSICIANS	188664	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
260760	Fee-for-Service	1700141157	1700141157	1	1	GURROLA, EDITH R MD	3/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136603	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13855 E 14TH STREET	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
260855	Fee-for-Service	1629005780	1629005780	1	1	GOODMAN, MARK H MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	31080	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
260865	Fee-for-Service	1922393503	1922393503	1	1	GRACIANO, MURIEL LMFT	11/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2009 PALO VERDE AVE	SUITE A	LONG BEACH	CA	90815	3322	19	06037	33.792597	-118.1080155	Los Angeles County
260926	Fee-for-Service	1972867703	1972867703	1	1	GUTIERREZ, CHRISTOPHERSON L	10/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
260972	Fee-for-Service	1518797539	1518797539	1	1	GREGORY, TAMBER	3/26/2025	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	9166 MIRA MESA BLVD	SUITE 4	SAN DIEGO	CA	92126	4804	37	06073	32.91724549	-117.1264365	San Diego County
260979	Fee-for-Service	1023645637	1023645637	1	1	GONZALEZ, LUISA F MD	8/29/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185706	None	None	0	In state provider	None	2 UPPER RAGSDALE DR	STE B-210	MONTEREY	CA	93940	7851	27	06053	36.57940327	-121.8142876	Monterey County
261034	Fee-for-Service	1467987677	1467987677	1	1	GANESAN, GOUTHAM MD	11/9/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171590	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
261050	Fee-for-Service	1114090537	1114090537	1	1	GWON, ARLENE MD	4/29/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	22586	18	Ophthalmology	0	In state provider	None	1401 AVOCADO AVE	STE 903	NEWPORT BEACH	CA	92660	7771	30	06059	33.61235015	-117.8704573	Orange County
261056	Fee-for-Service	1780619965	1780619965	1	1	GNAM, ROBERT E	2/8/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	HEARING AID DEALER	306 SONORA DR	None	SAN MATEO	CA	94402	2340	41	06081	37.55568121	-122.3258496	San Mateo County
261067	Fee-for-Service	1952377004	1952377004	1	1	GARTNER, RICHARD C MD	3/7/2021	207R00000X	NA	Other	026	PHYSICIANS	78383	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
261071	Fee-for-Service	1598967317	1598967317	1	1	GHEORGHIU, IOANA A MD	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116582	41	Internal Medicine	0	In state provider	None	2585 SAMARITAN DR	None	SAN JOSE	CA	95124	4107	43	06085	37.25083752	-121.9503884	Santa Clara County
261123	Fee-for-Service	1891705885	1891705885	1	1	GAW, MIRANDA P MD	11/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	52438	41	Internal Medicine	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
261136	Fee-for-Service	1710142575	1710142575	2	1	GHAI, SONIA MD	8/28/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	123795	None	None	0	In state provider	None	625 34TH STREET	STE 100 & 200	BAKERSFIELD	CA	93301	2305	15	06029	35.39046051	-119.0092725	Kern County
261158	Fee-for-Service	1467464271	1467464271	1	1	GARCIA, CASSANDRA N MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80685	08	Family Practice	0	In state provider	None	240 N CLOVERDALE BLVD	STE A	CLOVERDALE	CA	95425	3363	49	06097	38.80760945	-123.0187355	Sonoma County
261189	Fee-for-Service	1326032137	1326032137	1	1	GRACE HOME HEALTH CARE	11/7/1995	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1739 TERMINO AVE	None	LONG BEACH	CA	90804	2121	19	06037	33.78886597	-118.1459367	Los Angeles County
261213	Fee-for-Service	1265874283	1265874283	1	1	GARCIA, VANESSA LCSW	6/1/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER 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
261219	Fee-for-Service	1902814759	1902814759	1	3	GLENDALE DIAGNOSTIC	1/30/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING NETWORK MEDICAL	403 S GLENDALE AVE	None	GLENDALE	CA	91205	2222	19	06037	34.14140879	-118.2498988	Los Angeles County
261240	Fee-for-Service	1902248545	1902248545	1	1	GUADEZ, 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
261245	Fee-for-Service	1316218027	1316218027	1	1	GHALY, RAMEZ M D INC	2/8/2012	207L00000X	NA	Other	026	PHYSICIANS	96592	05	Anesthesiology	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
261275	Fee-for-Service	1154590776	1154590776	1	1	GLORIA, WENDELL CRNA	9/21/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	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
261284	Fee-for-Service	1962582098	1962582098	1	1	GEAS, FELICIA L MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72040	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
261297	Fee-for-Service	1164456513	1164456513	1	1	GILLIN, SCOTT A MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83435	None	None	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
261301	Fee-for-Service	1356002695	1356002695	1	1	GITONGA, LUCY W	3/3/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	4714 FORMOSA WAY	None	PERRIS	CA	92571	5116	33	06065	33.857541	-117.208108	Riverside County
261374	Fee-for-Service	1780951806	1780951806	1	1	GARFIELD BEACH CVS LLC	1/28/2013	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1120 FOREST AVE	None	CHICO	CA	95928	6303	04	06007	39.73881295	-121.8047594	Butte County
261383	Fee-for-Service	1982610887	1982610887	1	3	GUZMAN, EDUARDO J MD INC	9/26/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	50344	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11514 ROSECRANS AVE	None	NORWALK	CA	90650	3802	19	06037	33.9020805	-118.088145	Los Angeles County
261390	Fee-for-Service	1235154055	1235154055	1	1	GIESSER, BARBARA S MD	3/15/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50803	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA #B200	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
261482	Fee-for-Service	1023037215	1023037215	1	2	GANTI, SHASHI D MD	1/4/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	38830	None	None	0	In state provider	None	557 W MORTON AVE	SUITE # D	PORTERVILLE	CA	93257	3383	54	06107	36.07322866	-119.0294842	Tulare County
261530	Fee-for-Service	1689758682	1689758682	1	1	GAYRE, GREGG S MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80958	18	Ophthalmology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
261559	Fee-for-Service	1750667580	1750667580	1	1	GARCIA, RONALD MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117389	41	Internal Medicine	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
261574	Fee-for-Service	1962582098	1962582098	1	1	GEAS, FELICIA L MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72040	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
261588	Fee-for-Service	1356002695	1356002695	1	1	GITONGA, LUCY W	3/3/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	4714 FORMOSA WAY	None	PERRIS	CA	92571	5116	33	06065	33.857541	-117.208108	Riverside County
261608	Fee-for-Service	1508971631	1508971631	1	1	GG MEDICAL SUPPLY, INC.	3/25/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	GG MEDICAL SUPPLY	8836 S WESTERN AVE.	None	LOS ANGELES	CA	90047	3328	19	06037	33.957378	-118.308982	Los Angeles County
261612	Fee-for-Service	1548647993	1548647993	1	1	GLOBAL HEALTH EDUCATION &	8/28/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INFORMATION SERVICES INC	2284-2286 S GAREY AVE	None	POMONA	CA	91766	7106	19	06037	34.03005163	-117.7490076	Los Angeles County
261641	Fee-for-Service	1831649821	1831649821	1	1	GARFIELD BEACH CVS LLC	11/9/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27749 CLINTON KEITH RD	None	MURRIETA	CA	92562	0000	33	06065	33.59870473	-117.1776308	Riverside County
261649	Fee-for-Service	1447632898	1447632898	1	1	GONZALEZ, ERIK A MD	8/16/2019	390200000X	NA	Other	026	PHYSICIANS	148187	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
261663	Fee-for-Service	1881663136	1881663136	1	1	GHAEL, DINESHCHANDRA MD	4/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52976	40	Pediatrics	0	In state provider	None	11919 HESPERIA RD	None	HESPERIA	CA	92345	1855	36	06071	34.46759507	-117.2925837	San Bernardino County
261678	Fee-for-Service	1548206089	1548206089	1	1	GALIATZATOS, DOINA MD	10/1/2000	207R00000X	NA	Other	026	PHYSICIANS	70139	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
261679	Fee-for-Service	1396997268	1396997268	1	1	GOVIND, AKSHAY MD	9/29/2020	204E00000X	NA	Dental Provider	026	PHYSICIANS	154724	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
261694	Fee-for-Service	1972602480	1972602480	1	1	GLOBERSON, TERRY L MD	2/8/2015	207RP1001X	NA	Pulmonology	026	PHYSICIANS	36071	01	General Practice	0	In state provider	None	16300 SAND CANYON AVE	STE 910	IRVINE	CA	92618	3709	30	06059	33.66115075	-117.7742405	Orange County
261701	Fee-for-Service	1215951371	1215951371	1	1	GRADY, IAN P MD	6/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	73597	02	General Surgery	0	In state provider	None	1335 BUENAVENTURA BLVD	STE 204	REDDING	CA	96001	0160	45	06089	40.58222519	-122.4261823	Shasta County
261747	Fee-for-Service	1447577671	1447577671	1	1	GRAYSON, ANDREA CNP	2/21/2020	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
261761	Fee-for-Service	1962585273	1962585273	2	1	GARFIELD BEACH CVS LLC	12/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2462 FOOTHILL BLVD	None	LA VERNE	CA	91750	3056	19	06037	34.109496	-117.7597125	Los Angeles County
261791	Fee-for-Service	1659740843	1659740843	1	1	GONZALEZ, IVETTE LMFT	3/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1274 CENTER COURT DR	#112	COVINA	CA	91724	3668	19	06037	34.07278979	-117.8637519	Los Angeles County
261808	Fee-for-Service	1295294304	1295294304	1	1	GRANT, GEORGINA E MD	5/27/2022	390200000X	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
261892	Fee-for-Service	1497702252	1497702252	1	1	GARRY, DAVID PJ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3550 N UNIVERSITY AVE	STE 250	PROVO	UT	84604	6685	00	None	40.28087789	-111.6581666	Utah County
261938	Fee-for-Service	1346691680	1346691680	1	1	GONZALEZ, BRENDA M LCSW	10/13/2021	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
261944	Fee-for-Service	1649311671	1649311671	1	1	GOLDEN AGE MEDICAL TRANS	12/16/2004	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	11110 RED CEDAR DR	None	SAN DIEGO	CA	92131	1310	37	06073	32.90781632	-117.0929573	San Diego County
261975	Fee-for-Service	1841257557	1841257557	1	1	GOEL,TARUN 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	25 OFFICE PARK DR	None	HAMILTON	OH	45013	0000	00	None	39.42705759	-84.5770604	Butler County
262096	Fee-for-Service	1952309056	1952309056	1	1	GORDON, SUSANNA R MD	7/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	84560	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
262140	Fee-for-Service	1861919938	1861919938	2	1	GILL PHARMACY INC	10/9/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	201 E LOUISE AVE	None	LATHROP	CA	95330	8631	39	06077	37.81187054	-121.2914938	San Joaquin County
262162	Fee-for-Service	1659393288	1659393288	2	1	GARFIELD BEACH CVS LLC	12/1/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3527 W FLORIDA AVE	None	HEMET	CA	92545	3564	33	06065	33.745347	-117.0091125	Riverside County
262169	Fee-for-Service	1689736969	1689736969	1	1	GOLDEN ELITE PHARMACY	4/8/1997	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2048 PEPPER ST	None	ALHAMBRA	CA	91801	3162	19	06037	34.08850047	-118.1457945	Los Angeles County
262216	Fee-for-Service	1811084676	1811084676	1	17	GOLDEN BEAR PHYSICAL THERAPY	10/3/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	631 S HAM LN	STE B	LODI	CA	95242	3532	39	06077	38.12696729	-121.2882893	San Joaquin County
262219	Fee-for-Service	1801981667	1801981667	1	2	GREAT EXPECTATIONS SERVICES	8/31/2005	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	311 DEL FLORA ST	None	OCEANSIDE	CA	92054	7958	37	06073	33.24320251	-117.32918	San Diego County
262241	Fee-for-Service	1396721171	1396721171	1	1	GEORGE, KELLEY W MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62899	40	Pediatrics	0	In state provider	None	673 PAULINE CT	None	SONORA	CA	95370	5216	55	06109	37.97881022	-120.3720315	Tuolumne County
262268	Fee-for-Service	1124169917	1124169917	1	1	GARCIA, KATIA G NP	7/16/2024	163WP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
262282	Fee-for-Service	1164938080	1164938080	1	1	GRANT, TANYA R	1/10/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3536 SWEETWATER SPRINGS	BLVD D17	SPRING VALLEY	CA	91977	3155	37	06073	32.74387959	-116.9735463	San Diego County
262341	Fee-for-Service	1821144320	1821144320	1	1	GALEL, SUSAN A MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	42858	22	Pathology (M.D. only)	0	In state provider	THE STANFORD UNIVERSITY	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
262375	Fee-for-Service	1205916095	1205916095	1	1	GEBARSKI, KATHLEEN 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	1500 E MEDICAL CENTER DR	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
262418	Fee-for-Service	1922191717	1922191717	1	1	GORDON, ERLINDA M MD	6/11/1998	2080P0207X	NA	Hematology	026	PHYSICIANS	48717	68	Hematology	0	In state provider	None	2811 WILSHIRE BLVD	SUITE 414	SANTA MONICA	CA	90403	4804	19	06037	34.03785224	-118.4752132	Los Angeles County
262437	Fee-for-Service	1992243117	1992243117	1	1	GANDARA, BRIAN J MD	2/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167015	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
262481	Fee-for-Service	1073974952	1073974952	1	1	GARRETT, GIORGIA MD	10/18/2019	207R00000X	NA	Other	026	PHYSICIANS	158361	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
262579	Fee-for-Service	1164938080	1164938080	1	1	GRANT, TANYA R	1/10/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3536 SWEETWATER SPRINGS	BLVD D17	SPRING VALLEY	CA	91977	3155	37	06073	32.74387959	-116.9735463	San Diego County
262613	Fee-for-Service	1174545784	1174545784	2	1	GARFIELD BEACH CVS LLC	3/13/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 N 12TH AVE	None	HANFORD	CA	93230	5971	16	06031	36.32373	-119.6764065	Kings County
262647	Fee-for-Service	1669964938	1669964938	1	1	GREWAL, TARUNDEEP S MD	7/12/2024	2085R0204X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
262650	Fee-for-Service	1881155943	1881155943	1	1	GENIE, DANIEL LMFT	4/7/2025	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
262662	Fee-for-Service	1558549089	1558549089	1	1	GAPAY, MICHELLE S CNP	8/31/2021	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
262675	Fee-for-Service	1083173116	1083173116	1	1	GEBREKRISTOS, BERKENESH T MD	10/28/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	185753	25	Physical Medicine and Rehabilitation	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
262713	Fee-for-Service	1487699377	1487699377	1	1	GARFIELD BEACH CVS, LLC	9/3/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1545 WEST 17TH ST.	None	SANTA ANA	CA	92706	3300	30	06059	33.76008289	-117.8897744	Orange County
262739	Fee-for-Service	1477908549	1477908549	1	1	GOHEL, SURAGBHAI B	1/19/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157821	None	None	0	In state provider	None	15431 ANACAPA RD	STE D	VICTORVILLE	CA	92392	2458	36	06071	34.50544107	-117.3250832	San Bernardino County
262784	Fee-for-Service	1548266778	1548266778	1	1	GERBER MEMORIAL HEALTH SERVI	4/13/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	212 S SULLIVAN AVE	None	FREMONT	MI	49412	1548	00	None	43.46435604	-85.95079597	Newaygo County
262792	Fee-for-Service	1295873685	1295873685	1	1	GREENFIELD, MICHAEL MD	11/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35253	01	General Practice	0	In state provider	None	2500 HOSPITAL DR	STE 14	MOUNTAIN VIEW	CA	94040	4106	43	06085	37.36908	-122.081819	Santa Clara County
262836	Fee-for-Service	1225081516	1225081516	1	1	GADSDEN REGIONAL MEDICAL CEN	7/31/2021	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TER	1007 GOODYEAR AVE	None	GADSDEN	AL	35903	1195	00	None	34.00934587	-85.96782466	Etowah County
262840	Fee-for-Service	1770994071	1770994071	1	2	GONDI, SHREYA S MD	10/8/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	139837	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
262845	Fee-for-Service	1578199543	1578199543	1	1	GYURJIAN, KARO DO	11/8/2022	207R00000X	NA	Other	026	PHYSICIANS	20082	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
262881	Fee-for-Service	1467492371	1467492371	1	1	GANDHI, DEVINDER MD INC	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	48024	41	Internal Medicine	0	In state provider	None	1560 E CHEVY CHASE DR	STE 245	GLENDALE	CA	91206	4158	19	06037	34.15290734	-118.2302295	Los Angeles County
262906	Fee-for-Service	1043319965	1043319965	1	1	GREEN, JOANNA MD	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	56534	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
262916	Fee-for-Service	1497786396	1497786396	1	1	GARCIA, CHERIE R MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64031	41	Internal Medicine	0	In state provider	None	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
262922	Fee-for-Service	1912411687	1912411687	1	1	GJERDE, LARS NP	1/2/2019	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
262926	Fee-for-Service	1700860871	1700860871	1	6	GOLDEN STATE DERMATOLOGY ASS	3/3/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	1074 MURRIETA BLVD	None	LIVERMORE	CA	94550	4111	01	06001	37.67593509	-121.7822303	Alameda County
262940	Fee-for-Service	1982082582	1982082582	1	1	GRAHAM, KYLE A MD	11/15/2019	193400000X	NA	Other	026	PHYSICIANS	14428	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
262977	Fee-for-Service	1295770188	1295770188	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10208 BALBOA BLVD	None	GRANADA HILLS	CA	91344	7402	19	06037	34.25594307	-118.502327	Los Angeles County
262992	Fee-for-Service	1851527048	1851527048	1	1	GILLETT MEDICAL INC	8/25/2009	193400000X	NA	Other	026	PHYSICIANS	103362	41	Internal Medicine	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
263022	Fee-for-Service	1134611882	1134611882	1	1	GALLARDO, JACQUELINE NICOLE	8/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173639	None	None	0	In state provider	M MD	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
263033	Fee-for-Service	1376718023	1376718023	1	1	GOULD, DARIN MD	3/14/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161437	36	Psychiatry	0	In state provider	None	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	45	06089	40.57267376	-122.3643496	Shasta County
263037	Fee-for-Service	1467998948	1467998948	1	1	GARDNER, JOSEPH J LCSW	2/14/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	20652	-	NOT APPLICABLE	0	In state provider	None	11540 MARSH CREEK RD	None	CLAYTON	CA	94517	9759	07	06013	37.90029732	-121.8651978	Contra Costa County
263073	Fee-for-Service	1548266778	1548266778	1	1	GERBER MEMORIAL HEALTH SERVI	7/15/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	212 S SULLIVAN AVE	None	FREMONT	MI	49412	1548	00	None	43.46435604	-85.95079597	Newaygo County
263122	Fee-for-Service	1225081516	1225081516	1	1	GADSDEN REGIONAL MEDICAL CEN	7/31/2021	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	TER	1007 GOODYEAR AVE	None	GADSDEN	AL	35903	1195	00	None	34.00934587	-85.96782466	Etowah County
263129	Fee-for-Service	1407529803	1407529803	1	1	GOLDEN ESSENCE WELLNESS ACUP	8/1/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	UNCTURE AND INTEGRATIVE	1502 W MINERAL KING AVE	None	VISALIA	CA	93291	5819	54	06107	36.327609	-119.3082345	Tulare County
263165	Fee-for-Service	1609817576	1609817576	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1631 S MELROSE DR.	None	VISTA	CA	92081	2405	37	06073	33.16662307	-117.2471325	San Diego County
263189	Fee-for-Service	1427419944	1427419944	1	1	GARCIA, CALVIN J CRNA	5/29/2019	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
263202	Fee-for-Service	1356879530	1356879530	1	1	GU, HANNAH MD	7/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	172112	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
263210	Fee-for-Service	1407902190	1407902190	1	1	GALANIS, CHARLES J MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112172	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
263223	Fee-for-Service	1033401377	1033401377	1	1	GILL, ZORA S MD INC	5/31/2012	261QM2500X	NA	Other	026	PHYSICIANS	38733	02	General Surgery	0	In state provider	None	2808 F ST	STE A	BAKERSFIELD	CA	93301	1833	15	06029	35.3853	-119.023444	Kern County
263224	Fee-for-Service	1811084676	1811084676	1	1	GOLDEN BEAR PHYSICAL THERAPY	6/16/2020	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	AND SPORTS INJURY CENTE	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
263232	Fee-for-Service	1639679350	1639679350	1	1	GONDI, DANIEL S MD	10/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174353	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
263254	Fee-for-Service	1841641347	1841641347	1	1	GUPTA, MEGHA N MD	7/6/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	150612	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
263279	Fee-for-Service	1831675842	1831675842	1	1	G&G MEDICAL TRANSPORT LLC	8/6/2018	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1005 COLUMBUS WAY	None	LEMOORE	CA	93245	9171	16	06031	36.30820404	-119.7955273	Kings County
263286	Fee-for-Service	1033280888	1033280888	1	1	GOTTSCHALK, MICHAEL E MD	9/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55424	67	Endocrinology	0	In state provider	None	3030 CHILDRENS WAY	STE 210	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
263371	Fee-for-Service	1053598656	1053598656	1	1	GATEWAY UNIFIED SD	10/22/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	4411 MOUNTAIN LAKES BLVD	None	REDDING	CA	96003	1446	45	06089	40.63106375	-122.387577	Shasta County
263397	Fee-for-Service	1770946568	1770946568	1	1	GOYAL, VISHAL MD	11/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170305	08	Family Practice	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
263410	Fee-for-Service	1275037491	1275037491	1	1	GUGLIELMINO, KATHLEEN M MD	8/5/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178225	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
263417	Fee-for-Service	1255761847	1255761847	1	1	GANDIN, AMY LMFT	8/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5743 CORSA AVE	207	WESTLAKE VILLAGE	CA	91362	6464	56	06111	34.156863	-118.7994295	Los Angeles County
263427	Fee-for-Service	1780665356	1780665356	1	1	GERI-CARE V, LLC	12/1/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	44445 N 15TH ST W	None	LANCASTER	CA	93534	2801	19	06037	34.690212	-118.156877	Los Angeles County
263512	Fee-for-Service	1811084676	1811084676	1	1	GOLDEN BEAR PHYSICAL THERAPY	12/22/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
263514	Fee-for-Service	1689862732	1689862732	1	1	GORINSTEIN, ISRAEL MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	35991	13	Neurology (M.D. only)	0	In state provider	INC	5901 W OLYMPIC BLVD	STE 420	LOS ANGELES	CA	90036	4669	19	06037	34.05764121	-118.3603115	Los Angeles County
263525	Fee-for-Service	1417100348	1417100348	1	1	GENTLE TOUCH MEDICAL GROUP	1/26/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	16400 LARK AVE	STE 150	LOS GATOS	CA	95032	2563	43	06085	37.24806607	-121.9567922	Santa Clara County
263528	Fee-for-Service	1780348003	1780348003	1	1	GRIZZLY PHARMACY	5/4/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6017 N PALM AVE	None	FRESNO	CA	93704	1623	10	06019	36.82311727	-119.8084353	Fresno County
263530	Fee-for-Service	1245757632	1245757632	1	1	GUARDIAN FLIGHT LLC	4/17/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	2045 S 14TH AVENUE	UNIT 14	YUMA	AZ	85364	6285	00	None	32.690214	-114.6375585	Yuma County
263547	Fee-for-Service	1407332901	1407332901	1	1	GARCIA, MARY ANN	10/4/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
263575	Fee-for-Service	1033280888	1033280888	1	1	GOTTSCHALK, MICHAEL E MD	9/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55424	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 210	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
263614	Fee-for-Service	1093447864	1093447864	1	1	GERGURICH, HEIDI LCSW	10/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
263631	Fee-for-Service	1710988035	1710988035	1	1	GUZMAN, BENNY J	11/20/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72290	None	None	0	In state provider	None	8253 SIERRA AVE	SUITE 200	FONTANA	CA	92335	3578	36	06071	34.10379	-117.4357525	San Bernardino County
263664	Fee-for-Service	1689137861	1689137861	1	1	GLENDA FAYE CORBIN	5/11/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	38228 RIOJA CT	None	PALMDALE	CA	93550	6533	19	06037	34.57712265	-118.0815785	Los Angeles County
263693	Fee-for-Service	1164580866	1164580866	1	1	GRIJNSZTEIN, MARK I MD	12/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96813	03	Allergy	0	In state provider	None	8170 LAGUNA BLVD	None	ELK GROVE	CA	95758	7901	34	06067	38.421054	-121.405365	Sacramento County
263697	Fee-for-Service	1932561925	1932561925	1	1	GOLDSTEIN, ZACHARY M MD	10/4/2023	207ZD0900X	NA	Other	026	PHYSICIANS	149661	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
263726	Fee-for-Service	1205949070	1205949070	1	1	GRANT, PHILIP M MD	6/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96353	77	Infectious Disease	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
263750	Fee-for-Service	1356347298	1356347298	1	1	GINIER, BRUCE MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	45708	None	None	0	In state provider	UCD PROFESSIONAL BILLING	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
263768	Fee-for-Service	1538196746	1538196746	1	1	GERBICH, STEPHEN J MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	59912	40	Pediatrics	0	In state provider	None	429 DEL NORTE AVE	None	YUBA CITY	CA	95991	4113	51	06101	39.1440204	-121.6186799	Sutter County
263808	Fee-for-Service	1659739183	1659739183	1	1	GARST, SHANE M CRNA	3/10/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	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
263811	Fee-for-Service	1417100348	1417100348	1	1	GENTLE TOUCH MEDICAL GROUP	1/26/2010	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16400 LARK AVE	STE 150	LOS GATOS	CA	95032	2563	43	06085	37.24806607	-121.9567922	Santa Clara County
263816	Fee-for-Service	1518975879	1518975879	1	1	GASTROENTEROLOGY ASSOC.	3/2/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF THE SOUTH BAY APMC	20911 EARL ST	STE 280	TORRANCE	CA	90503	4354	19	06037	33.840459	-118.3580985	Los Angeles County
263821	Fee-for-Service	1619049434	1619049434	1	1	GEHRIG, JAMES JR MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	42960	45	Nephrology (Renal-Kidney)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
263845	Fee-for-Service	1225592512	1225592512	1	1	GRAVATIS HOME HEALTH CARE	3/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	427 S VICTORY BLVD	STE B	BURBANK	CA	91502	2353	19	06037	34.16984851	-118.3139105	Los Angeles County
263906	Fee-for-Service	1821178039	1821178039	1	1	GALVEZ-PICON, MARIA G MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81557	40	Pediatrics	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
263909	Fee-for-Service	1942440359	1942440359	1	1	GREGORIUS, MELISSA D CRNA	11/5/2009	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
263918	Fee-for-Service	1467539536	1467539536	1	1	GRINDE, TAMMY G DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1880 MARRON RD	STE 102	CARLSBAD	CA	92008	1178	37	06073	33.1764243	-117.3374811	San Diego County
263928	Fee-for-Service	1053351825	1053351825	1	1	GASTON, JANET E MD	9/12/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	38245	41	Internal Medicine	0	In state provider	None	1505 SAINT ALPHONSUS CT	None	ALAMO	CA	94507	1533	07	06013	37.85356704	-122.03496	Contra Costa County
263944	Fee-for-Service	1386667780	1386667780	1	1	GAUTO, ANIBAL R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36734	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39700 BOB HOPE DR	STE 213	RANCHO MIRAGE	CA	92270	7126	33	06065	33.760683	-116.4080645	Riverside County
263954	Fee-for-Service	1689137861	1689137861	1	1	GLENDA FAYE CORBIN	5/11/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	38228 RIOJA CT	None	PALMDALE	CA	93550	6533	19	06037	34.57712265	-118.0815785	Los Angeles County
263961	Fee-for-Service	1508027541	1508027541	1	1	GAURAV DAGAR M.D	8/16/2023	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
263982	Fee-for-Service	1407584840	1407584840	1	1	GRANT SERENITY OF BURBANK,	8/15/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	436 N. REESE PLACE	None	BURBANK	CA	91506	1956	19	06037	34.17253709	-118.3255276	Los Angeles County
263984	Fee-for-Service	1902460041	1902460041	1	1	GOLDEN LIFE HOSPICE INC	7/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12011 VICTORY BLVD	#207	NORTH HOLLYWOOD	CA	91606	3330	19	06037	34.18670845	-118.394784	Los Angeles County
264007	Fee-for-Service	1780736587	1780736587	1	1	GOLDFARB, AARON SCOTT MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7950	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
264055	Fee-for-Service	1518193887	1518193887	1	1	GALAVIZ-BARCELO, SUSANA MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106061	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
264081	Fee-for-Service	1053534925	1053534925	1	1	GORDON, EARL M MD	1/1/1982	207RN0300X	NA	Nephrology	026	PHYSICIANS	35140	45	Nephrology (Renal-Kidney)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
264095	Fee-for-Service	1467799502	1467799502	1	2	GREIG, CHRISTINA K MD	4/20/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	138223	-	NOT APPLICABLE	0	In state provider	None	1525 UNION AVE	None	FAIRFIELD	CA	94533	5049	48	06095	38.25801699	-122.0404396	Solano County
264104	Fee-for-Service	1518975879	1518975879	1	1	GASTROENTEROLOGY ASSOC.	3/2/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OF THE SOUTH BAY APMC	20911 EARL ST	STE 280	TORRANCE	CA	90503	4354	19	06037	33.840459	-118.3580985	Los Angeles County
264110	Fee-for-Service	1801813266	1801813266	1	1	GREGG W BEAN 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
264144	Fee-for-Service	1760019368	1760019368	1	1	GHOUSE, YOUHI MD	7/17/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	182385	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
264147	Fee-for-Service	1134178478	1134178478	1	1	GROSSMAN, WILLIAM MD	5/31/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	83785	47	Miscellaneous	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
264148	Fee-for-Service	1427093228	1427093228	2	1	GARFIELD BEACH CVS, LLC	5/22/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	727 S ARROYO PKWY	None	PASADENA	CA	91105	3209	19	06037	34.133454	-118.1474185	Los Angeles County
264161	Fee-for-Service	1922400530	1922400530	1	1	GUPTA, GARIMA DO	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13569	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
264202	Fee-for-Service	1891937249	1891937249	1	1	GUERRERO FERNANDES, ANDRE V	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126757	01	General Practice	0	In state provider	MD	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
264203	Fee-for-Service	1275043770	1275043770	1	1	GRANITE RIDGE HOME HEALTH	10/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	NURSING CARE INC	35300 HIGHWAY 41	SUITE 201	COARSEGOLD	CA	93614	8717	20	06039	37.26198151	-119.7000643	Madera County
264232	Fee-for-Service	1386667780	1386667780	1	1	GAUTO, ANIBAL R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36734	02	General Surgery	0	In state provider	None	39700 BOB HOPE DR	STE 213	RANCHO MIRAGE	CA	92270	7126	33	06065	33.760683	-116.4080645	Riverside County
264272	Fee-for-Service	1902460041	1902460041	1	1	GOLDEN LIFE HOSPICE INC	7/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12011 VICTORY BLVD	#207	NORTH HOLLYWOOD	CA	91606	3330	19	06037	34.18670845	-118.394784	Los Angeles County
264295	Fee-for-Service	1821129057	1821129057	1	2	GRIGORIAN, STEPHAN R MD	11/18/2021	207ZP0102X	NA	Other	026	PHYSICIANS	88170	None	None	0	In state provider	None	800 S CENTRAL AVE	SUITE 208	GLENDALE	CA	91204	4644	19	06037	34.13654729	-118.2578243	Los Angeles County
264304	Fee-for-Service	1114131166	1114131166	1	1	GHANEM, HODA M MD	4/22/2009	207R00000X	NA	Other	026	PHYSICIANS	92248	41	Internal Medicine	0	In state provider	None	5725 W LAS POSITAS BLVD	STE 210	PLEASANTON	CA	94588	4000	01	06001	37.688107	-121.8861427	Alameda County
264325	Fee-for-Service	1720022098	1720022098	1	1	GARFIELD BEACH CVS LLC	4/5/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8530 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4628	19	06037	34.225389	-118.5360525	Los Angeles County
264343	Fee-for-Service	1629735196	1629735196	1	1	GENOA HEALTHCARE LLC	6/1/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	451 W LINCOLN AVENUE	SUITE 100, ROOM P	ANAHEIM	CA	92805	2912	30	06059	33.83445082	-117.9189372	Orange County
264361	Fee-for-Service	1588816474	1588816474	1	1	GARFIELD BEACH CVS, LLC	2/25/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	510 C ST.	None	SAN DIEGO	CA	92101	5208	37	06073	32.71677138	-117.1597186	San Diego County
264384	Fee-for-Service	1609348887	1609348887	1	1	GLORIA HOME HEALTH INC	3/9/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	STE 201	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
264395	Fee-for-Service	1861480097	1861480097	1	2	GARDEN CREST CONV HOSP	4/20/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	889 LUCILLE AVE	None	LOS ANGELES	CA	90026	1509	19	06037	34.08550269	-118.2825686	Los Angeles County
264403	Fee-for-Service	1528658481	1528658481	1	1	GORMAN, LINDSEY A CRNA	3/8/2021	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
264428	Fee-for-Service	1902849862	1902849862	1	1	GREEN, VINCENT W MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74885	None	None	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
264449	Fee-for-Service	1194785428	1194785428	1	1	GOTTLIEB, MARCI L MD	11/30/1988	207R00000X	NA	Other	026	PHYSICIANS	61193	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
264469	Fee-for-Service	1699936781	1699936781	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 S EUCLID ST	None	ANAHEIM	CA	92802	1011	30	06059	33.83116576	-117.9415311	Orange County
264477	Fee-for-Service	1558802975	1558802975	1	1	GREEN, KELLY	10/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15340 DEVONSHIRE ST.	7	MISSION HILLS	CA	91345	2755	19	06037	34.25726849	-118.4664285	Los Angeles County
264490	Fee-for-Service	1871231936	1871231936	1	1	GROUNDED ROOTS MENTAL HEALTH	3/20/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	THERAPY	2735 TERESITA ST	None	SAN DIEGO	CA	92104	5254	37	06073	32.73445388	-117.1213962	San Diego County
264494	Fee-for-Service	1043233760	1043233760	1	1	GRANT, ELLSWORTH R	10/16/2008	207RH0003X	NA	Oncology	026	PHYSICIANS	73084	78	Neoplastic Diseases/Oncology	0	In state provider	None	1245 WILSHIRE BLVD	STE 514	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
264515	Fee-for-Service	1336874098	1336874098	1	1	GOLDEN CARE HOME HEALTH INC	1/17/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	SUITE 297	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
264522	Fee-for-Service	1851458194	1851458194	1	1	GREVE, ROBERT L DC	8/31/1995	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	664 AZALEA AVE	A	REDDING	CA	96002	0217	45	06089	40.57743872	-122.3589472	Shasta County
264545	Fee-for-Service	1497213151	1497213151	1	1	GROONWALD, ANN E CNM	1/24/2020	163WM0102X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3630 ENTERPRISE STREET	None	SAN DIEGO	CA	92110	3212	37	06073	32.74601586	-117.1985439	San Diego County
264581	Fee-for-Service	1144571167	1144571167	2	1	GAMMADA, YOMIYYU Z MD	6/19/2023	207R00000X	NA	Other	026	PHYSICIANS	176423	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
264586	Fee-for-Service	1750726857	1750726857	1	1	GRIGORYAN, GRIGOR MD	8/22/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	134603	20	Orthopedic Surgery	0	In state provider	None	900 E WASHINGTON ST	STE 200	COLTON	CA	92324	4192	36	06071	34.04820662	-117.3128102	San Bernardino County
264600	Fee-for-Service	1962596924	1962596924	1	1	GORGONA, MARIA T MD	1/16/2025	207R00000X	NA	Other	026	PHYSICIANS	None	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
264615	Fee-for-Service	1366052094	1366052094	1	1	GIDNER, BREE A PSYD	11/26/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
264650	Fee-for-Service	1437249927	1437249927	1	1	GOKDEN, NERIMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 783	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
264667	Fee-for-Service	1760568117	1760568117	2	1	GLANN, CAROL E MD	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	71014	40	Pediatrics	0	In state provider	None	3055 MACARTHUR BLVD	None	OAKLAND	CA	94602	3211	01	06001	37.79662303	-122.20399	Alameda County
264687	Fee-for-Service	1063507184	1063507184	1	1	GOODIN, DOUGLAS S MD	11/15/2005	2084N0400X	NA	Neurology	026	PHYSICIANS	40444	13	Neurology (M.D. only)	0	In state provider	UCSF NEPROLOGY MED GROUP	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
264699	Fee-for-Service	1780613695	1780613695	1	1	GBADEBO,ADEBAYO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4441 E MCDOWELL RD	STE 101	PHOENIX	AZ	85008	4503	00	None	33.465339	-111.9855735	Maricopa County
264710	Fee-for-Service	1811084676	1811084676	1	18	GOLDEN BEAR PHYSICAL THERAPY	12/17/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	Y SPORTS INJURY CENTER,	1533 OAKDALE RD	STE B	MODESTO	CA	95355	3305	50	06099	37.66667747	-120.957587	Stanislaus County
264756	Fee-for-Service	1740310283	1740310283	1	1	GILBERT K ONG MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	21601 76TH AVE W	None	EDMONDS	WA	98026	7507	00	None	47.803239	-122.335652	Snohomish County
264768	Fee-for-Service	1265693428	1265693428	1	1	GRIFFETH, BRAD C MD	7/12/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	120601	30	Radiology	0	In state provider	None	44274 GEORGE CUSHMAN CT	108	TEMECULA	CA	92592	5945	33	06065	33.48313254	-117.0888293	Riverside County
264780	Fee-for-Service	1043233760	1043233760	1	1	GRANT, ELLSWORTH R	10/16/2008	207RH0003X	NA	Oncology	026	PHYSICIANS	73084	68	Hematology	0	In state provider	None	1245 WILSHIRE BLVD	STE 514	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
264785	Fee-for-Service	1659690261	1659690261	2	1	GARFIELD BEACH CVS LLC	5/15/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5001 JUNIPERO SERRA BLVD	None	COLMA	CA	94014	3217	41	06081	37.67271336	-122.4659691	San Mateo County
264809	Fee-for-Service	1639238785	1639238785	1	1	GOMEZ, REBECCA LMFT	12/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	334 SHAW	106	CLOVIS	CA	93612	3847	10	06019	36.80839352	-119.7049776	Fresno County
264843	Fee-for-Service	1184646879	1184646879	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	250 BROADWAY	None	EL CAJON	CA	92021	4539	37	06073	32.809743	-116.959347	San Diego County
264854	Fee-for-Service	1104096411	1104096411	1	1	GEHANI, ARTI T MD	4/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102358	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
264895	Fee-for-Service	1306669585	1306669585	1	1	GARCIA, RENE PT	1/3/2025	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
264896	Fee-for-Service	1851170179	1851170179	1	1	GILL, PARDEEP NP	9/3/2024	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
264911	Fee-for-Service	1073883765	1073883765	1	1	GONZALES, DAVID J DO	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12117	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
264912	Fee-for-Service	1215003330	1215003330	1	1	GARNER, BRANDI S LMFT	10/29/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49045	-	NOT APPLICABLE	0	In state provider	None	1001 GRAND AVE	None	SACRAMENTO	CA	95838	3512	34	06067	38.637036	-121.443399	Sacramento County
264916	Fee-for-Service	1326195926	1326195926	1	1	G V MEDICAL EQUIPMENT &	5/16/1997	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLY	21032 HAWTHORNE BLVD	None	TORRANCE	CA	90503	4614	19	06037	33.83911171	-118.3536144	Los Angeles County
264930	Fee-for-Service	1194163295	1194163295	1	1	GONZALEZ, ROSIE LMFT	1/26/2023	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	308 W STATE ST	STE 3D	REDLANDS	CA	92373	4653	36	06071	34.05649746	-117.18603	San Bernardino County
264945	Fee-for-Service	1285348201	1285348201	1	1	GRAHAM, CODY B CRNA	11/6/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	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
265020	Fee-for-Service	1447358981	1447358981	1	1	GALFAIAN, ANAIT MD	1/22/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	38864	08	Family Practice	0	In state provider	AMERICARE MEDICAL CTR	445 W BROADWAY	None	GLENDALE	CA	91204	1208	19	06037	34.14684551	-118.2633525	Los Angeles County
265095	Fee-for-Service	1598846727	1598846727	1	1	GROSS, BARRY 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	1500 E MEDICAL CENTER DR	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
265111	Fee-for-Service	1225179823	1225179823	1	1	GAETA, RAYMOND R MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	60351	05	Anesthesiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
265113	Fee-for-Service	1346300316	1346300316	1	1	GABBARD, LEWIS	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
265157	Fee-for-Service	1275843542	1275843542	1	1	GONERKO, CHRISTINA N LCSW	6/23/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER 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
265186	Fee-for-Service	1013939644	1013939644	2	1	GARFIELD BEACH CVS LLC	4/23/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12471 LIMONITE AVE	None	EASTVALE	CA	91752	2457	33	06065	33.978384	-117.554346	Riverside County
265247	Fee-for-Service	1003058637	1003058637	1	1	GRANDHE, JANARDHAN R MD	5/1/2002	207LP2900X	NA	Other	026	PHYSICIANS	52798	05	Anesthesiology	0	In state provider	AMC	6401 TRUXTUN AVE	SUITE B	BAKERSFIELD	CA	93309	0613	15	06029	35.36227673	-119.07391	Kern County
265264	Fee-for-Service	1932265600	1932265600	1	1	GUSS, JEE H MD	8/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108519	36	Psychiatry	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	5681	07	06013	38.00771973	-122.1331484	Contra Costa County
265282	Fee-for-Service	1083845598	1083845598	1	1	GHORBANI, SHIREEN MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115117	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
265285	Fee-for-Service	1306390638	1306390638	1	1	GUZMAN, CRETIA R CNP	12/14/2017	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
265297	Fee-for-Service	1629147103	1629147103	1	1	GAVIN S YOUNG MD	3/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 KOOTENAI HEALTH WAY	None	COEUR D ALENE	ID	83814	6051	00	None	47.695635	-116.792906	Kootenai County
265301	Fee-for-Service	1043356033	1043356033	1	1	GERTSCH, RONALD L MD	1/19/2021	163WG0000X	NA	Other	026	PHYSICIANS	35744	None	None	0	In state provider	None	8590 RIO SAN DIEGO DR	SUITE 111	SAN DIEGO	CA	92108	5507	37	06073	32.77472926	-117.1448295	San Diego County
265362	Fee-for-Service	1225160039	1225160039	1	1	GREGG, JEFFREY W OD	9/27/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5500 GROSSMONT CENTER DR	STE 210	LA MESA	CA	91942	3071	37	06073	32.7793549	-117.0091108	San Diego County
265365	Fee-for-Service	1497017875	1497017875	1	1	GLASER, CHRISTINE M MD	8/23/2017	207R00000X	NA	Other	026	PHYSICIANS	150243	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
265416	Fee-for-Service	1336168285	1336168285	1	1	GREGORY CHEER 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	100 HIGH ST	DEPT OF SURGERY	BUFFALO	NY	14203	0000	00	None	42.900903	-78.865983	Erie County
265421	Fee-for-Service	1285714337	1285714337	1	1	GUPTA, RANJAN MD	3/31/1996	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	83863	20	Orthopedic Surgery	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
265436	Fee-for-Service	1457373243	1457373243	2	1	GARFIELD BEACH CVS LLC	10/4/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3300 S BRISTOL ST	None	SANTA ANA	CA	92704	7246	30	06059	33.70286893	-117.885648	Orange County
265438	Fee-for-Service	1801645569	1801645569	1	1	GARBAN, NATALIA BIRTH DOULA	6/14/2024	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	19	06037	0	0	None
265447	Fee-for-Service	1114378353	1114378353	1	1	GREENAWALT, ASHLEY N OD	10/10/2017	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
265457	Fee-for-Service	1700860871	1700860871	1	4	GOLDEN STATE DERMATOLOGY ASS	3/2/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	1000 DELBON AVE	STE 8	TURLOCK	CA	95382	2008	50	06099	37.51054507	-120.8367636	Stanislaus County
265504	Fee-for-Service	1033751540	1033751540	1	1	GUILLERMO A. YOUNG, MD INC	12/21/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1300 N VERMONT AVE	SUITE 402	LOS ANGELES	CA	90027	6086	19	06037	34.0956033	-118.2916918	Los Angeles County
265509	Fee-for-Service	1154375632	1154375632	1	1	GORDON, RHONDA K K MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65857	40	Pediatrics	0	In state provider	None	300 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1316	42	06083	34.4458497	-119.779596	Santa Barbara County
265530	Fee-for-Service	1821348780	1821348780	1	2	GUTHREY, CHRISTOPHER R PSYD	8/20/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	REY PSYD	511 E. MAIN ST	None	QUINCY	CA	95971	0000	32	06063	39.93514028	-120.928531	Plumas County
265545	Fee-for-Service	1477501310	1477501310	1	1	GARTH E FLETCHER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	988095 NEBRASKA MEDICAL	None	OMAHA	NE	68198	0000	00	None	0	0	None
265573	Fee-for-Service	1679122766	1679122766	1	1	GUTIERREZ, SUNNY R	9/18/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1959 ALICE WAY	None	SACRAMENTO	CA	95834	2807	34	06067	38.631591	-121.501377	Sacramento County
265602	Fee-for-Service	1750867453	1750867453	1	1	GHANEM, HEBAH MD	9/20/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	158819	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
265646	Fee-for-Service	1912167933	1912167933	1	1	GRIGGS, RACHEL M MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125328	30	Radiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
265653	Fee-for-Service	1972651883	1972651883	1	1	GOHARDERAKHSHAN, REZA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67691	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
265657	Fee-for-Service	1811034820	1811034820	1	1	GAITO, JENNIFER M LMFT	6/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
265673	Fee-for-Service	1952342834	1952342834	1	1	GARFIELD BEACH CVS LLC	10/26/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3020 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2717	19	06037	33.82423345	-118.3402536	Los Angeles County
265710	Fee-for-Service	1285714337	1285714337	1	1	GUPTA, RANJAN MD	3/31/1996	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	83863	46	Hand Surgery	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
265717	Fee-for-Service	1477974780	1477974780	1	2	GARCIA, TERRY A PHD	11/22/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 S FOREST RD	None	SONORA	CA	95370	4895	55	06109	37.98108453	-120.3904912	Tuolumne County
265812	Fee-for-Service	1730459363	1730459363	1	1	GOLDNER, BRIAN W MD	9/2/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163415	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
265835	Fee-for-Service	1689668873	1689668873	1	1	GREGORY S SKOPEC MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
265842	Fee-for-Service	1710151196	1710151196	1	1	GESSEL, MARIE MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	192247	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
265847	Fee-for-Service	1154780161	1154780161	1	1	GENTILE, CHRISTINA T PSYD	4/19/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 MEDICAL PLAZA STE 70	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
265857	Fee-for-Service	1679122766	1679122766	1	1	GUTIERREZ, SUNNY R	9/18/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1959 ALICE WAY	None	SACRAMENTO	CA	95834	2807	34	06067	38.631591	-121.501377	Sacramento County
265867	Fee-for-Service	1821700667	1821700667	1	1	GONZALEZ, RUBEN LPCC	3/12/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17 CHAMISO DR.	None	LOS ALAMOS	CA	93440	1031	42	06083	34.74770443	-120.2813948	Santa Barbara County
265941	Fee-for-Service	1972651883	1972651883	1	1	GOHARDERAKHSHAN, REZA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67691	34	Urology and Urological Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
265952	Fee-for-Service	1447496393	1447496393	1	1	GLEICHER, MARCI E	2/21/2023	363LP0808X	NA	Nurse Practitioner	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
265978	Fee-for-Service	1558320317	1558320317	1	1	GANSERT, GUY 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
265986	Fee-for-Service	1174142533	1174142533	1	1	GUZMAN JR, RUBEN MD	8/1/2023	207P00000X	NA	Other	026	PHYSICIANS	184194	None	None	0	In state provider	None	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
266009	Fee-for-Service	1881290500	1881290500	1	1	GORDON, DANIELLE W LMFT	10/24/2021	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
266026	Fee-for-Service	1215003603	1215003603	2	1	GENOMIC HEALTH INC.	4/17/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	301 PENOBSCOT DR	None	REDWOOD CITY	CA	94063	4700	41	06081	37.49855473	-122.217534	San Mateo County
266048	Fee-for-Service	1992749303	1992749303	1	1	GONZALEZ, HENRY J MD	5/11/1995	207L00000X	NA	Other	026	PHYSICIANS	56342	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
266073	Fee-for-Service	1356984637	1356984637	1	1	GUBUAN, SHIRLEEN S NP	6/18/2020	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
266104	Fee-for-Service	1194716498	1194716498	1	1	GARRICK, JOCELYN F MD	4/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78711	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
266147	Fee-for-Service	1790726669	1790726669	1	1	GARFIELD BEACH CVS, LLC	3/21/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9225 TWIN TRAILS DRV	None	SAN DIEGO	CA	92129	2692	37	06073	32.95691919	-117.1281241	San Diego County
266205	Fee-for-Service	1124374947	1124374947	1	1	GONZALEZ, DORA N MSW LCSW	1/17/2025	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
266207	Fee-for-Service	1528127198	1528127198	1	1	GWEON, PAUL Y MD	3/1/1999	208800000X	NA	Other	026	PHYSICIANS	73207	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
266258	Fee-for-Service	1245380013	1245380013	1	1	GRISWOLD, JENNY C MD	5/23/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	84517	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
266266	Fee-for-Service	1285860403	1285860403	1	1	GRANITE WELLNESS CENTERS	3/5/2018	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	159 BRENTWOOD DR	None	GRASS VALLEY	CA	95945	5703	29	06057	39.23230278	-121.0486552	Nevada County
266294	Fee-for-Service	1205255841	1205255841	1	1	GILBRETH, MARGARET E MD	6/23/2017	390200000X	NA	Other	026	PHYSICIANS	147274	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
266327	Fee-for-Service	1033134564	1033134564	1	1	GRAVES, MICHAEL C MD	6/11/1998	2084N0400X	NA	Neurology	026	PHYSICIANS	21341	13	Neurology (M.D. only)	0	In state provider	None	710 WESTWOOD PLZ	RM C2	LOS ANGELES	CA	90095	8353	19	06037	34.06680182	-118.4450804	Los Angeles County
266339	Fee-for-Service	1295731990	1295731990	1	1	GARDNER, STEVEN E MD	7/15/2013	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	53689	77	Infectious Disease	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
266385	Fee-for-Service	1023607827	1023607827	1	1	GILI, GERELYN P NP	4/26/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
266408	Fee-for-Service	1073893723	1073893723	1	1	GARCIA, MARIBEL LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
266422	Fee-for-Service	1750385167	1750385167	1	1	GHC OF PLEASANTON LLC	5/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	300 NEAL ST	None	PLEASANTON	CA	94566	7317	01	06001	37.65848249	-121.8720632	Alameda County
266426	Fee-for-Service	1750330080	1750330080	1	1	GROOMS, SHANDA 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
266469	Fee-for-Service	1750040499	1750040499	1	1	GOLDEN STATE MARRIAGE AND FA	10/10/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	515 E 1ST ST	SUITE D	TUSTIN	CA	92780	3335	30	06059	33.74583051	-117.8188245	Orange County
266477	Fee-for-Service	1811084676	1811084676	1	6	GOLDEN BEAR PHYSICAL THERAPY	12/27/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	3184 COLLINS DR	None	MERCED	CA	95348	3132	24	06047	37.32178614	-120.4760525	Merced County
266503	Fee-for-Service	1255692752	1255692752	1	2	GANDHI, SHEIPHALI A MD	2/23/2022	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	162380	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
266504	Fee-for-Service	1194725705	1194725705	1	1	GABE CARE DIRECT RX INC	1/12/2023	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	830 KIRTS BLVD	STE 300	TROY	MI	48084	4897	00	None	42.55682552	-83.15900452	Oakland County
266506	Fee-for-Service	1689074791	1689074791	1	1	GARFIELD BEACH CVS LLC	9/28/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2004 EL CAMINO REAL	None	SANTA CLARA	CA	95050	4051	43	06085	37.349901	-121.9605435	Santa Clara County
266530	Fee-for-Service	1114002888	1114002888	1	1	GREER,JENNIFER MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72241	02	General Surgery	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
266573	Fee-for-Service	1407053358	1407053358	1	1	GOLDENBERG, WILLIAM D MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146053	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91944	0158	37	06073	32.781483	-117.007182	San Diego County
266628	Fee-for-Service	1033135488	1033135488	1	1	GABOIAN, KARINE	8/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80337	None	None	0	In state provider	None	1058 N VINE ST	None	LOS ANGELES	CA	90038	2745	19	06037	34.090065	-118.3265925	Los Angeles County
266642	Fee-for-Service	1255499018	1255499018	1	1	GONZALEZ, SOFIA N PHD	7/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 FILLMORE STREET	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
266683	Fee-for-Service	1083960348	1083960348	1	1	GASTELUM, NORMA A LCSW	5/16/2020	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
266777	Fee-for-Service	1366869554	1366869554	1	1	GOLESTANEH, SAFIEH MD	8/10/2023	207R00000X	NA	Other	026	PHYSICIANS	185855	None	None	0	In state provider	None	10441 LAKEWOOD BLVD	None	DOWNEY	CA	90241	2744	19	06037	33.94358034	-118.1193714	Los Angeles County
266848	Fee-for-Service	1023380425	1023380425	1	1	GEORGE DELSHAD MD A PROFESSI	5/7/2012	193400000X	NA	Other	026	PHYSICIANS	83566	None	None	0	In state provider	IC	15211 VANOWEN STREET	SUITE 310	VAN NUYS	CA	91405	3615	19	06037	34.19395411	-118.4642527	Los Angeles County
266884	Fee-for-Service	1184071631	1184071631	1	1	GOMEZ, ANA C NP	11/15/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1288 CAMINO DEL RIO N	None	SAN DIEGO	CA	92108	1511	37	06073	32.7668181	-117.150708	San Diego County
266900	Fee-for-Service	1619920667	1619920667	1	1	GHALAMBOR, NAVID MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	79882	20	Orthopedic Surgery	0	In state provider	None	2226 MEDICAL CENTER DR	None	PERRIS	CA	92571	2657	33	06065	33.81247205	-117.2217746	Riverside County
266915	Fee-for-Service	1811275415	1811275415	1	1	GUPTA, RAJIB KUMAR MD	9/5/2023	207ZP0102X	NA	Other	026	PHYSICIANS	187966	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
266919	Fee-for-Service	1790878494	1790878494	1	1	GRAHAM, DAVID M MD	2/1/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34436	47	Miscellaneous	0	In state provider	None	305 E 8TH ST	None	NATIONAL CITY	CA	91950	2311	37	06073	32.67676952	-117.1036528	San Diego County
266940	Fee-for-Service	1487170890	1487170890	1	1	GHC OF SAN FRAN 180, LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1359 PINE ST	None	SAN FRANCISCO	CA	94109	4807	38	06075	37.7898738	-122.4183401	San Francisco County
266943	Fee-for-Service	1902499619	1902499619	1	1	GROWTH MINDSET, A LICENSED C	5/10/2022	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LINICAL SOCIAL WORKER PR	23470 OLIVE WOOD PLAZA D	110	MORENO VALLEY	CA	92553	5264	33	06065	33.94013493	-117.2532525	Riverside County
266960	Fee-for-Service	1134609902	1134609902	1	1	GHAFFARI VAFA, AMANDA N LMFT	5/7/2024	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
266961	Fee-for-Service	1770886558	1770886558	1	1	GOLDEN STATE EMERGENCY	1/1/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS INC	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
266983	Fee-for-Service	1275187460	1275187460	1	1	GARFIELD HEALTH CENTER	6/18/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	701 S ATLANTIC BLVD	STE 200	MONTEREY PARK	CA	91754	3845	19	06037	34.05382447	-118.1363489	Los Angeles County
267002	Fee-for-Service	1013953173	1013953173	1	1	GARFIELD BEACH CVS LLC	3/8/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5735 E LA PALMA AVE	None	ANAHEIM	CA	92807	2229	30	06059	33.85961898	-117.7892961	Orange County
267020	Fee-for-Service	1336225846	1336225846	1	1	GRAVES, MICHAEL A II DPM	5/17/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	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
267038	Fee-for-Service	1801831706	1801831706	1	1	GARFIELD BEACH CVS, LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2091 E LAKESHORE DR	None	LAKE ELSINORE	CA	92530	4415	33	06065	33.66055415	-117.30188	Riverside County
267043	Fee-for-Service	1780137851	1780137851	1	1	GONZALEZ, JOSEPH PT	10/5/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3400 CALLOWAY DR	600	BAKERSFIELD	CA	93312	2513	15	06029	35.39110123	-119.1097878	Kern County
267049	Fee-for-Service	1972923886	1972923886	1	1	GEZALIAN, MICHAEL M MD	2/13/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	145192	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
267066	Fee-for-Service	1710901590	1710901590	1	1	GIESEMANN, LESLIE A MD	7/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62713	89	Surgery-Traumatic	0	In state provider	None	1180 N INDIAN CANYON DR	STE E425	PALM SPRINGS	CA	92262	4868	33	06065	33.839505	-116.5455735	Riverside County
267151	Fee-for-Service	1962498766	1962498766	1	1	GREENBERG, JERRY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1444 S POTOMAC ST	STE 300	AURORA	CO	80012	4510	00	None	39.690306	-104.830155	Arapahoe County
267163	Fee-for-Service	1861887077	1861887077	1	1	GHIASSI, KIA MD	9/15/2021	207RC0200X	NA	Other	026	PHYSICIANS	15558	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
267182	Fee-for-Service	1912941287	1912941287	1	1	GARFIELD BEACH CVS, LLC	1/15/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17320 VENTURA BLVD	None	ENCINO	CA	91316	3904	19	06037	34.16093637	-118.5106255	Los Angeles County
267189	Fee-for-Service	1619920667	1619920667	1	1	GHALAMBOR, NAVID MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	79882	41	Internal Medicine	0	In state provider	None	2226 MEDICAL CENTER DR	None	PERRIS	CA	92571	2657	33	06065	33.81247205	-117.2217746	Riverside County
267230	Fee-for-Service	1902499619	1902499619	1	1	GROWTH MINDSET, A LICENSED C	5/10/2022	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	LINICAL SOCIAL WORKER PR	23470 OLIVE WOOD PLAZA D	110	MORENO VALLEY	CA	92553	5264	33	06065	33.94013493	-117.2532525	Riverside County
267248	Fee-for-Service	1790354702	1790354702	1	1	GENOA HEALTHCARE LLC	3/11/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2677 NORTH MAIN STREET	SUITE 110, ROOM P	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
267269	Fee-for-Service	1275187460	1275187460	1	1	GARFIELD HEALTH CENTER	6/18/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	701 S ATLANTIC BLVD	STE 200	MONTEREY PARK	CA	91754	3845	19	06037	34.05382447	-118.1363489	Los Angeles County
267274	Fee-for-Service	1902814759	1902814759	1	2	GLENDALE DIAGNOSTIC	1/30/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING NETWORK MEDICAL	4910 VAN NUYS BLVD	STE 108	SHERMAN OAKS	CA	91403	1757	19	06037	34.15979697	-118.4486826	Los Angeles County
267294	Fee-for-Service	1982138368	1982138368	1	1	GUEST, CHRISTINA MD	7/8/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157271	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
267301	Fee-for-Service	1023270063	1023270063	1	1	GRADY, JOHN M DO	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	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
267302	Fee-for-Service	1285799924	1285799924	1	1	GALASI, KATALIN 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
267310	Fee-for-Service	1083890768	1083890768	1	1	GAMBLE, SUSAN R PSYD	1/5/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	24885 WHITEWOOD RD	SUITE 102	MURRIETA	CA	92563	2004	33	06065	33.5778899	-117.1788877	Riverside County
267337	Fee-for-Service	1063412005	1063412005	1	1	GARDENA HOSP, LP	9/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEMORIAL HOSP OF GARDENA	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
267342	Fee-for-Service	1982752812	1982752812	1	1	GARCIA, MERCEDES M MD	8/27/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43612	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
267359	Fee-for-Service	1841867405	1841867405	1	1	GLICK, STEPHANIE MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	183102	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
267375	Fee-for-Service	1942640529	1942640529	1	1	GROVE, ROBERT N PHD	9/27/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	79301 COUNTRY CLUB DR	101	INDIO	CA	92203	1245	33	06065	33.75168224	-116.2799439	Riverside County
267411	Fee-for-Service	1922634377	1922634377	1	1	GEORGE CALASA LICENSED PROFE	11/30/2020	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SSIONAL CLINICAL COUNSEL	154 EL MONTE AVENUE	None	VENTURA	CA	93004	1754	56	06111	34.28128736	-119.1796331	Ventura County
267427	Fee-for-Service	1992027247	1992027247	1	1	GLATER, JAMIE L	1/16/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2100 WEST 3RD STREET	None	LOS ANGELES	CA	90057	1944	19	06037	34.06308947	-118.2733326	Los Angeles County
267469	Fee-for-Service	1750306155	1750306155	1	1	GOLD, MICHAEL E MD	5/31/1984	2084N0400X	NA	Neurology	026	PHYSICIANS	47870	13	Neurology (M.D. only)	0	In state provider	None	2021 SANTA MONICA BLVD	STE 525	SANTA MONICA	CA	90404	2219	19	06037	34.02922048	-118.4793681	Los Angeles County
267509	Fee-for-Service	1346801396	1346801396	1	1	GEORGE, NICHOLAS K MD	7/9/2024	207P00000X	NA	Other	026	PHYSICIANS	179991	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
267513	Fee-for-Service	1285980037	1285980037	2	1	GARFIELD BEACH CVS LLC	12/26/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	789 MISSION ST	None	SAN FRANCISCO	CA	94103	3132	38	06075	37.78477479	-122.4038656	San Francisco County
267525	Fee-for-Service	1942345145	1942345145	1	1	GODDARD, DANIEL J LMFT	6/14/2019	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
267539	Fee-for-Service	1013977511	1013977511	1	1	GILES,RYAN 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	3580 WEST 9000 SOUTH	None	WEST JORDAN	UT	84088	8812	00	None	40.590153	-111.974634	Salt Lake County
267547	Fee-for-Service	1902045040	1902045040	1	2	GRAIDUKEL MED INC	8/30/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	65 N. MADISON AVE	SUITE #410	PASADENA	CA	91101	2049	19	06037	34.14705803	-118.1384317	Los Angeles County
267589	Fee-for-Service	1578170205	1578170205	1	1	GLENDALE HOSPICE INC	1/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7430 COLDWATER CANYON AV	UNIT A	NORTH HOLLYWOOD	CA	91605	3501	19	06037	34.20551872	-118.413917	Los Angeles County
267603	Fee-for-Service	1508476532	1508476532	1	1	GONZALEZ, CELENE	4/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	908 VILLAGE OAKS DR	STE 250	COVINA	CA	91724	3684	19	06037	34.07329753	-117.8625586	Los Angeles County
267621	Fee-for-Service	1063412005	1063412005	1	1	GARDENA HOSP, LP	9/1/1999	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEMORIAL HOSP OF GARDENA	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
267622	Fee-for-Service	1225079130	1225079130	1	1	GARFIELD BEACH CVS, LLC	6/6/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9089 WOODMAN AVE.	None	ARLETA	CA	91331	6404	19	06037	34.23524257	-118.4404018	Los Angeles County
267672	Fee-for-Service	1851411540	1851411540	1	1	GELB, ARTHUR F MD INC	3/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3650 SOUTH ST	STE 308	LAKEWOOD	CA	90712	1518	19	06037	33.86019847	-118.149255	Los Angeles County
267680	Fee-for-Service	1326507211	1326507211	1	1	GAMBHIR, SIMRAN K MD	8/26/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180056	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
267682	Fee-for-Service	1942247580	1942247580	1	1	GELFAND, GILBERT F MD	11/17/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	36369	83	Rheumatology	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
267735	Fee-for-Service	1851510507	1851510507	1	1	GENESIS PROGRAMS, INC.	11/12/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1732 PALMA DR	SUITE 208	VENTURA	CA	93003	5749	56	06111	34.25702666	-119.2274867	Ventura County
267748	Fee-for-Service	1184035743	1184035743	1	1	GRUZENSKY, MICHAELA MD	3/17/2025	207R00000X	NA	Other	026	PHYSICIANS	145399	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
267751	Fee-for-Service	1750306155	1750306155	1	1	GOLD, MICHAEL E MD	5/31/1984	2084N0400X	NA	Neurology	026	PHYSICIANS	47870	01	General Practice	0	In state provider	None	2021 SANTA MONICA BLVD	STE 525	SANTA MONICA	CA	90404	2219	19	06037	34.02922048	-118.4793681	Los Angeles County
267756	Fee-for-Service	1790758233	1790758233	1	1	GREEN, JASON T. DO	5/26/2009	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	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
267765	Fee-for-Service	1497137996	1497137996	1	1	GREWAL, SUPREET K MD	8/5/2021	207L00000X	NA	Other	026	PHYSICIANS	169825	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
267798	Fee-for-Service	1619498656	1619498656	1	1	GONG, CELIA R OD	10/26/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
267799	Fee-for-Service	1376674937	1376674937	1	1	GIRVETZ, JON E PHD	1/1/1979	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	550 WATER ST	STE F3	SANTA CRUZ	CA	95060	4131	44	06087	36.98046158	-122.018718	Santa Cruz County
267813	Fee-for-Service	1437265089	1437265089	1	1	GITLIN, JAMES G MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25576	41	Internal Medicine	0	In state provider	None	17822 BEACH BLVD	STE 300	HUNTINGTON BEACH	CA	92647	7172	30	06059	33.70331388	-117.9890471	Orange County
267818	Fee-for-Service	1376026435	1376026435	1	1	GOLDEN, HANNAH	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	43	06085	0	0	None
267863	Fee-for-Service	1962475194	1962475194	1	1	GARYFALLOU, GARY T. MD	12/2/2007	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	0000	00	None	39.74280302	-105.0412741	City and County of Denver
267865	Fee-for-Service	1578170205	1578170205	1	1	GLENDALE HOSPICE INC	1/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7430 COLDWATER CANYON AV	UNIT A	NORTH HOLLYWOOD	CA	91605	3501	19	06037	34.20551872	-118.413917	Los Angeles County
268036	Fee-for-Service	1063970150	1063970150	1	1	GROWTH RINGS RELATIONSHIP &	9/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FAMILY THERAPY INC	4405 RIVERSIDE DR	STE 206	BURBANK	CA	91505	4050	19	06037	34.15222929	-118.3480509	Los Angeles County
268080	Fee-for-Service	1780945212	1780945212	1	1	GUPTA, PIYUSH MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135911	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
268087	Fee-for-Service	1770159618	1770159618	1	1	GOG HOME HEALTH INC	2/14/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15125 VENTURA BLVD	STE 2-22	SHERMAN OAKS	CA	91403	3306	19	06037	34.15324933	-118.4626202	Los Angeles County
268118	Fee-for-Service	1407808074	1407808074	1	1	GEORGE H.GLADE ARNP	2/14/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	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
268151	Fee-for-Service	1831133107	1831133107	1	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2315 HUNTINGTON DR	None	DUARTE	CA	91010	2102	19	06037	34.13984946	-117.954981	Los Angeles County
268159	Fee-for-Service	1609593060	1609593060	1	1	GREEN ELITE NON-EMERGENT MED	4/22/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6965 DOVER CT.,	None	HIGHLAND	CA	92346	5068	36	06071	34.12723526	-117.1788542	San Bernardino County
268195	Fee-for-Service	1366429771	1366429771	1	1	GANDHI, MEHUL M MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54271	41	Internal Medicine	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
268215	Fee-for-Service	1578839791	1578839791	1	1	GARFIELD BEACH CVS LLC	11/19/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5995 E KINGS CANYON RD	None	FRESNO	CA	93727	5594	10	06019	36.73694306	-119.6827261	Fresno County
268218	Fee-for-Service	1134788862	1134788862	1	1	GARCIA, DANTE MD	9/28/2022	207R00000X	NA	Other	026	PHYSICIANS	178793	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
268263	Fee-for-Service	1770998080	1770998080	1	1	GRANDCARE INC	10/16/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6101 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.612079	-121.329315	Sacramento County
268265	Fee-for-Service	1104878735	1104878735	1	2	GOLDEN EMPIRE CARDIOLOGY, A	3/20/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	MEDICAL GROUP INC	3838 SAN DIMAS ST	SUITE B-201	BAKERSFIELD	CA	93301	1456	15	06029	35.3946385	-119.008203	Kern County
268274	Fee-for-Service	1538523394	1538523394	1	1	GELLEIN, TATIANA MD	3/3/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155443	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
268313	Fee-for-Service	1053321901	1053321901	1	1	GHAFOURI, NEGAR M MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65438	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
268319	Fee-for-Service	1750660098	1750660098	1	1	GOVINDAPPAGARI, SHRAVYA MD	8/17/2020	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147935	15	Obstetrics (D.O. only)	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
268327	Fee-for-Service	1649783739	1649783739	1	1	GILBERT MARRIAGE AND FAMILY	1/31/2020	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	43460 RIDGE PARK DR	STE 200-C	TEMECULA	CA	92590	5518	33	06065	33.49676946	-117.1608841	Riverside County
268364	Fee-for-Service	1992799399	1992799399	1	1	GRIFFIN, JOSEPH B MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	66332	25	Physical Medicine and Rehabilitation	0	In state provider	None	862 MEINECKE AVE	STE 200	SAN LUIS OBISPO	CA	93405	3704	40	06079	35.29243951	-120.668652	San Luis Obispo County
268387	Fee-for-Service	1164849253	1164849253	1	1	GEHA, RABIH M MD	5/10/2017	390200000X	NA	Other	026	PHYSICIANS	141890	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
268400	Fee-for-Service	1114438538	1114438538	1	1	GAY, JENNIFER A LMFT	11/26/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	109700	-	NOT APPLICABLE	0	In state provider	None	3288 EL CAJON BLVD	STE 1A, 1B, 3, 5, 6, 8	SAN DIEGO	CA	92104	1430	37	06073	32.75537145	-117.1228095	San Diego County
268468	Fee-for-Service	1528205994	1528205994	1	1	GOUGH, MARY M LCSW	4/13/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	768 PLEASANT VALLEY ROAD	STE 201	DIAMOND SPRINGS	CA	95619	9260	09	06017	38.69498433	-120.8070771	El Dorado County
268474	Fee-for-Service	1366429771	1366429771	1	1	GANDHI, MEHUL M MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54271	66	Emergency Medicine (Urgent Care)	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
268478	Fee-for-Service	1588812978	1588812978	1	1	GANGADHARAN, PALLIYATH N MD	5/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112962	08	Family Practice	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
268498	Fee-for-Service	1134325202	1134325202	1	1	GRIFFIN, ANDREW L	5/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106487	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
268515	Fee-for-Service	1164704599	1164704599	1	1	GREENBERG, JULIE K LMSW	5/5/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
268533	Fee-for-Service	1013936608	1013936608	1	1	GREGORIUS, FREDERICK K	5/11/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	15246	14	Neurological Surgery	0	In state provider	MD	2209 N CALIFORNIA ST	None	STOCKTON	CA	95204	5503	39	06077	37.97364653	-121.290359	San Joaquin County
268547	Fee-for-Service	1770998080	1770998080	1	1	GRANDCARE INC	9/9/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6101 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.612079	-121.329315	Sacramento County
268583	Fee-for-Service	1376565978	1376565978	2	1	GARFIELD BEACH CVS LLC	3/22/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5700 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3704	19	06037	33.94933002	-118.1673268	Los Angeles County
268604	Fee-for-Service	1750660098	1750660098	1	1	GOVINDAPPAGARI, SHRAVYA MD	8/17/2020	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147935	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
268612	Fee-for-Service	1285795773	1285795773	2	2	GOOD SAMARITAN MEDICAL CLINI	6/8/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C, INC	801 N HARBOR BLVD	None	ANAHEIM	CA	92805	1810	30	06059	33.84310811	-117.92254	Orange County
268642	Fee-for-Service	1376526236	1376526236	1	1	GILLIAM, DAVID R MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	36497	08	Family Practice	0	In state provider	None	1620 PENNSYLVANIA AVE	STE C	FAIRFIELD	CA	94533	3509	48	06095	38.2594713	-122.0498661	Solano County
268657	Fee-for-Service	1073044624	1073044624	1	1	GOODWIN, DIAMOND M MD	9/28/2023	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	161426	None	None	0	In state provider	None	8631 W THIRD STREET	None	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
268730	Fee-for-Service	1265708218	1265708218	1	1	GIBSON, KATHERINE N MD	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71925	01	General Practice	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
268746	Fee-for-Service	1699805846	1699805846	1	1	GROBES, JANEL M LMFT	8/27/2018	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
268781	Fee-for-Service	1457656332	1457656332	1	1	GREEN MEADOWS HOME HEALTH	10/26/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2204 E 4TH STREET	STE 200	SANTA ANA	CA	92705	3868	30	06059	33.74809332	-117.8356441	Orange County
268803	Fee-for-Service	1841013448	1841013448	1	1	GLENDENING, KERRY LAC	4/28/2025	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2222 E CLIFF DR	216	SANTA CRUZ	CA	95062	4739	44	06087	36.96437495	-122.0009863	Santa Cruz County
268807	Fee-for-Service	1225169931	1225169931	1	1	GINOSYAN, ANAIT MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	84764	-	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
268846	Fee-for-Service	1619990637	1619990637	1	1	GUTIERREZ, SVETLANA T MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109885	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
268853	Fee-for-Service	1548300072	1548300072	1	1	GASTON, MARIA K MD	1/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37653	40	Pediatrics	0	In state provider	None	95 MONTGOMERY DR	None	SANTA ROSA	CA	95404	6630	49	06097	38.442357	-122.704641	Sonoma County
268867	Fee-for-Service	1316286982	1316286982	1	1	GOSWAMI, AMITABH U DO INC	8/27/2013	193400000X	NA	Other	026	PHYSICIANS	9044	None	None	0	In state provider	None	7235 N FIRST ST	SUITE 103	FRESNO	CA	93720	2937	10	06019	36.84157633	-119.7748355	Fresno County
268878	Fee-for-Service	1811342223	1811342223	1	1	GRUVER, CHARLES MD	6/21/2019	207L00000X	NA	Other	026	PHYSICIANS	143979	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVENUE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
268880	Fee-for-Service	1215456017	1215456017	1	1	GONZALEZ ALVARADO, EZEQUIEL	10/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	212 COFFEE RD	SUITE 100	BAKERSFIELD	CA	93309	1273	15	06029	35.356392	-119.092153	Kern County
268887	Fee-for-Service	1750660098	1750660098	1	1	GOVINDAPPAGARI, SHRAVYA MD	8/17/2020	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147935	09	Gynecology (D.O. only)	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
268904	Fee-for-Service	1396783270	1396783270	1	1	GREWAL, NARINDER S AMC	7/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	42572	05	Anesthesiology	0	In state provider	SANTA CLARITA SURGERY	23861 MCBEAN PKWY	STE A-1	VALENCIA	CA	91355	2003	19	06037	34.39567343	-118.5542698	Los Angeles County
268942	Fee-for-Service	1437577343	1437577343	1	1	GOBRIAL, MARK N	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148741	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
268982	Fee-for-Service	1669768438	1669768438	1	1	GARBER, BRYAN J MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124745	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
268985	Fee-for-Service	1396190153	1396190153	1	1	GENSTLER, KEREN C MD	6/27/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	151049	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
269003	Fee-for-Service	1811084676	1811084676	1	16	GOLDEN BEAR PHYSICAL THERAPY	8/10/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	2908 E WHITMORE AVE	STE E	CERES	CA	95307	2800	50	06099	37.59473048	-120.9412035	Stanislaus County
269022	Fee-for-Service	1174043442	1174043442	1	1	GENTILE, CHRISTIAN G AU	10/28/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
269057	Fee-for-Service	1700268232	1700268232	1	1	GOOD MEASURE FAMILY	9/4/2018	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COUNSELING INC	38800 SKY CANYON DR	STE B	MURRIETA	CA	92563	2540	33	06065	33.55625282	-117.1375585	Riverside County
269102	Fee-for-Service	1285798223	1285798223	1	1	GREIER, KARIN M	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
269112	Fee-for-Service	1457849432	1457849432	1	1	GOYAL, ANJU MD	4/24/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	165150	68	Hematology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
269114	Fee-for-Service	1639255169	1639255169	1	1	GREENBERG, DEBORA B MD	8/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	40957	22	Pathology (M.D. only)	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
269126	Fee-for-Service	1699047225	1699047225	2	1	GOLDEN STATE CARDIAC AND	4/1/2012	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	THORACIC SURGERY INC	505 W MAIN ST	SUITE 405	VISALIA	CA	93291	0000	54	06107	36.330003	-119.297097	Tulare County
269159	Fee-for-Service	1508958240	1508958240	1	1	GORSKI, TITO F MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68155	02	General Surgery	0	In state provider	None	36320 INLAND VALLEY DR	SUITE 201	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
269165	Fee-for-Service	1902364151	1902364151	1	1	GONZALEZ, KIMBERLY NP	8/17/2020	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	500 OLD RIVER RD	250	BAKERSFIELD	CA	93311	9515	15	06029	35.35127492	-119.1142991	Kern County
269191	Fee-for-Service	1306529284	1306529284	1	1	GRIFFITHS, ADRIANNE CNP	1/22/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3327 ROSECRANS ST	None	SAN DIEGO	CA	92110	4223	37	06073	32.74779742	-117.2076448	San Diego County
269223	Fee-for-Service	1528216546	1528216546	1	1	GUPTA, SHILPA DO	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12178	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
269258	Fee-for-Service	1225220114	1225220114	1	1	GOGIA, MANEESH K MD	10/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102160	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
269271	Fee-for-Service	1578694113	1578694113	1	1	GRAMMATICO, MARGHERITA V	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
269289	Fee-for-Service	1003162868	1003162868	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	280 E VIA RANCHO PKWY	None	ESCONDIDO	CA	92025	8005	37	06073	33.06855532	-117.0663192	San Diego County
269393	Fee-for-Service	1457849432	1457849432	1	1	GOYAL, ANJU MD	4/24/2024	2080P0207X	NA	Hematology	026	PHYSICIANS	165150	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
269406	Fee-for-Service	1447278429	1447278429	1	1	GOODMAN, CYNTHIA M MD	12/1/2000	208200000X	NA	General Surgery	026	PHYSICIANS	73359	24	Plastic Surgery	0	In state provider	None	1240 S ELISEO DR	STE 201	GREENBRAE	CA	94904	2027	21	06041	37.94422763	-122.5361926	Marin County
269442	Fee-for-Service	1528528668	1528528668	1	1	GEORGE, JOSE MD	7/3/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	179948	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
269450	Fee-for-Service	1578601571	1578601571	1	1	GUIDE, ANAHITA MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79739	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
269501	Fee-for-Service	1710334487	1710334487	1	1	GENMAR HOMES INC	8/22/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1942 THOREAU STREET	None	LOS ANGELES	CA	90047	4725	19	06037	33.93564623	-118.3125748	Los Angeles County
269566	Fee-for-Service	1083106637	1083106637	1	1	GOWER, ARJAN MD	4/24/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	164983	41	Internal Medicine	0	In state provider	None	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
269583	Fee-for-Service	1770783250	1770783250	1	1	GOLDYN, SHERYL R MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102296	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
269610	Fee-for-Service	1760821888	1760821888	1	1	GOODMAN, DAVID JR	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141304	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
269639	Fee-for-Service	1235364878	1235364878	1	1	GONZALEZ, JOSHUA R MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129702	34	Urology and Urological Surgery	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
269643	Fee-for-Service	1821038159	1821038159	1	1	GORDON, SCOTT M MD	3/17/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171153	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
269663	Fee-for-Service	1881668796	1881668796	1	1	GRASS VALLEY DIALYSIS	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	360 CROWN POINT CIRCLE	STE 210	GRASS VALLEY	CA	95945	2543	29	06057	39.22016193	-121.0288872	Nevada County
269685	Fee-for-Service	1497078810	1497078810	1	1	GARDNER, SHANNA CCC-SLP	3/3/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
269754	Fee-for-Service	1942756143	1942756143	1	1	GARCIA, DAVID MD	8/7/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169322	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
269840	Fee-for-Service	1285845032	1285845032	1	1	GANESH KAKARLAPUDI	4/9/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 HOSPITAL DR	STE 325	BATAVIA	OH	45103	1986	00	None	39.08059702	-84.14696917	Clermont County
269845	Fee-for-Service	1083106637	1083106637	1	1	GOWER, ARJAN MD	4/24/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	164983	68	Hematology	0	In state provider	None	2020 SANTA MONICA BLVD	210, 220, 230, 240	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
269877	Fee-for-Service	1427047463	1427047463	1	1	GLENN C COOK,MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7400 E THOMPSON PEAK PKW	None	SCOTTSDALE	AZ	85255	4109	00	None	33.670791	-111.921669	Maricopa County
269886	Fee-for-Service	1760821888	1760821888	1	1	GOODMAN, DAVID JR	4/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141304	77	Infectious Disease	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
269890	Fee-for-Service	1518985738	1518985738	1	1	GRAU, MARITZA LCSW	12/5/2024	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
269905	Fee-for-Service	1477013357	1477013357	1	1	GONZALES, MANUEL M MD	2/7/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	182215	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
269937	Fee-for-Service	1811084676	1811084676	1	19	GOLDEN BEAR PHYSICAL THERAPY	10/21/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPORTS INJURY CENTER, I	1019 S MAIN ST	None	MANTECA	CA	95337	5703	39	06077	37.78880388	-121.2161899	San Joaquin County
269951	Fee-for-Service	1891771168	1891771168	1	1	GROSSMAN, LAUREN S MD	2/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152577	66	Emergency Medicine (Urgent Care)	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
269982	Fee-for-Service	1639104136	1639104136	1	1	GASTROENTEROLOGY	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	1	Border provider	CONSULTANTS P C	2860 CREEKSIDE CIR	None	MEDFORD	OR	97504	8442	00	None	42.31518009	-122.8313093	Jackson County
269983	Fee-for-Service	1043525504	1043525504	1	1	GARCIA, CARLOS A MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121546	05	Anesthesiology	0	In state provider	None	3330 WEST LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
269996	Fee-for-Service	1285887042	1285887042	1	1	GOO, TYRALEE M MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112645	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
270040	Fee-for-Service	1639520349	1639520349	1	1	GIANG, MICHAEL E MD	6/6/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154039	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
270050	Fee-for-Service	1629371927	1629371927	1	1	GUPTA, RISHI J MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126825	02	General Surgery	0	In state provider	None	2521 STOCKTON BLVD	STE 200	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
270093	Fee-for-Service	1861847048	1861847048	1	1	GARCIA, MARK C MD	10/7/2021	2080P0207X	NA	Hematology	026	PHYSICIANS	162813	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
270094	Fee-for-Service	1548283187	1548283187	1	2	GARNER, STEVEN L MD FACS	4/29/2019	208200000X	NA	General Surgery	086	MEDICAL DIRECTORS	68153	-	NOT APPLICABLE	0	In state provider	None	707 FAIR AVE	None	SANTA CRUZ	CA	95060	5840	44	06087	36.95634406	-122.0452904	Santa Cruz County
270187	Fee-for-Service	1629497193	1629497193	1	1	GOPAL, SAVITA S MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149426	01	General Practice	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
270190	Fee-for-Service	1174706527	1174706527	1	1	GULATYAN, LUCY LMFT	1/28/2020	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
270206	Fee-for-Service	1124036462	1124036462	1	1	GHAZINOOR, SHAYA MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76305	30	Radiology	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
270210	Fee-for-Service	1144218512	1144218512	1	1	GASTROENTEROLOGY CONSULT	1/3/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	1	Border provider	LTD	880 RYLAND ST	None	RENO	NV	89502	1603	00	None	39.52378631	-119.8009873	Washoe County
270243	Fee-for-Service	1245722529	1245722529	1	1	GLICKSBERG, MIRIAM C AU	11/5/2018	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	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
270261	Fee-for-Service	1942426135	1942426135	1	1	GOLDEN CARE MEDICAL GRP	2/28/1996	363A00000X	NA	Physician Assistant	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	6330 VAN NUYS BLVD	None	VAN NUYS	CA	91401	2610	19	06037	34.18546095	-118.4487065	Los Angeles County
270271	Fee-for-Service	1790710903	1790710903	1	1	GRIFFITH, DAVID L MD	10/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
270276	Fee-for-Service	1255362679	1255362679	1	1	GOFFIGAN, JOHN C MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72847	None	None	0	In state provider	None	9320 BASELINE RD	STE C	RANCHO CUCAMONGA	CA	91701	5829	36	06071	34.12156453	-117.6018255	San Bernardino County
270297	Fee-for-Service	1902814759	1902814759	1	1	GLENDALE DIAGNOSTIC	9/25/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IMAGING NETWORK MEDICAL	800 S CENTRAL AVE	STE 100B	GLENDALE	CA	91204	4375	19	06037	34.13654729	-118.2578243	Los Angeles County
270325	Fee-for-Service	1629371927	1629371927	1	1	GUPTA, RISHI J MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126825	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	STE 200	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
270326	Fee-for-Service	1962764340	1962764340	1	1	GOLDEN ARDAYA & LIN	11/19/2012	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY INC	11245 E WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
270357	Fee-for-Service	1144812322	1144812322	1	1	GLOBE HOME HEALTH CARE INC	11/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1010 N GLENDALE AVE	SUITE 208	GLENDALE	CA	91206	2121	19	06037	34.16066484	-118.2372103	Los Angeles County
270371	Fee-for-Service	1841434115	1841434115	1	1	GRACE, ELIZABETH M MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120712	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
270399	Fee-for-Service	1801452180	1801452180	1	1	GOOD LIFE PALLLIATIVE CARE	1/26/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20953 DEVONSHIRE ST	STE #8A	CHATSWORTH	CA	91311	2371	19	06037	34.25728152	-118.5904935	Los Angeles County
270421	Fee-for-Service	1336427186	1336427186	1	1	GUNTHER, DANIEL J LCSW	10/31/2016	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	801 PORTOLA DRIVE	STE 207	SAN FRANCISCO	CA	94127	1234	38	06075	37.74384194	-122.4540609	San Francisco County
270442	Fee-for-Service	1801080197	1801080197	1	1	GELAREH K ALAVI M.D.	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3300 GALLOWS RD	None	FALLS CHURCH	VA	22042	3307	00	None	38.858193	-77.226426	City of Fairfax
270443	Fee-for-Service	1558657361	1558657361	1	1	GILES, ERIN E DO	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12661	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
270508	Fee-for-Service	1518478478	1518478478	1	1	GLOBAL MERCANTILE INC	4/29/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	28863 INDUSTRY DR	None	VALENCIA	CA	91355	5419	19	06037	34.45523539	-118.6381548	Los Angeles County
270519	Fee-for-Service	1265965107	1265965107	1	1	GORE, NIKITA C MD	9/15/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169850	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
270524	Fee-for-Service	1700860871	1700860871	1	2	GOLDEN STATE DERMATOLOGY ASS	3/7/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	6769 N FRESNO ST	STE 101	FRESNO	CA	93710	3715	10	06019	36.83686637	-119.7813437	Fresno County
270526	Fee-for-Service	1548201791	1548201791	1	1	GOLDBERG, IRWIN M MD	5/31/1988	174400000X	NA	Other	026	PHYSICIANS	31901	47	Miscellaneous	0	In state provider	None	510 N PROSPECT AVE	STE 310	REDONDO BEACH	CA	90277	3032	19	06037	33.85259344	-118.379739	Los Angeles County
270539	Fee-for-Service	1942426135	1942426135	1	1	GOLDEN CARE MEDICAL GRP	2/28/1996	363A00000X	NA	Physician Assistant	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6330 VAN NUYS BLVD	None	VAN NUYS	CA	91401	2610	19	06037	34.18546095	-118.4487065	Los Angeles County
270563	Fee-for-Service	1710178520	1710178520	1	1	GILGENBERG-CASTILLO, KIMBERL	11/7/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	Y A LCSW	982 MISSION STREET	None	SAN FRANCISCO	CA	94103	2911	38	06075	37.7813638	-122.4082438	San Francisco County
270599	Fee-for-Service	1811075526	1811075526	1	1	GOODWIN, HILLARY C MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	83315	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
270624	Fee-for-Service	1275547705	1275547705	2	1	GOULD, RICHARD A MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	52934	40	Pediatrics	0	In state provider	None	425 UNIVERSITY AVE	STE 200	SACRAMENTO	CA	95825	6509	34	06067	38.570067	-121.4177265	Sacramento County
270648	Fee-for-Service	1962526806	1962526806	1	1	GALLERIA MEDICAL CLINIC INC	1/6/2015	207R00000X	NA	Other	026	PHYSICIANS	52655	41	Internal Medicine	0	In state provider	None	2340 E 8TH STREET	SUITE J	NATIONAL CITY	CA	91950	2876	37	06073	32.6824287	-117.0833043	San Diego County
270678	Fee-for-Service	1801452180	1801452180	1	1	GOOD LIFE PALLLIATIVE CARE	1/26/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20953 DEVONSHIRE ST	STE #8A	CHATSWORTH	CA	91311	2371	19	06037	34.25728152	-118.5904935	Los Angeles County
270692	Fee-for-Service	1770773301	1770773301	1	1	GRUNSTEIN, LEV L MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109055	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
270706	Fee-for-Service	1992955793	1992955793	1	1	GOLDEN WELLNESS RX INC	5/26/2009	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	GOLDEN WELLNESS RX	1230 MONTANA AVE	STE 106	SANTA MONICA	CA	90403	5986	19	06037	34.03120426	-118.4963686	Los Angeles County
270725	Fee-for-Service	1407352743	1407352743	1	1	GHEBRENDRIAS, SELEMAWIT	12/30/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166026	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
270743	Fee-for-Service	1952529422	1952529422	1	2	GIVEN, JEANNETTE E PHD	9/20/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	582 MARKET ST	SUITE 408	SAN FRANCISCO	CA	94104	5301	38	06075	37.78931415	-122.4013437	San Francisco County
270807	Fee-for-Service	1417930975	1417930975	1	1	GIANZERO, MARC VINCENT	2/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54882	01	General Practice	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
270812	Fee-for-Service	1790771152	1790771152	1	1	GARRETT, ROBERT E 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 DR	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
270818	Fee-for-Service	1942426135	1942426135	1	1	GOLDEN CARE MEDICAL GRP	2/28/1996	363A00000X	NA	Physician Assistant	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	6330 VAN NUYS BLVD	None	VAN NUYS	CA	91401	2610	19	06037	34.18546095	-118.4487065	Los Angeles County
270869	Fee-for-Service	1942598289	1942598289	1	1	GARZA, CHRISTINA Z MD	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127969	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
270871	Fee-for-Service	1457891137	1457891137	1	1	GREEN, HEATHER LMFT	11/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1221 STATE ST	STE 12-92023	SANTA BARBARA	CA	93101	2648	42	06083	34.42387954	-119.7052267	Santa Barbara County
270883	Fee-for-Service	1013658749	1013658749	1	1	GUINA, JESSICA CRNA	2/21/2024	163WC0200X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	75 NIELSON	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
270897	Fee-for-Service	1417375940	1417375940	1	1	GUPTA, NUPUR DO	12/20/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	22801	77	Infectious Disease	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
270901	Fee-for-Service	1285675314	1285675314	1	1	GREWAL, GAGANDEEP S MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68101	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
270905	Fee-for-Service	1316218266	1316218266	1	1	GUEVARA, JUANITA M LCSW	9/29/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7365 CARNELIAN ST	STE 202	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
270953	Fee-for-Service	1508090671	1508090671	1	1	GEORGE, LILY MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	50342	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
270957	Fee-for-Service	1093210742	1093210742	1	1	GOPALAN, ANU DO	11/16/2023	207P00000X	NA	Other	026	PHYSICIANS	21096	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
270966	Fee-for-Service	1598389603	1598389603	1	1	GRANT, MEGAN T NP	2/16/2023	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
270970	Fee-for-Service	1790084143	1790084143	1	1	GARIBYAN, VARTAN N DO	7/29/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	12504	06	Cardiovascular Disease (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
270980	Fee-for-Service	1790728277	1790728277	1	1	GERBERICH, BRADLEY K MD	7/31/1987	207P00000X	NA	Other	026	PHYSICIANS	61036	None	None	0	In state provider	None	7860 MISSION CENTER CT	# 20	SAN DIEGO	CA	92108	1329	37	06073	32.77370228	-117.1549878	San Diego County
270987	Fee-for-Service	1972008993	1972008993	1	1	GREENLEE, MACKENZIE G	2/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3737 MORAGA AVE	A203	SAN DIEGO	CA	92117	5491	37	06073	32.8086683	-117.2109991	San Diego County
271010	Fee-for-Service	1407112428	1407112428	1	1	GO, MINJOUNG MD	6/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126614	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
271023	Fee-for-Service	1447644885	1447644885	1	1	GREIF, SHANA	3/2/2018	390200000X	NA	Other	026	PHYSICIANS	146672	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
271025	Fee-for-Service	1770296451	1770296451	1	1	GATHUU, MARY WANJIKU	1/12/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1267 BEE BALM ROAD	None	HEMET	CA	92545	8725	33	06065	33.72597592	-117.0042645	Riverside County
271032	Fee-for-Service	1962483099	1962483099	1	1	GORDON, JOHN B MD III	10/10/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	42631	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	7901 FROST ST	FL 9	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
271038	Fee-for-Service	1720096639	1720096639	1	1	GILL, AJAIPAL S MD	5/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	55220	41	Internal Medicine	0	In state provider	None	414 G ST	STE 221	MARYSVILLE	CA	95901	5663	58	06115	39.13913942	-121.5934649	Yuba County
271070	Fee-for-Service	1437355765	1437355765	1	1	GAARDER, KIRSTEN L MD	8/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55837	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	93405	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271084	Fee-for-Service	1356414262	1356414262	1	1	GLAZE, NIJOLE	12/23/1997	207R00000X	NA	Other	026	PHYSICIANS	63700	01	General Practice	0	In state provider	None	3737 MARTIN LUTHER KING	SUITE 404	LYNWOOD	CA	90262	3534	19	06037	33.92872742	-118.2006921	Los Angeles County
271099	Fee-for-Service	1831613231	1831613231	1	1	GUARDIAN PHARMACY OF SOUTHER	9/1/2017	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA LLC	184 EAST LIBERTY AVE	None	ANAHEIM	CA	92801	1011	30	06059	33.8609912	-117.9163352	Orange County
271103	Fee-for-Service	1811074404	1811074404	1	1	GALLEGO, HUMBERTO MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87386	07	Dermatology	0	In state provider	None	19066 MAGNOLIA AVE	None	HUNTINGTON BEACH	CA	92646	2232	30	06059	33.68568661	-117.9714001	Orange County
271180	Fee-for-Service	1467820639	1467820639	1	1	GARFIELD BEACH CVS LLC	11/25/2015	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1745 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4243	13	06025	32.77792365	-115.569499	Imperial County
271189	Fee-for-Service	1063839843	1063839843	1	1	GOOD SAMARITAN SHELTER	4/7/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	104 SOUTH C STREET	SUITE A	LOMPOC	CA	93436	6924	42	06083	34.638645	-120.4514709	Santa Barbara County
271192	Fee-for-Service	1982688990	1982688990	1	1	GITLIN, GRAHAM MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63525	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
271197	Fee-for-Service	1154343846	1154343846	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3401 MALL VIEW ROAD	None	BAKERSFIELD	CA	93306	3060	15	06029	35.3948702	-118.9549703	Kern County
271207	Fee-for-Service	1659867489	1659867489	1	1	GOLDSTEIN, MITCHELL NP	4/30/2024	363LF0000X	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
271215	Fee-for-Service	1568766517	1568766517	1	1	GHOBRIAL, MARIANNE M MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118274	41	Internal Medicine	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
271220	Fee-for-Service	1902824089	1902824089	1	1	GREWAL, RASVIN S MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86539	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
271225	Fee-for-Service	1295475648	1295475648	1	1	GRANT SERENITY HOMES INC	10/6/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	409 WING STREET	None	GLENDALE	CA	91205	1915	19	06037	34.14132766	-118.2384391	Los Angeles County
271257	Fee-for-Service	1487813366	1487813366	1	1	GRAHAM, MARIANA LMFT	3/29/2019	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
271270	Fee-for-Service	1598099939	1598099939	1	1	GARFIELD BEACH CVS LLC	11/29/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	102 S SANDERSON AVE	None	SAN JACINTO	CA	92582	3730	33	06065	33.786711	-117.0067955	Riverside County
271274	Fee-for-Service	1992230403	1992230403	1	1	GHERMEZI, MICHAEL MD	9/9/2020	207P00000X	NA	Other	026	PHYSICIANS	163852	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
271301	Fee-for-Service	1770296451	1770296451	1	1	GATHUU, MARY WANJIKU	1/12/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1267 BEE BALM ROAD	None	HEMET	CA	92545	8725	33	06065	33.72597592	-117.0042645	Riverside County
271307	Fee-for-Service	1922471895	1922471895	1	1	GNASS, RONALDO D MD	9/6/2017	207ZP0101X	NA	Other	026	PHYSICIANS	103463	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
271313	Fee-for-Service	1720096639	1720096639	1	1	GILL, AJAIPAL S MD	5/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	55220	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	414 G ST	STE 221	MARYSVILLE	CA	95901	5663	58	06115	39.13913942	-121.5934649	Yuba County
271328	Fee-for-Service	1952529422	1952529422	1	1	GIVEN, JEANNETTE E PHD	4/25/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VIICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
271366	Fee-for-Service	1336256148	1336256148	1	1	GARDNER, ROBERT W MD	10/22/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	67955	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
271373	Fee-for-Service	1275725897	1275725897	1	2	GILMORE, NATHAN T MD	8/10/2023	207RC0200X	NA	Other	026	PHYSICIANS	126324	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
271422	Fee-for-Service	1427340488	1427340488	1	1	GLEZER, ROBYN G DO	9/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12584	01	General Practice	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
271461	Fee-for-Service	1831558329	1831558329	1	1	GUPTA, SHELLY MD	9/17/2021	390200000X	NA	Other	026	PHYSICIANS	151829	None	None	0	In state provider	None	6380 CLARK AVE	SUITE C-1	DUBLIN	CA	94568	3036	01	06001	37.70451998	-121.9205494	Alameda County
271492	Fee-for-Service	1801449145	1801449145	1	1	GIBBS, PAUL J PHD	5/10/2024	103T00000X	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
271514	Fee-for-Service	1427217421	1427217421	1	1	GAINES, KIMBERLY A LMFT	12/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39755 MURRIETA HOT SPRIN	SUITE D160	MURRIETA	CA	92563	9113	33	06065	33.55575954	-117.1627899	Riverside County
271559	Fee-for-Service	1861973406	1861973406	1	1	GARLIT, NICOLE ASHLEY M PT	3/9/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
271561	Fee-for-Service	1326364282	1326364282	1	1	GUEZ, GHISLAINE Y MD	2/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123617	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
271568	Fee-for-Service	1528274701	1528274701	1	1	GUPTILL, MINDI J MD	6/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101689	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
271578	Fee-for-Service	1578521811	1578521811	1	1	GYVES-RAY, KATHERINE M MD	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	88889	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
271582	Fee-for-Service	1598100067	1598100067	1	1	GEET GANDHI, MD	1/6/2021	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
271605	Fee-for-Service	1861451841	1861451841	1	1	GIDDAS HOME HEALTH SERVICES	2/10/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13351 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	5802	19	06037	33.91121233	-118.3528005	Los Angeles County
271613	Fee-for-Service	1700842697	1700842697	2	1	GREWAL, HARPREET MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40558	08	Family Practice	0	In state provider	None	530 W EATON AVE	SUITE K	TRACY	CA	95376	3455	39	06077	37.74328351	-121.433886	San Joaquin County
271653	Fee-for-Service	1275274003	1275274003	1	1	GREGOR MEDICAL CORPORATION	6/23/2022	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9377 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5340	36	06071	34.083504	-117.575611	San Bernardino County
271676	Fee-for-Service	1437348968	1437348968	1	1	GAWAD, CHARLES MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101795	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271679	Fee-for-Service	1053766030	1053766030	1	1	GARRISON-DIEHN, CHRISTINA G	9/12/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
271683	Fee-for-Service	1225311806	1225311806	1	1	GIETZEN, MEGAN E PSYD	3/23/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
271689	Fee-for-Service	1881624583	1881624583	1	9	GENESISCARE OF CALIFORNIA, A	2/26/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	11190 WARNER AVENUE	SUITE 115	FOUNTAIN VALLEY	CA	92708	4028	30	06059	33.714	-117.9333585	Orange County
271726	Fee-for-Service	1720570963	1720570963	1	1	GEE, TIFFANY F MD	10/7/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179413	None	None	0	In state provider	None	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	07	06013	37.77580025	-121.9664884	Contra Costa County
271771	Fee-for-Service	1174802961	1174802961	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8251 MIRA MESA BLVD	None	SAN DIEGO	CA	92126	2603	37	06073	32.910282	-117.1460295	San Diego County
271786	Fee-for-Service	1396853818	1396853818	1	1	GOUMAS, REA C MD	2/28/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	57279	40	Pediatrics	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
271834	Fee-for-Service	1114963279	1114963279	1	1	GARFIELD BEACH CVS, LLC	9/9/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1020 IRVINE AVE.	None	NEWPORT BEACH	CA	92660	4602	30	06059	33.627816	-117.906624	Orange County
271879	Fee-for-Service	1902820905	1902820905	1	1	GOLDFARB, LILLIAN J LMSW	5/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1000 BUSINESS CENTER CIR	100	NEWBURY PARK	CA	91320	1938	56	06111	34.19271	-118.9425915	Ventura County
271898	Fee-for-Service	1245818517	1245818517	1	1	GROSS, CASSANDRA A MD	3/17/2025	207RG0300X	NA	Adult Primary Care	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
271904	Fee-for-Service	1184924193	1184924193	1	2	GOLDEN STATE RADIATION ONCOL	1/11/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SAN FERNANDO VALLEY	21300 ERWIN ST	None	WOODLAND HILLS	CA	91367	3717	19	06037	34.1828125	-118.5957855	Los Angeles County
271928	Fee-for-Service	1275274003	1275274003	1	1	GREGOR MEDICAL CORPORATION	6/23/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	9377 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5340	36	06071	34.083504	-117.575611	San Bernardino County
271930	Fee-for-Service	1184147662	1184147662	1	1	GEORGE M. ZAKHARY D.D.S., M.	8/14/2017	261QS0112X	NA	Other	026	PHYSICIANS	None	85	Surgery-Pediatric	0	In state provider	D., INC	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
271951	Fee-for-Service	1437348968	1437348968	1	1	GAWAD, CHARLES MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101795	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
271975	Fee-for-Service	1912982620	1912982620	1	1	GUSTAFSON, COREY G DO	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13551	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
271987	Fee-for-Service	1194716498	1194716498	1	2	GARRICK, JOCELYN F MD	1/22/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	78711	-	NOT APPLICABLE	0	In state provider	None	2035 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1088	01	06001	37.71033965	-122.1212739	Alameda County
271988	Fee-for-Service	1679014211	1679014211	1	1	GOLDHOR, SASCHA LMFT	5/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	790 E SANTA CLARA ST	101C	VENTURA	CA	93001	2964	56	06111	34.27950947	-119.2888755	Ventura County
271999	Fee-for-Service	1447308259	1447308259	1	1	GELPI, CARLOS E MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	48339	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
272046	Fee-for-Service	1427617117	1427617117	1	1	GOLDBERG, JENNIFER MD	9/9/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181124	None	None	0	In state provider	None	568 N SUNRISE AVE	STE 250	ROSEVILLE	CA	95661	3035	31	06061	38.7576732	-121.2534645	Placer County
272049	Fee-for-Service	1376702282	1376702282	1	1	GRAY, JAMIE L LCSW	1/7/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	980 PLACER ST	None	REDDING	CA	96001	1125	45	06089	40.58374257	-122.384609	Shasta County
272065	Fee-for-Service	1861521205	1861521205	1	1	GOSHGARIAN, PAUL SAMUEL	12/1/2004	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1220 S BELHAVEN ST	SUITE 31	ANAHEIM	CA	92806	5231	30	06059	33.81682299	-117.8848164	Orange County
272105	Fee-for-Service	1811084676	1811084676	1	10	GOLDEN BEAR PHYSICAL THERAPY	12/29/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	1222 W COLONY RD	STE 130	RIPON	CA	95366	9480	39	06077	37.75395862	-121.136171	San Joaquin County
272112	Fee-for-Service	1831213958	1831213958	1	1	GARDNER, CARTER C PHD	12/8/2016	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4700 SPRING STREET	SUITE 204	LA MESA	CA	91942	0263	37	06073	32.76503682	-117.0203822	San Diego County
272172	Fee-for-Service	1245818517	1245818517	1	1	GROSS, CASSANDRA A MD	3/17/2025	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	38	Geriatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
272201	Fee-for-Service	1275274003	1275274003	1	1	GREGOR MEDICAL CORPORATION	6/6/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9377 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5340	36	06071	34.083504	-117.575611	San Bernardino County
272204	Fee-for-Service	1477302305	1477302305	1	1	GRIGORYAN, TATEVIK NP	3/11/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
272224	Fee-for-Service	1437348968	1437348968	1	1	GAWAD, CHARLES MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101795	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
272229	Fee-for-Service	1972049021	1972049021	1	1	GONZALES, DAVID C	4/27/2017	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
272259	Fee-for-Service	1497569412	1497569412	1	1	GARCIA, SANDY E LCSW	2/10/2025	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
272262	Fee-for-Service	1972335073	1972335073	1	1	GUMASTE, KRISHNA A PT	10/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	177 NORTH REINO RD	None	NEWBURY PARK	CA	91320	3710	56	06111	34.18076257	-118.9529104	Ventura County
272263	Fee-for-Service	1528383437	1528383437	1	1	GOMEZ, JESUS E MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118900	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
272284	Fee-for-Service	1700236841	1700236841	1	1	GARLICH, JOHN M MD	9/16/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	142256	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
272292	Fee-for-Service	1992967210	1992967210	1	1	GARG, JOY MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	89494	02	General Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
272303	Fee-for-Service	1063410421	1063410421	1	1	GREENBERG, TODD MD	12/13/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54573	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
272304	Fee-for-Service	1821371022	1821371022	1	1	GREEN, ERICK J MD	4/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	130378	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2021 HERNDON AVE	SUITE 101	CLOVIS	CA	93611	6101	10	06019	36.83757551	-119.6792955	Fresno County
272356	Fee-for-Service	1568698090	1568698090	1	1	GUTIERREZ, JUAN R MD	5/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108242	40	Pediatrics	0	In state provider	None	1001 POTRERRO AVE	6E 6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
272380	Fee-for-Service	1811084676	1811084676	1	2	GOLDEN BEAR PHYSICAL THERAPY	12/27/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	1229 COMMERCE AVE	None	ATWATER	CA	95301	5224	24	06047	37.34298769	-120.6128556	Merced County
272401	Fee-for-Service	1255112389	1255112389	1	1	GARCIA, BRIANNA PT	11/29/2023	225100000X	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
272467	Fee-for-Service	1720412679	1720412679	2	1	GARFIELD BEACH CVS LLC	12/26/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2675 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3400	38	06075	37.78227651	-122.4465218	San Francisco County
272473	Fee-for-Service	1851941876	1851941876	1	1	GOOD SAMARITAN MED SUPPLY IN	5/18/2020	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	C	37555 SYCAMORE ST	7	NEWARK	CA	94560	3939	01	06001	37.52634396	-122.031224	Alameda County
272501	Fee-for-Service	1356498976	1356498976	1	1	GHASRI, PEYMAN MD APC	2/23/2010	207N00000X	NA	Dermatology	026	PHYSICIANS	83809	01	General Practice	0	In state provider	None	5363 BALBOA BLVD	#333	ENCINO	CA	91316	2805	19	06037	34.169058	-118.5011265	Los Angeles County
272532	Fee-for-Service	1245817931	1245817931	1	1	GATTI, MALLOREY R PSYD	6/18/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
272555	Fee-for-Service	1194390260	1194390260	1	1	GREINER, HOLLY	3/14/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1827 KNOLL DR	None	VENTURA	CA	93003	7321	56	06111	34.25641704	-119.2199387	Ventura County
272648	Fee-for-Service	1356456008	1356456008	1	1	GREEN, LOUISE B PHD	9/2/2008	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5333 MISSION CENTER RD	STE 354	SAN DIEGO	CA	92108	1350	37	06073	32.77178608	-117.1547851	San Diego County
272674	Fee-for-Service	1679528897	1679528897	2	1	GUERRA, BILLIE Y DO	10/14/2014	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	8965	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1111 N CHINA LAKE BLVD	SUITE 190	RIDGECREST	CA	93555	3131	15	06029	35.64171	-117.669847	Kern County
272682	Fee-for-Service	1861567620	1861567620	1	1	GAREY DIALYSIS CENTER	1/29/1998	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	PARTNERSHIP	120 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3364	19	06037	34.13598151	-117.8662995	Los Angeles County
272703	Fee-for-Service	1366061491	1366061491	1	1	GELZAYD, EVAN MD	7/4/2024	207L00000X	NA	Other	026	PHYSICIANS	185820	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
272718	Fee-for-Service	1770809337	1770809337	1	1	GATES, CAROLYN A MD	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117795	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9542 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87472553	-118.1294775	Los Angeles County
272750	Fee-for-Service	1679060917	1679060917	1	1	GUSOFF, GEOFFREY M MD	7/26/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174094	None	None	0	In state provider	None	1920 COLORADO AVENUE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
272782	Fee-for-Service	1477038370	1477038370	1	1	GEILFUSS, JOSEPH	6/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
272802	Fee-for-Service	1801338793	1801338793	1	1	GUEVARRA, MARIANNE CNP	10/7/2021	363LF0000X	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
272887	Fee-for-Service	1629012612	1629012612	1	1	GLASS, EDWIN C MD	12/12/2019	207U00000X	NA	Other	026	PHYSICIANS	35240	42	Nuclear Medicine	0	In state provider	None	2827 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	4801	19	06037	34.03803747	-118.4750347	Los Angeles County
272919	Fee-for-Service	1275976037	1275976037	1	1	GUPTA, PRABHAS MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139676	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
273073	Fee-for-Service	1447671037	1447671037	1	1	GRACE-BRAUN, VIRGINIA LPCC	11/16/2023	101Y00000X	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
273116	Fee-for-Service	1548473465	1548473465	1	1	GREGORIUS, DAVID D DO	2/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9897	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
273125	Fee-for-Service	1427041672	1427041672	1	1	GALINDO,BENEDICTO 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	94-366 PUPUPANI ST	STE # 118	WAIPAHU	HI	96797	0000	00	None	21.38140249	-158.0167966	Honolulu County
273163	Fee-for-Service	1891365078	1891365078	1	1	GOLDENBERG, MITCHELL G MD	8/21/2023	208800000X	NA	Other	026	PHYSICIANS	173371	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
273196	Fee-for-Service	1235149675	1235149675	1	1	GEIGER, MITCHELL H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69795	20	Orthopedic Surgery	0	In state provider	None	770 MAGNOLIA AVE	STE 1D	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
273228	Fee-for-Service	1003825571	1003825571	1	1	GILANI, SAPIDEH MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80720	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
273230	Fee-for-Service	1710286034	1710286034	1	1	GONZALEZ, LISA-MARIE LMFT	11/17/2020	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
273280	Fee-for-Service	1831401207	1831401207	1	1	GUTHRIE, CARLY C MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142772	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
273313	Fee-for-Service	1477003044	1477003044	1	1	GORDON, BRIAN MD	7/21/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	145371	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
273326	Fee-for-Service	1538745369	1538745369	1	1	GLENN, CHASE MD	4/4/2024	390200000X	NA	Other	026	PHYSICIANS	182137	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
273367	Fee-for-Service	1780763771	1780763771	1	1	GILMORE, MELISSA P MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82928	05	Anesthesiology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
273374	Fee-for-Service	1033140801	1033140801	1	1	GORDON, SCOTT A MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61930	41	Internal Medicine	0	In state provider	None	5750 DOWNEY AVE	STE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
273419	Fee-for-Service	1558439935	1558439935	1	1	GENNIS, DAVID P LMFT	7/23/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	46820	-	NOT APPLICABLE	0	In state provider	None	905-907 PICO BLVD	None	SANTA MONCIA	CA	90405	1326	19	06037	34.0130557	-118.4815764	Los Angeles County
273425	Fee-for-Service	1902967565	1902967565	1	1	GUTIERREZ, DENISE	11/26/2012	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
273434	Fee-for-Service	1639131709	1639131709	1	1	GILMORE, GERALD T MD	5/24/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	842 E MAIN ST	None	MEDFORD	OR	97504	7134	00	None	42.32787853	-122.863311	Jackson County
273458	Fee-for-Service	1578132171	1578132171	1	1	GRIMALDO, STEPHANIE LPCC	5/17/2024	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
273462	Fee-for-Service	1922395888	1922395888	1	1	GUERRERO, REYNA LMFT	1/28/2021	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
273468	Fee-for-Service	1760526289	1760526289	1	1	GLENOAKS MEDICAL CENTER INC	9/29/2015	207R00000X	NA	Other	026	PHYSICIANS	52175	None	None	0	In state provider	None	1911 W GLENOAKS BLVD	STE B	GLENDALE	CA	91201	4746	19	06037	34.17434179	-118.2939072	Los Angeles County
273481	Fee-for-Service	1003979873	1003979873	1	1	GADDE, KISHORE M MD	1/4/2023	2084B0002X	NA	Psychiatry	026	PHYSICIANS	182643	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 53	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
273492	Fee-for-Service	1851401251	1851401251	1	1	G&E HEALTHCARE SERVICES	10/1/1998	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ASTORIA NURSING & REHAB	14040 ASTORIA ST	None	SYLMAR	CA	91342	2949	19	06037	34.3111872	-118.4390874	Los Angeles County
273493	Fee-for-Service	1104843960	1104843960	1	1	GANCAYCO, ANTONIO M MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50208	40	Pediatrics	0	In state provider	None	1164 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849621	-117.941612	Orange County
273503	Fee-for-Service	1124064282	1124064282	1	1	GARFIELD BEACH CVS, LLC	5/1/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5020 W 190TH ST	None	TORRANCE	CA	90503	1004	19	06037	33.85824648	-118.363374	Los Angeles County
273529	Fee-for-Service	1083872618	1083872618	1	1	GOGIA, RAVINDER S MD	10/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114126	07	Dermatology	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
273542	Fee-for-Service	1467813873	1467813873	1	2	GURMANT P SINGH MD INC	8/27/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	IALISTS	1205 GARCES HWY	STE.303	DELANO	CA	93215	3639	15	06029	35.76144147	-119.2400687	Kern County
273555	Fee-for-Service	1790719045	1790719045	1	1	GANESHA,MEENA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1601 RIO GRANDE ST	None	AUSTIN	TX	78701	1137	00	None	30.28011967	-97.74568692	Travis County
273591	Fee-for-Service	1700860871	1700860871	1	3	GOLDEN STATE DERMATOLOGY ASS	2/15/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	200 COTTAGE AVE	STE 201	MANTECA	CA	95336	4935	39	06077	37.79956104	-121.1982472	San Joaquin County
273601	Fee-for-Service	1396770269	1396770269	1	1	GRANITE PT PARTNERS LLC	1/31/2005	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AUBURN	11879 KEMPER RD	STE 15	AUBURN	CA	95603	9021	31	06061	38.93136899	-121.0916266	Placer County
273666	Fee-for-Service	1467403568	1467403568	1	1	GREEN, GOPA B MD	6/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91188	45	Nephrology (Renal-Kidney)	0	In state provider	None	1265 N DUTTON AVE	None	SANTA ROSA	CA	95401	7101	49	06097	38.448657	-122.7332025	Sonoma County
273711	Fee-for-Service	1881436467	1881436467	1	1	GHANEM, MARIKO N LMFT	8/1/2024	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
273739	Fee-for-Service	1659472298	1659472298	1	1	GALOFRE, GABRIEL F MD	6/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74880	41	Internal Medicine	0	In state provider	None	124 E WEBSTER ST	None	COLUSA	CA	95932	2950	06	06011	39.20761123	-122.0010846	Colusa County
273746	Fee-for-Service	1366266629	1366266629	1	1	GARCIA, MARLON CNP	4/18/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	33	06065	33.74753552	-116.9593245	Riverside County
273753	Fee-for-Service	1679922892	1679922892	1	1	GYSI, MADELEINE L MD	2/21/2020	207R00000X	NA	Other	026	PHYSICIANS	161123	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
273771	Fee-for-Service	1063422061	1063422061	1	1	GARCIA, WILLIAM J	7/7/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11930 HERITAGE OAKS PL	STE 8 & 9	AUBURN	CA	95603	2458	31	06061	38.94059662	-121.0995593	Placer County
273814	Fee-for-Service	1396024931	1396024931	1	1	GRENNAN, CARRI A CRNA	4/28/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
273891	Fee-for-Service	1750326641	1750326641	1	1	GARFIELD BEACH CVS LLS	12/19/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	510 S BEACH BLVD	None	ANAHEIM	CA	92804	1811	30	06059	33.825501	-117.993222	Orange County
273920	Fee-for-Service	1790738169	1790738169	1	1	GALLOWAY, JENNY R MD	10/1/1996	207ZP0102X	NA	Other	026	PHYSICIANS	83749	22	Pathology (M.D. only)	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
273925	Fee-for-Service	1104451186	1104451186	1	1	GALLEGOS, RICHIE V CRNA	8/10/2020	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
273933	Fee-for-Service	1467403568	1467403568	1	1	GREEN, GOPA B MD	6/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91188	41	Internal Medicine	0	In state provider	None	1265 N DUTTON AVE	None	SANTA ROSA	CA	95401	7101	49	06097	38.448657	-122.7332025	Sonoma County
273956	Fee-for-Service	1821348780	1821348780	1	1	GUTHREY, CHRISTOPHER R PSYD	4/20/2023	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
273983	Fee-for-Service	1588606834	1588606834	1	1	GLENDALE EMERGENCY MED	9/17/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
274003	Fee-for-Service	1962563494	1962563494	1	1	GORLA, SILVIA PHD	7/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	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
274024	Fee-for-Service	1376832139	1376832139	1	1	GARDIZI, ADAM CRNA	1/22/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
274052	Fee-for-Service	1164485595	1164485595	1	2	GEORGE RAPPARD MD INC	6/27/2024	2085R0204X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	8929 WILSHIRE BLVD	SUITE 210	BEVERLY HILLS	CA	90211	1951	19	06037	34.06709669	-118.386182	Los Angeles County
274064	Fee-for-Service	1255317780	1255317780	1	1	GAYLORD, ERIC E OD	10/2/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3756 SANTA ROSALIA DR	STE 320	LOS ANGELES	CA	90008	3615	19	06037	34.00888336	-118.3389334	Los Angeles County
274085	Fee-for-Service	1376781575	1376781575	1	1	GUPTA, VIPUL MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119408	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4053 LONE TREE WAY	STE 200	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
274103	Fee-for-Service	1427057843	1427057843	1	1	GANDHI, SAUMIL M MD	12/11/2002	207RN0300X	NA	Nephrology	026	PHYSICIANS	54272	45	Nephrology (Renal-Kidney)	0	In state provider	None	2950 SYCAMORE DR	STE 100	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
274118	Fee-for-Service	1063465995	1063465995	1	1	GRABER,TERRY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1039 MONTGOMERY ST	None	CLUSTER	SD	57730	1304	00	None	43.77194058	-103.5939373	Custer
274135	Fee-for-Service	1851615520	1851615520	1	1	GUPTA, RESHMA MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128870	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
274172	Fee-for-Service	1861432403	1861432403	1	1	GREENBERG, ANDREW M MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71504	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	350 30TH ST	STE 520	OAKLAND	CA	94609	3426	01	06001	37.81892183	-122.2640154	Alameda County
274197	Fee-for-Service	1275631418	1275631418	1	1	GILMORE,STEVAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EMERGENCY PHYS PROF ASS	4401 GARTH ROAD	None	BAYTOWN	TX	77521	0000	00	None	29.76910842	-94.97759843	Harris County
274274	Fee-for-Service	1306170972	1306170972	1	1	GAJO, ALDEN H MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49002	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
274279	Fee-for-Service	1831583392	1831583392	1	1	GENG, YIFAN MD	4/9/2020	208M00000X	NA	Other	026	PHYSICIANS	144139	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
274303	Fee-for-Service	1316424815	1316424815	1	1	GARAY, RICHARD A RCP	10/8/2018	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
274307	Fee-for-Service	1922092550	1922092550	1	1	GARDNER, SUSAN B MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	35137	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
274311	Fee-for-Service	1235766106	1235766106	1	1	GRACE, AUGUST MD	9/5/2024	207P00000X	NA	Other	026	PHYSICIANS	None	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
274328	Fee-for-Service	1376579664	1376579664	1	1	GULATI, RAJEEV MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86583	02	General Surgery	0	In state provider	None	1940 N ORANGE GROVE AVE	None	POMONA	CA	91767	3002	19	06037	34.07889352	-117.7478982	Los Angeles County
274367	Fee-for-Service	1427057843	1427057843	1	1	GANDHI, SAUMIL M MD	12/11/2002	207RN0300X	NA	Nephrology	026	PHYSICIANS	54272	41	Internal Medicine	0	In state provider	None	2950 SYCAMORE DR	STE 100	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
274388	Fee-for-Service	1609633825	1609633825	1	1	GARCIA LOZA, VICTOR R PT	3/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1620 E SECOND ST	I, J	BEAUMONT	CA	92223	3171	33	06065	33.92359885	-116.9480354	Riverside County
274400	Fee-for-Service	1427565506	1427565506	1	1	GLENDALE HOSPITALIST MEDICAL	2/4/2019	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
274433	Fee-for-Service	1407880693	1407880693	1	1	GROTEN, DAWN M MD	10/31/1986	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	54516	41	Internal Medicine	0	In state provider	None	3010 BEARD RD	None	NAPA	CA	94558	3673	28	06055	38.32003352	-122.2948827	Napa County
274444	Fee-for-Service	1598718157	1598718157	1	1	GIERBOLINI, MAYTE P MD	1/13/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173270	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
274448	Fee-for-Service	1336344910	1336344910	1	1	GIBBONS, PATRICK S MD	8/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92569	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
274506	Fee-for-Service	1871723320	1871723320	1	1	GIBSON, ERIKA R MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124396	05	Anesthesiology	0	In state provider	None	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
274549	Fee-for-Service	1952384695	1952384695	1	1	GEE, TIMOTHY C MD	7/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	43628	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1625 HILL RD	None	NOVATO	CA	94947	4316	21	06041	38.09815363	-122.5798889	Marin County
274588	Fee-for-Service	1245694736	1245694736	1	1	GATEAU, KAMEELAH L MD	5/5/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	141025	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
274594	Fee-for-Service	1376579664	1376579664	1	1	GULATI, RAJEEV MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86583	33	Thoracic Surgery	0	In state provider	None	1940 N ORANGE GROVE AVE	None	POMONA	CA	91767	3002	19	06037	34.07889352	-117.7478982	Los Angeles County
274626	Fee-for-Service	1558603290	1558603290	1	1	GILL, HARSIMRAN MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139858	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
274628	Fee-for-Service	1033154034	1033154034	1	1	GARFIELD BEACH CVS LLC	3/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11735 WHITTIER BLVD	None	WHITTIER	CA	90601	3939	19	06037	33.9816992	-118.0517012	Los Angeles County
274633	Fee-for-Service	1427057843	1427057843	1	1	GANDHI, SAUMIL M MD	12/11/2002	207RN0300X	NA	Nephrology	026	PHYSICIANS	54272	01	General Practice	0	In state provider	None	2950 SYCAMORE DR	STE 100	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
274650	Fee-for-Service	1023295292	1023295292	1	1	GRIJALVA, RAMON A MD	11/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105392	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
274669	Fee-for-Service	1912902792	1912902792	1	1	GOSS, JEFFREY D DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	16311 VENTURA BLVD	STE 630	ENCINO	CA	91436	2172	19	06037	34.15706864	-118.4885978	Los Angeles County
274688	Fee-for-Service	1538238118	1538238118	1	1	GILLESPIE, WILLIAM M MD	3/9/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	81203	36	Psychiatry	0	In state provider	None	510 S GRAND AVENUE	STE 200	GLENDORA	CA	91741	4291	19	06037	34.13034587	-117.8725246	Los Angeles County
274691	Fee-for-Service	1083091946	1083091946	1	1	GAJO, EILEEN MD	1/1/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	765 MEDICAL CENTER CT	STE 211	CHULA VISTA	CA	91911	6656	37	06073	32.619069	-117.020835	San Diego County
274701	Fee-for-Service	1780614354	1780614354	1	1	GERSON, ROBERT S MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
274769	Fee-for-Service	1275738288	1275738288	1	1	GIZZO, DANIEL P PHD	8/22/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1630 E MAIN ST	None	EL CAJON	CA	92021	5204	37	06073	32.80766827	-116.9222044	San Diego County
274855	Fee-for-Service	1982251369	1982251369	1	1	GONZALEZ, CHANPHANY CHARLENE	9/3/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3741 N FELAND AVE	None	FRESNO	CA	93722	4522	10	06019	36.79262774	-119.8483836	Fresno County
274907	Fee-for-Service	1518160811	1518160811	1	1	GOMEZ-ABRAHAIM, JESUS A MD	2/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110113	33	Thoracic 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
274917	Fee-for-Service	1982910741	1982910741	1	1	GRIMALDI, JOHN A D O INC	11/17/2010	193400000X	NA	Other	026	PHYSICIANS	11355	34	Urology and Urological Surgery	0	In state provider	None	450 4TH AVE	STE 312	CHULA VISTA	CA	91910	4429	37	06073	32.63513513	-117.0820663	San Diego County
274995	Fee-for-Service	1972958866	1972958866	1	1	GREEN, DAVID I MD	9/18/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	169523	18	Ophthalmology	0	In state provider	None	39263 MISSION BLVD	None	FREMONT	CA	94539	3037	01	06001	37.56282031	-121.9592214	Alameda County
275116	Fee-for-Service	1982251369	1982251369	1	1	GONZALEZ, CHANPHANY CHARLENE	9/3/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3741 N FELAND AVE	None	FRESNO	CA	93722	4522	10	06019	36.79262774	-119.8483836	Fresno County
275127	Fee-for-Service	1336379619	1336379619	1	1	GARFIELD BEACH CVS LLC	4/23/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6500 NILES ST	None	BAKERSFIELD	CA	93306	4858	15	06029	35.37615351	-118.9307835	Kern County
275131	Fee-for-Service	1477674455	1477674455	1	1	GRADY MAGURES	1/1/1979	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	DBA AMPLEX HEARING CTRS	2717 EL CAMINO AVE	None	SACRAMENTO	CA	95821	5903	34	06067	38.611188	-121.3988535	Sacramento County
275157	Fee-for-Service	1790727048	1790727048	1	1	GARFIELD BEACH CVS, LLC	4/6/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29610 RANCHO CALIFORNIA	None	TEMECULA	CA	92591	5283	33	06065	33.50455159	-117.1462052	Riverside County
275186	Fee-for-Service	1689616427	1689616427	1	1	GOLDSTEIN,MICHEAL I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	60 MARINER WAY	None	MONSEY	NY	10952	0000	00	None	41.142888	-74.068614	Rockland County
275217	Fee-for-Service	1023548120	1023548120	1	1	GARNER, JASON A DO	8/1/2020	207P00000X	NA	Other	026	PHYSICIANS	18340	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
275242	Fee-for-Service	1154688612	1154688612	1	1	GULRAIZ, MARYAM	6/4/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15272 SUMMIT AVE	None	FONTANA	CA	92336	0231	36	06071	34.152624	-117.4724415	San Bernardino County
275244	Fee-for-Service	1811384225	1811384225	1	1	GARCIA, AENRI LMFT	4/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	202 E AIRPORT DR	SUITE 120	SAN BERNARDINO	CA	92408	3429	36	06071	34.06737938	-117.2834702	San Bernardino County
275248	Fee-for-Service	1457670028	1457670028	1	1	GROUSE, CARRIE K MD	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129593	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
275359	Fee-for-Service	1376718023	1376718023	1	2	GOULD, DARIN E MD	3/26/2025	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	161437	-	NOT APPLICABLE	0	In state provider	None	22 MAIDEN LN	None	DOWNIEVILLE	CA	95936	0038	46	06091	39.56061816	-120.8285843	Sierra County
275372	Fee-for-Service	1831167899	1831167899	2	1	GADE, GOPAL MD	4/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35041	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6183 N FRESNO ST	SUITE 105	FRESNO	CA	93710	8611	10	06019	36.82625378	-119.7814317	Fresno County
275381	Fee-for-Service	1124687173	1124687173	1	1	GROSSMAN, DANIELLE MD	11/22/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181121	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
275385	Fee-for-Service	1811084676	1811084676	1	4	GOLDEN BEAR PHYSICAL THERAPY	12/26/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	146 N MAAG AVE	STE B	OAKDALE	CA	95361	2249	50	06099	37.77365727	-120.8319425	Stanislaus County
275395	Fee-for-Service	1356549687	1356549687	1	1	GEORGE, TELA R	6/16/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 DISCOVERY DR	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
275401	Fee-for-Service	1609819945	1609819945	1	1	GARFIELD BEACH CVS LLC	5/2/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19353 VICTORY BLVD	None	RESEDA	CA	91335	6302	19	06037	34.18659936	-118.5552114	Los Angeles County
275469	Fee-for-Service	1154675916	1154675916	1	1	GLEN, DOUGLAS LMFT	5/2/2023	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
275482	Fee-for-Service	1619266111	1619266111	1	1	GALVEZ, MICHAEL G MD	1/25/2019	2086S0122X	NA	General Surgery	026	PHYSICIANS	122755	46	Hand Surgery	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
275494	Fee-for-Service	1366925133	1366925133	1	1	GUO CHINESE MEDICAL CENTER	3/26/2018	193400000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1865 E 4TH ST	UNIT C-1	ONTARIO	CA	91764	2652	36	06071	34.077996	-117.611856	San Bernardino County
275500	Fee-for-Service	1003828443	1003828443	1	1	GOLDSTEIN, TATIANA MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70141	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
275509	Fee-for-Service	1467813873	1467813873	1	1	GURMANT P SINGH MD INC	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114308	02	General Surgery	0	In state provider	IALISTS	8307 BRIMHALL RD	1706	BAKERSFIELD	CA	93312	4343	15	06029	35.366481	-119.0948445	Kern County
275586	Fee-for-Service	1043211816	1043211816	1	1	GATMAITAN, BIENVENIDO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	621 MATLOCK CENTRE CIR	None	ARLINGTON	TX	76015	2535	00	None	32.70145045	-97.113852	Tarrant County
275620	Fee-for-Service	1053810341	1053810341	1	1	GEIGER, DOROTHY K LMFT	1/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
275660	Fee-for-Service	1477069375	1477069375	1	1	GAGE MEDICAL CLINIC INC	1/25/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	R OF HUNTINGTON PARK	3203 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5831	19	06037	33.97264641	-118.2101997	Los Angeles County
275703	Fee-for-Service	1598857930	1598857930	1	1	GAULT, MICHAEL J MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72812	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
275728	Fee-for-Service	1538393699	1538393699	1	1	GREEN, NELLA L MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113685	77	Infectious Disease	0	In state provider	None	15644 POMERADO ROAD	SUITE 202	POWAY	CA	92064	2400	37	06073	32.99717879	-117.0579379	San Diego County
275750	Fee-for-Service	1538628524	1538628524	1	1	GASSNER, STEPHEN F MD	7/5/2022	390200000X	NA	Other	026	PHYSICIANS	177552	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
275794	Fee-for-Service	1760560676	1760560676	1	1	GUTHRIE, BRIAN D MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	57783	40	Pediatrics	0	In state provider	None	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
275801	Fee-for-Service	1629412937	1629412937	1	1	GREEN, TYLER S MD	8/15/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	162586	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
275807	Fee-for-Service	1720680341	1720680341	1	2	GRAND CARE MEDICAL TRANSPORT	11/17/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ATION INC	415 HARVARD	203 A	GLENDALE	CA	91205	1057	19	06037	34.14448348	-118.250604	Los Angeles County
275854	Fee-for-Service	1225440746	1225440746	1	1	GRAHAM, JOHN G MD	4/18/2025	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
275919	Fee-for-Service	1194760199	1194760199	1	1	GARFIELD BEACH CVS, LLC	2/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CVS PHARMACY #09195	8831 VILLA LA JOLLA	None	LA JOLLA	CA	92037	1949	37	06073	32.869242	-117.230535	San Diego County
275970	Fee-for-Service	1306274451	1306274451	1	1	GAGNON, EVA K LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
275980	Fee-for-Service	1538393699	1538393699	1	1	GREEN, NELLA L MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113685	41	Internal Medicine	0	In state provider	None	15644 POMERADO ROAD	SUITE 202	POWAY	CA	92064	2400	37	06073	32.99717879	-117.0579379	San Diego County
275982	Fee-for-Service	1154613701	1154613701	1	1	GORGULHO, ALESSANDRA A MD	5/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA DR	STE 200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
275995	Fee-for-Service	1316251945	1316251945	1	1	GRANBERG, KARIN I	11/9/2010	225100000X	NA	Physical Therapist	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
276000	Fee-for-Service	1326543984	1326543984	1	1	GUTIERREZ, BLANCA K MD	3/13/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	550 WASHINGTON ST	STE 300	SAN DIEGO	CA	92103	2213	37	06073	32.75003652	-117.1603431	San Diego County
276006	Fee-for-Service	1467834275	1467834275	1	1	GAWARGI, SAMUEL M OD	8/17/2018	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
276054	Fee-for-Service	1164464657	1164464657	1	1	GRUMET, JENNIFER B MD	4/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89363	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
276152	Fee-for-Service	1205033248	1205033248	1	1	GUPTA, NEIL M MD	2/18/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144579	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
276187	Fee-for-Service	1447422241	1447422241	1	1	GUNVILLE, CHAD	5/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
276188	Fee-for-Service	1386685295	1386685295	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12490 SEAL BEACH BLVD	None	SEAL BEACH	CA	90740	2711	30	06059	33.78058686	-118.0719115	Orange County
276196	Fee-for-Service	1003993940	1003993940	1	1	GOLDMAN, FLAIR D DPM	5/7/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
276363	Fee-for-Service	1023276383	1023276383	1	1	GARFIN, PHILLIP M MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107078	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
276399	Fee-for-Service	1790989846	1790989846	1	1	GARCIA, MONICA L LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
276442	Fee-for-Service	1558310722	1558310722	1	1	GREGORY, GEORGE A MD	1/1/1979	207L00000X	NA	Other	026	PHYSICIANS	21077	05	Anesthesiology	0	In state provider	UCSF DEPT ANESTH	513 PARNASSUS AVE	# S436	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
276450	Fee-for-Service	1508944661	1508944661	1	1	GIESE, LIGIA E MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75599	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
276466	Fee-for-Service	1881717155	1881717155	1	1	GIANNETTO, DAVID D MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69419	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
276478	Fee-for-Service	1356890768	1356890768	1	1	GAVASKAR, TANMAYEE	1/12/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
276502	Fee-for-Service	1285344788	1285344788	1	1	GEMGUI, ZOLBOO NP	2/17/2023	363LF0000X	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
276508	Fee-for-Service	1699836353	1699836353	1	1	GABRIEL, RONALD S MD	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	9877	13	Neurology (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	STE 203	LOS ANGELES	CA	90067	2005	19	06037	34.05887194	-118.4122914	Los Angeles County
276511	Fee-for-Service	1689018574	1689018574	1	1	GHAMARIAN, PEDRAM DO	11/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16393	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
276516	Fee-for-Service	1164489456	1164489456	1	1	GOLD, ROBERT A MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47614	41	Internal Medicine	0	In state provider	None	1500 W WEST COVINA PKWY	1ST FLOOR	WEST COVINA	CA	91790	2703	19	06037	34.06953243	-117.9391587	Los Angeles County
276552	Fee-for-Service	1225263999	1225263999	1	1	GROGAN, KATE E MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113166	90	Pathology-Forensic	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
276591	Fee-for-Service	1255952024	1255952024	1	1	GUTIERREZ, JERALDINE CCC-SL	11/16/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
276592	Fee-for-Service	1578508461	1578508461	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1701 SOUTH WESTERN AVE	None	LOS ANGELES	CA	90006	5803	19	06037	34.042743	-118.3090595	Los Angeles County
276617	Fee-for-Service	1023276383	1023276383	1	1	GARFIN, PHILLIP M MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107078	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
276671	Fee-for-Service	1134427636	1134427636	1	1	GUAN, HOWARD D MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119766	None	None	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
276690	Fee-for-Service	1558310722	1558310722	1	1	GREGORY, GEORGE A MD	1/1/1979	207L00000X	NA	Other	026	PHYSICIANS	21077	01	General Practice	0	In state provider	UCSF DEPT ANESTH	513 PARNASSUS AVE	# S436	SAN FRANCISCO	CA	94143	2205	38	06075	37.76344756	-122.4581992	San Francisco County
276715	Fee-for-Service	1962568881	1962568881	1	1	GUSS, JOEL MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107626	84	Surgery-Head and Neck	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
276727	Fee-for-Service	1811129034	1811129034	1	1	GOLDNER, BRYAN S DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11443	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
276757	Fee-for-Service	1114993656	1114993656	1	1	GALLEN, JOHN T MD	1/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	67	Endocrinology	1	Border provider	None	555 BLACK OAK DR	400	MEDFORD	OR	97504	3653	00	None	42.318873	-122.835653	Jackson County
276778	Fee-for-Service	1275187460	1275187460	1	2	GARFIELD HEALTH CENTER	7/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	19138 E WALNUT DR NORTH	SUITE 202	ROWLAND HEIGHTS	CA	91748	1432	19	06037	33.99570698	-117.8850338	Los Angeles County
276791	Fee-for-Service	1306023221	1306023221	1	1	GOPALRATHNAM, UMAMAHESWARI M	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100879	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
276832	Fee-for-Service	1740392588	1740392588	1	1	GALLARDO, PAUL MD	10/31/1988	207R00000X	NA	Other	026	PHYSICIANS	61112	08	Family Practice	0	In state provider	None	502 W VALLEY BLVD	None	COLTON	CA	92324	2249	36	06071	34.06784567	-117.3307387	San Bernardino County
276865	Fee-for-Service	1023276383	1023276383	1	1	GARFIN, PHILLIP M MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107078	68	Hematology	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
276926	Fee-for-Service	1578278925	1578278925	1	1	GILLIAM, JENNETTA D BIRTH DO	6/5/2023	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
276927	Fee-for-Service	1356363048	1356363048	2	1	GARFIELD BEACH CVS LLC	12/15/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2255 S EL CAMINO REAL	None	OCEANSIDE	CA	92054	6318	37	06073	33.184215	-117.3302955	San Diego County
276947	Fee-for-Service	1346516937	1346516937	1	1	GRANITE HILLS HEALTHCARE &	7/29/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTRE LLC	1340 E MADISON AVE	None	EL CAJON	CA	92021	8501	37	06073	32.80019746	-116.934156	San Diego County
276962	Fee-for-Service	1821726217	1821726217	1	1	GARFIELD BEACH CVS, L.L.C.	6/7/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 N LA BREA AVE	None	INGLEWOOD	CA	90301	1243	19	06037	33.96574374	-118.3533377	Los Angeles County
276975	Fee-for-Service	1811129034	1811129034	1	1	GOLDNER, BRYAN S DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11443	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
276977	Fee-for-Service	1942246343	1942246343	1	1	GEAN-MARTON, ALISA MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	66034	30	Radiology	0	In state provider	None	1001 POTRERO AVE	# 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
276982	Fee-for-Service	1336116904	1336116904	1	1	GOYAL, NAMITA A MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55400	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
276995	Fee-for-Service	1740417070	1740417070	1	1	GILBRETH, SHINOBU K MD	12/18/2024	208M00000X	NA	Other	026	PHYSICIANS	106823	08	Family Practice	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
277006	Fee-for-Service	1306354428	1306354428	1	1	GREENE, LAUREN LMFT	4/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	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
277025	Fee-for-Service	1275187460	1275187460	1	2	GARFIELD HEALTH CENTER	7/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	19138 E WALNUT DR NORTH	SUITE 202	ROWLAND HEIGHTS	CA	91748	1432	19	06037	33.99570698	-117.8850338	Los Angeles County
277033	Fee-for-Service	1033617568	1033617568	1	1	GANAGA, SVETLANA NP	6/1/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
277080	Fee-for-Service	1750374450	1750374450	1	1	GEE, ARNOLD MD	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 AVE	STE 110	TUCSON	AZ	85719	2380	00	None	32.26833	-110.94327	Pima County
277102	Fee-for-Service	1063958668	1063958668	1	1	GSM HEALTHCARE SERVICES LLC	5/16/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15125 GALE AVE	None	HACIENDA HEIGHTS	CA	91745	1407	19	06037	34.01543459	-117.976925	Los Angeles County
277104	Fee-for-Service	1548469968	1548469968	1	1	GOODMAN, PATRICK T LPCC	12/19/2018	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
277151	Fee-for-Service	1811084676	1811084676	1	7	GOLDEN BEAR PHYSICAL THERAPY	12/27/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	AND SPORTS INJURY CENTE	1700 KEYSTONE PACIFIC PK	STE C2	PATTERSON	CA	95363	8874	50	06099	37.47600952	-121.160718	Stanislaus County
277153	Fee-for-Service	1740338557	1740338557	1	1	GOBRAN, MAHER MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76045	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
277211	Fee-for-Service	1407988058	1407988058	1	1	GLENDALE COMMUNITY FAMILY	4/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85330	08	Family Practice	0	In state provider	PRACTICE INC	222 W EULALIA ST	STE 200	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
277235	Fee-for-Service	1073534525	1073534525	1	1	GINSBERG,DAVID A MD	5/22/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	72638	34	Urology and Urological Surgery	0	In state provider	None	7601 EAST IMPERIAL HWY	None	LOS ANGELES	CA	90030	3075	19	06037	33.9309663	-118.4309476	Los Angeles County
277256	Fee-for-Service	1861042939	1861042939	1	1	GUNADI, NICOLE C NP	1/1/2020	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
277259	Fee-for-Service	1881624583	1881624583	1	11	GENESISCARE OF CALIFORNIA, A	2/17/2020	261QX0203X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	1316 NELSON AVENUE	None	MODESTO	CA	95350	5341	50	06099	37.66206042	-120.9881734	Stanislaus County
277321	Fee-for-Service	1558341073	1558341073	1	1	GIUDICI, MARIO C MD	4/15/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159883	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
277323	Fee-for-Service	1396409439	1396409439	1	1	GOMEZ PEREZ, RUTH CNP	11/2/2021	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
277340	Fee-for-Service	1326087552	1326087552	1	1	GREENE, GERALD R MD	8/1/1967	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	13351	40	Pediatrics	0	In state provider	DEPT OF PEDIATRICS	UNIVERSITY OF CALIFORNIA	None	IRVINE	CA	92717	0000	30	06059	0	0	None
277359	Fee-for-Service	1427567700	1427567700	1	1	GARAYALDE, ANGELINA T LCSW	5/23/2018	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
277387	Fee-for-Service	1851605521	1851605521	1	1	GALLAGHER, DIANA F NP	9/22/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	733218	-	NOT APPLICABLE	0	In state provider	None	2100 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	5721	34	06067	38.572722	-121.479849	Sacramento County
277410	Fee-for-Service	1487796579	1487796579	1	1	GAVI, BENNY MD	7/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89436	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
277412	Fee-for-Service	1255339826	1255339826	1	1	GAMBOL, JOHN S MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87090	66	Emergency Medicine (Urgent Care)	0	In state provider	None	43830 NORTH 10TH ST W	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
277437	Fee-for-Service	1902102726	1902102726	1	1	GHOSH, TULIKA MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156387	41	Internal Medicine	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
277466	Fee-for-Service	1114948767	1114948767	1	1	GEORGE, JAMES PT	8/27/2018	2251G0304X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ELLNESS	414 TENNESSEE ST STE F	None	REDLANDS	CA	92373	8152	36	06071	34.058439	-117.2000425	San Bernardino County
277467	Fee-for-Service	1356492219	1356492219	1	1	GARY LANE	4/5/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1925 E ORMAN AVE	STE A109	PUEBLO	CO	81004	3555	00	None	38.23382772	-104.6206733	Pueblo County
277495	Fee-for-Service	1881900116	1881900116	1	1	GENERAL, GERARDO, M MD INC	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	51732	41	Internal Medicine	0	In state provider	None	5385 WALNUT AVE	SUITE 5	CHINO	CA	91710	2605	36	06071	34.02627451	-117.6872175	San Bernardino County
277507	Fee-for-Service	1851643282	1851643282	1	2	GUTIERREZ, RUBEN LMFT	9/4/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27201 TOURNEY ROAD,	STE 201K	VALENCIA	CA	91355	0935	19	06037	34.41741018	-118.5770409	Los Angeles County
277535	Fee-for-Service	1114025061	1114025061	1	1	GOSAVI, SUCHETA MD	5/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111131	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
277542	Fee-for-Service	1477640001	1477640001	1	1	GHAZAL, RONNY MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63535	20	Orthopedic Surgery	0	In state provider	None	225 W HOSPITALITY LN	STE 108	SAN BERNARDINO	CA	92408	3244	36	06071	34.06586109	-117.2884682	San Bernardino County
277567	Fee-for-Service	1619787413	1619787413	1	1	GREENE, JENNIE	1/16/2025	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	42	06083	0	0	None
277610	Fee-for-Service	1275546590	1275546590	1	1	GASPAR DE ALBA, MARIO J MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PARKWAY	# 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
277666	Fee-for-Service	1689873804	1689873804	1	1	GARCIA, RAQUEL LMFT	3/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
277712	Fee-for-Service	1154884880	1154884880	1	1	GIRALICO-WYMAN, JANETTE LMF	10/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2248 HERITAGE DR.	None	ROSEVILLE	CA	95678	3411	31	06061	38.77219674	-121.2784099	Placer County
277718	Fee-for-Service	1114556040	1114556040	1	1	GUZMAN, IRISHA	9/12/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
277720	Fee-for-Service	1598807935	1598807935	1	1	GONZALEZ, GUILLERMO	11/3/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	815 THIRD AVENUE	SUITE 317	CHULA VISTA	CA	91911	1310	37	06073	32.62337313	-117.072841	San Diego County
277732	Fee-for-Service	1801912340	1801912340	1	1	GARCIA, ANALILIA LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
277738	Fee-for-Service	1851959365	1851959365	1	1	GUZMAN, JANETH M LMFT	7/14/2022	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
277745	Fee-for-Service	1831188275	1831188275	1	1	GLENDALE ADVENTIST MED	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
277764	Fee-for-Service	1326443466	1326443466	1	1	GONZALEZ, BLANCA A LMFT	12/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3585 MAPLE ST	246	VENTURA	CA	93003	3504	56	06111	34.26916737	-119.2456769	Ventura County
277804	Fee-for-Service	1710296835	1710296835	1	1	GUILLEN, BELEN G LMFT	6/16/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5005 CANYON CREST DR	None	RIVERSIDE	CA	92507	7721	33	06065	33.95957554	-117.3311659	Riverside County
277809	Fee-for-Service	1912424250	1912424250	1	1	GUARDIAN FLIGHT LLC	2/12/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	141 W 40TH ST	None	YUMA	AZ	85365	9641	00	None	32.654331	-114.62067	Yuma County
277827	Fee-for-Service	1952673154	1952673154	1	1	GRAJEDA, DOLORES A LMFT	1/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	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
277864	Fee-for-Service	1164721619	1164721619	1	1	GROTTING, LINDSAY A MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145578	18	Ophthalmology	0	In state provider	None	4201 TORRANCE BLVD	SUITE 220	TORRANCE	CA	90503	4537	19	06037	33.8375955	-118.358748	Los Angeles County
277941	Fee-for-Service	1447406889	1447406889	1	1	GARDNER, JULIE MD	10/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100736	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
277990	Fee-for-Service	1831188275	1831188275	1	1	GLENDALE ADVENTIST MED	12/1/1979	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
278021	Fee-for-Service	1710420807	1710420807	1	1	GREAVES, PENNY D NP	1/10/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1310 STEWART DR	STE 301	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
278082	Fee-for-Service	1366837551	1366837551	1	1	GUILE, ALEXANDER MD	12/12/2017	390200000X	NA	Other	026	PHYSICIANS	150104	08	Family Practice	0	In state provider	None	27200 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.8955513	-117.189743	Riverside County
278114	Fee-for-Service	1033389572	1033389572	1	1	GINEX, STEVEN L DPM INC	2/3/2011	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	74050 ALESSANDRO DR	STE A	PALM DESERT	CA	92260	3705	33	06065	33.72202952	-116.372853	Riverside County
278156	Fee-for-Service	1316202054	1316202054	1	1	GARST OROZCO, JESSICA MD	3/1/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
278218	Fee-for-Service	1558305821	1558305821	1	1	GARFIELD BEACH CVS, LLC	2/25/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8280 MAGNOLIA AVE	None	RIVERSIDE	CA	92504	3413	33	06065	33.93325037	-117.4237004	Riverside County
278270	Fee-for-Service	1811189822	1811189822	1	1	GABRIELIAN, VICTOR A MD	10/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101256	None	None	0	In state provider	None	315 N THIRD AVE	STE 207	COVINA	CA	91723	1912	19	06037	34.08873786	-117.8923869	Los Angeles County
278294	Fee-for-Service	1295803963	1295803963	1	1	GYOR, LORRAINE M NP	12/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
278300	Fee-for-Service	1679061113	1679061113	1	1	GUO, LUCIE Y MD	6/19/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	182502	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
278310	Fee-for-Service	1588928451	1588928451	1	1	GIBBONS, MATTHEW T PSYD	6/13/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7700 IRVINE CENTER DR	STE 800	IRVINE	CA	92618	3047	30	06059	33.65876225	-117.7500004	Orange County
278331	Fee-for-Service	1861711913	1861711913	1	1	GLAUNER, KATHI S MD	2/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154067	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2170 SOUTH AVE	None	SO LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
278334	Fee-for-Service	1316954191	1316954191	1	1	GREENWALD, RONALD S MD	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	56400	14	Neurological Surgery	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
278337	Fee-for-Service	1518981661	1518981661	1	1	GORSUCH, HEIDI D MD	4/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87131	02	General Surgery	0	In state provider	None	1335 BUENAVENTURA BLVD	STE 204	REDDING	CA	96001	0160	45	06089	40.58222519	-122.4261823	Shasta County
278338	Fee-for-Service	1336200245	1336200245	1	1	GEORGE MARK CHILDREN'S F	6/19/2007	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2121 GEORGE MARK LN	None	SAN LEANDRO	CA	94578	1017	01	06001	37.70872706	-122.1163458	Alameda County
278355	Fee-for-Service	1528196904	1528196904	1	1	GARCIA, VANESSA LMFT	3/18/2025	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
278460	Fee-for-Service	1235417478	1235417478	1	1	GALLO, TIFFANY	3/13/2018	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	25880 TOURNAMENT RD	SUITE 109	VALENCIA	CA	91355	2349	19	06037	34.39184204	-118.5626441	Los Angeles County
278510	Fee-for-Service	1356415962	1356415962	1	1	GUTFREUND, CATHERINE MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85869	08	Family Practice	0	In state provider	None	500 DOYLE PARK DR	STE G04	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
278531	Fee-for-Service	1235305855	1235305855	1	1	GANDHAVADI, MAHEER MD	7/1/2019	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	102854	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
278545	Fee-for-Service	1720004690	1720004690	1	1	GUTFINGER, DAN E MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83536	33	Thoracic Surgery	0	In state provider	None	1310 W STEWART DR	STE 502	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
278571	Fee-for-Service	1811392418	1811392418	1	1	GALAXY PHARMACY INC	5/21/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1295 E ANAHEIM ST	None	LONG BEACH	CA	90813	3709	19	06037	33.78264053	-118.175796	Los Angeles County
278583	Fee-for-Service	1669840393	1669840393	1	1	GOLDENBERG, JOY LMFT	5/16/2020	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
278638	Fee-for-Service	1770515991	1770515991	1	1	GOOD SAMARITAN MEDICAL CENTE	12/21/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	R	1309 N FLAGLER DR	None	WEST PALM BEACH	FL	33401	3406	00	None	26.725428	-80.05203	Palm Beach County
278639	Fee-for-Service	1013388750	1013388750	1	1	GEANA HOSPICE CARE INC	5/17/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	820 N MOUNTAIN AVE	SUITE 107	UPLAND	CA	91786	4163	36	06071	34.10373359	-117.6701283	San Bernardino County
278643	Fee-for-Service	1043607245	1043607245	1	1	GROBMAN, LILLIAN	4/29/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146078	None	None	0	In state provider	None	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
278644	Fee-for-Service	1265583173	1265583173	1	1	GRAY, CHRISTINE C PHD	5/26/2011	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
278705	Fee-for-Service	1760904924	1760904924	1	1	GOMEZ, SARAH MD	2/26/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	161320	08	Family Practice	0	In state provider	None	34675 YUCAIPA BLVD	SUITER 102	YUCAIPA	CA	92399	4155	36	06071	34.03384452	-117.048195	San Bernardino County
278750	Fee-for-Service	1295706331	1295706331	1	1	GROFF, HAROLD L MD	7/28/2020	207RC0200X	NA	Other	026	PHYSICIANS	166469	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
278764	Fee-for-Service	1225186000	1225186000	1	1	GEANACOU, CAROLYN A MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73440	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
278784	Fee-for-Service	1720004690	1720004690	1	1	GUTFINGER, DAN E MD	10/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83536	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1310 W STEWART DR	STE 502	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
278797	Fee-for-Service	1962516310	1962516310	1	1	GREENWALD, DAVID L MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86184	14	Neurological Surgery	0	In state provider	None	561 SAXONY PL	STE 102	ENCINITAS	CA	92024	7700	37	06073	33.05483867	-117.2872577	San Diego County
278807	Fee-for-Service	1932526886	1932526886	1	1	GUGLIELMO, MONA S MD	9/1/2020	2080P0203X	NA	Other	026	PHYSICIANS	140682	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
278812	Fee-for-Service	1487403937	1487403937	1	1	GUARDIAN SAINT LLC	8/19/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	523 E GLENOAKS BLVD	UNIT B	GLENDALE	CA	91207	2015	19	06037	34.15835768	-118.2492102	Los Angeles County
278845	Fee-for-Service	1972855237	1972855237	1	1	GUTIERREZ, VANESSA K LMFT	3/23/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	137159	-	NOT APPLICABLE	0	In state provider	None	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	33	06065	33.99323085	-117.3355363	Riverside County
278868	Fee-for-Service	1770536070	1770536070	1	1	GUERERO, ANTHONY 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	96826	1001	00	None	21.30030321	-157.8342762	Honolulu County
278872	Fee-for-Service	1770515991	1770515991	1	1	GOOD SAMARITAN MEDICAL CENTE	12/21/2018	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	R	1309 N FLAGLER DR	None	WEST PALM BEACH	FL	33401	3406	00	None	26.725428	-80.05203	Palm Beach County
278875	Fee-for-Service	1013388750	1013388750	1	1	GEANA 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	820 N MOUNTAIN AVE	SUITE 107	UPLAND	CA	91786	4163	36	06071	34.10373359	-117.6701283	San Bernardino County
278891	Fee-for-Service	1942740972	1942740972	1	1	GONZALEZ, JENELLE V NP	8/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1255 TRAVIS BLVD	None	FAIRFIELD	CA	94533	4801	48	06095	38.25815459	-122.0487714	Solano County
278894	Fee-for-Service	1669520490	1669520490	1	1	GHIASI, ZAHRA MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78525	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
278906	Fee-for-Service	1982063020	1982063020	1	1	GRAY, WENDY PHD	10/5/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	STE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
278913	Fee-for-Service	1417179458	1417179458	1	1	GREENE, NICOLE A CCC-A	9/19/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1450 SAN PABLO STREET	SUITE 5901	LOS ANGELES	CA	90033	5313	19	06037	34.06189518	-118.203256	Los Angeles County
278916	Fee-for-Service	1235194697	1235194697	1	1	GUDE, JAMES K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1221 FARMERS LN	STE 500	SANTA ROSA	CA	95405	6712	49	06097	38.439405	-122.6875995	Sonoma County
278945	Fee-for-Service	1801894944	1801894944	1	1	GERALDE, RENATO A DO MD	1/24/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19095	None	None	0	In state provider	None	19270 SONOMA HIGHWAY 12	None	SONOMA	CA	95476	5414	49	06097	38.29871411	-122.4751509	Sonoma County
278968	Fee-for-Service	1558354332	1558354332	1	1	GONZALEZ, GUSTAVO A MD	1/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	78302	18	Ophthalmology	0	In state provider	None	210 GREEN VALLEY RD	None	FREEDOM	CA	95019	3135	44	06087	36.93777813	-121.7711905	Santa Cruz County
278975	Fee-for-Service	1114298338	1114298338	1	1	GRASS, LOUIS H CRNA	1/17/2022	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
279005	Fee-for-Service	1023638087	1023638087	1	1	GUERRERO-MARTINEZ, SARA LPC	2/21/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
279042	Fee-for-Service	1578190666	1578190666	1	1	GUERRERO, JESUSA J CRNA	8/10/2020	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
279046	Fee-for-Service	1609440866	1609440866	1	1	GRAVES, SARA D MD	12/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
279075	Fee-for-Service	1245542224	1245542224	1	1	GREENOUGH, MARGARET B MD	11/9/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	128317	01	General Practice	0	In state provider	None	1941 JOHNSON AVE	STE 301	SAN LUIS OBISPO	CA	93401	4175	40	06079	35.27804785	-120.649711	San Luis Obispo County
279096	Fee-for-Service	1912518341	1912518341	1	1	GOLDSTONE HOSPICE INC	9/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15480 ARROW HWY	UNIT 206	BALDWIN PARK	CA	91706	1863	19	06037	34.1069457	-117.9432474	Los Angeles County
279110	Fee-for-Service	1689191231	1689191231	1	1	GARCIA, JOSEPH PT	8/19/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	328 COMMERCIAL ROAD	SUITE 108	SAN BERNARDINO	CA	92408	3766	36	06071	34.05583518	-117.2779712	San Bernardino County
279120	Fee-for-Service	1417976705	1417976705	1	1	GREATER LONG BEACH	4/30/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GENITO URINARY MED GRP	3650 SOUTH ST	STE 408	LAKEWOOD	CA	90712	1510	19	06037	33.86019847	-118.149255	Los Angeles County
279148	Fee-for-Service	1033423579	1033423579	1	1	GARCIA, KRISTINE A MD	3/26/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	192564	None	None	0	In state provider	None	4770 W HERNDON AVE	SUITE 108	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
279205	Fee-for-Service	1518052877	1518052877	1	1	GINWALLA, MAHAZARIN B MD	12/17/2019	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	114478	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
279209	Fee-for-Service	1306406657	1306406657	1	1	GOLDBERG, LIOR MD	4/22/2022	2080P0207X	NA	Hematology	026	PHYSICIANS	177720	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
279214	Fee-for-Service	1245215201	1245215201	1	1	GODDARD, SUSAN J. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	345 SMITH AVE N	None	SAINT PAUL	MN	55102	2346	00	None	44.94251219	-93.1074995	Ramsey County
279220	Fee-for-Service	1205271640	1205271640	1	1	GILMORE, GREGORY A DO	2/25/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	13656	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	SUITE 501	SAN BERNARDINO	CA	92404	3879	36	06071	34.1358627	-117.2757898	San Bernardino County
279249	Fee-for-Service	1215315858	1215315858	1	1	GILLIS, SUSAN E MD FAAP	5/2/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	172110	None	None	0	In state provider	None	6942 UNIVERSITY AVE	#A	LA MESA	CA	91941	5963	37	06073	32.75532823	-117.0487443	San Diego County
279283	Fee-for-Service	1609440866	1609440866	1	1	GRAVES, SARA D MD	12/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
279330	Fee-for-Service	1912518341	1912518341	1	1	GOLDSTONE HOSPICE INC	9/28/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15480 ARROW HWY	UNIT 206	BALDWIN PARK	CA	91706	1863	19	06037	34.1069457	-117.9432474	Los Angeles County
279379	Fee-for-Service	1447404611	1447404611	1	1	GARDEN PEDIATRIC GRP INC	2/3/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	101 EAST REDLANDS BLVD	SUITE 106	REDLANDS	CA	92373	0000	36	06071	34.05731952	-117.181197	San Bernardino County
279387	Fee-for-Service	1467801407	1467801407	1	1	GROSSI, SARA M MD	8/5/2021	208600000X	NA	General Surgery	026	PHYSICIANS	155041	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
279409	Fee-for-Service	1922528108	1922528108	1	1	GILYARD, SHENISE N MD	5/26/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176191	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
279448	Fee-for-Service	1154387413	1154387413	1	1	GLASSBERG, EDWARD MD	7/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	61252	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
279450	Fee-for-Service	1205271640	1205271640	1	1	GILMORE, GREGORY A DO	2/25/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	13656	68	Hematology	0	In state provider	None	399 E HIGHLAND AVE	SUITE 501	SAN BERNARDINO	CA	92404	3879	36	06071	34.1358627	-117.2757898	San Bernardino County
279470	Fee-for-Service	1265186381	1265186381	1	1	GORDONS GRACE II CO	6/10/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	524 W 104TH ST	None	LOS ANGELES	CA	90044	4402	19	06037	33.94230453	-118.2836582	Los Angeles County
279493	Fee-for-Service	1720205479	1720205479	1	1	GIAMPAOLO, ANGELA MD	5/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
279501	Fee-for-Service	1528420817	1528420817	1	1	GREENE, AARON J MD	4/27/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	150561	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
279523	Fee-for-Service	1275158545	1275158545	1	1	GENERAL PRACTICE PARTNERS PC	6/30/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	3808 RIVERSIDE DR	STE 301	BURBANK	CA	91505	4325	19	06037	34.15252315	-118.3412174	Los Angeles County
279552	Fee-for-Service	1437852985	1437852985	1	1	GRANT, MIKAYLA CNP	6/23/2023	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
279563	Fee-for-Service	1033503081	1033503081	1	1	GANDHI, KEVIN DO	9/1/2020	208M00000X	NA	Other	026	PHYSICIANS	17112	41	Internal Medicine	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
279582	Fee-for-Service	1831329101	1831329101	1	1	GROVER, MONICA MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136582	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
279591	Fee-for-Service	1295005940	1295005940	1	1	GANGA, RAMA RAO	7/18/2023	208600000X	NA	General Surgery	026	PHYSICIANS	184707	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
279604	Fee-for-Service	1326031881	1326031881	1	1	GREENVILLE RANCHERIA	9/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PO BOX 279	410 MAIN ST	None	GREENVILLE	CA	95947	0279	32	06063	40.14051184	-120.9500717	Plumas County
279610	Fee-for-Service	1134331366	1134331366	1	1	GREGG HELLWIG	1/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 S CEDAR CREST BLVD	None	ALLENTOWN	PA	18103	6202	00	None	40.566627	-75.5237925	Lehigh County
279613	Fee-for-Service	1720420573	1720420573	1	1	GLOBAL RX INC	11/1/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 E THOUSAND OAKS BLV	None	WESTLAKE VILLAGE	CA	91362	3607	56	06111	34.16423881	-118.8289076	Ventura County
279649	Fee-for-Service	1881705887	1881705887	1	1	GREENBERG, CHIWAMI PSYD	1/16/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4425 JAMBOREE RD	STE 173	NEWPORT BEACH	CA	92660	3010	30	06059	33.66279574	-117.8576757	Orange County
279659	Fee-for-Service	1902984883	1902984883	2	1	GHIAI FATEMI, AFSHAN MD	4/18/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	70771	09	Gynecology (D.O. only)	0	In state provider	None	2901 N VENTURA RD	STE 110	OXNARD	CA	93036	9705	56	06111	34.24479149	-119.1814409	Ventura County
279663	Fee-for-Service	1417950064	1417950064	1	1	GERSTEN, LARRY M MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	50397	20	Orthopedic Surgery	0	In state provider	None	24953 PASEO DE VALENCIA	STE 20A	LAGUNA HILLS	CA	92653	4338	30	06059	33.60028568	-117.7010887	Orange County
279782	Fee-for-Service	1750458766	1750458766	1	1	GREGORIO, MARTINA C MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64812	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
279837	Fee-for-Service	1326031881	1326031881	1	1	GREENVILLE RANCHERIA	9/1/2002	193200000X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	PO BOX 279	410 MAIN ST	None	GREENVILLE	CA	95947	0279	32	06063	40.14051184	-120.9500717	Plumas County
279851	Fee-for-Service	1538588538	1538588538	1	1	GIRMA, MAHLET MD	11/26/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	163092	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
279854	Fee-for-Service	1265854855	1265854855	2	1	GENETIC TECHNOLOGICAL INNOVA	4/5/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	TIONS, LLC	13402 SCOTTSDALE	B190	SCOTTSDALE	AZ	85254	4054	00	None	33.608241	-111.9273885	Maricopa County
279893	Fee-for-Service	1902984883	1902984883	2	1	GHIAI FATEMI, AFSHAN MD	4/18/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	70771	15	Obstetrics (D.O. only)	0	In state provider	None	2901 N VENTURA RD	STE 110	OXNARD	CA	93036	9705	56	06111	34.24479149	-119.1814409	Ventura County
279909	Fee-for-Service	1265094205	1265094205	1	1	GARNAAS, KATHERINE	2/11/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	429 REDCLIFF DR	225	REDDING	CA	96002	0167	45	06089	40.57490364	-122.363412	Shasta County
279937	Fee-for-Service	1134637952	1134637952	1	1	GAMEZ, MADELAINE A NP	7/19/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
279983	Fee-for-Service	1588602106	1588602106	1	1	GUNNERSON, DAVID C MD	9/20/2021	207R00000X	NA	Other	026	PHYSICIANS	170090	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
279986	Fee-for-Service	1932678851	1932678851	1	1	GGA HOME HEALTH CARE INC	4/28/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2829 N GLENOAKS BLVD	STE 101	BURBANK	CA	91504	2660	19	06037	34.2035185	-118.3349635	Los Angeles County
279988	Fee-for-Service	1538347455	1538347455	1	1	GOTTS, JEFFREY E MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102162	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
280016	Fee-for-Service	1326110156	1326110156	1	1	GANPULE, NANDINI MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33030	36	Psychiatry	0	In state provider	None	1120 MCKENDRIE ST	None	SAN JOSE	CA	95126	1406	43	06085	37.34129763	-121.9245735	Santa Clara County
280037	Fee-for-Service	1659459311	1659459311	1	1	GAGGERO, GEOFFERY L DPM	5/18/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
280041	Fee-for-Service	1205947488	1205947488	1	1	GWALTNEY, SCOTT R MD	4/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76028	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
280060	Fee-for-Service	1699853507	1699853507	1	1	GAMBHIR, ANITA R MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84218	02	General Surgery	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
280063	Fee-for-Service	1093914442	1093914442	1	1	GRIFFITH, DAVID L MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116812	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
280100	Fee-for-Service	1194374892	1194374892	1	1	GRATEFUL HEART HOME CARE INC	12/11/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14223 POINTER LOOP	None	EASTVALE	CA	92880	3572	33	06065	33.94569448	-117.597159	Riverside County
280109	Fee-for-Service	1457738965	1457738965	1	1	GRAZIANI, STEPHANIE M DO	7/31/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	16294	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
280112	Fee-for-Service	1053442251	1053442251	1	1	GRIGORIOU, JENNIFER A PSYD	6/9/2016	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
280194	Fee-for-Service	1013522838	1013522838	1	1	GORDER, JULIANNA L PSYD	10/22/2020	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
280214	Fee-for-Service	1538347455	1538347455	1	1	GOTTS, JEFFREY E MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102162	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
280230	Fee-for-Service	1487197927	1487197927	1	1	GOVEA, JENNIFER R LCSW	12/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
280247	Fee-for-Service	1497199780	1497199780	1	1	GABRIEL, VIKTOR MD	2/1/2018	208600000X	NA	General Surgery	026	PHYSICIANS	138820	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
280255	Fee-for-Service	1932242575	1932242575	1	1	GLENN CO OFC OF ED	1/4/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	311 SOUTH VILLA AVE	None	WILLOWS	CA	95988	2959	11	06021	39.51614345	-122.2088586	Glenn County
280349	Fee-for-Service	1851499800	1851499800	1	1	GOGIA, HARMOHINDER S MD	8/24/2004	207R00000X	NA	Other	026	PHYSICIANS	35075	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
280364	Fee-for-Service	1801964465	1801964465	1	1	GETTOGETHER ADULT DAY	8/6/2002	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE	16636 CRENSHAW BLVD	None	TORRANCE	CA	90504	2108	19	06037	33.879384	-118.326471	Los Angeles County
280366	Fee-for-Service	1194769463	1194769463	1	1	GARFIELD BEACH CVS LLC	5/7/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3710 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6046	19	06037	33.9440993	-118.2048912	Los Angeles County
280367	Fee-for-Service	1639620305	1639620305	1	1	GREEN, MARIA A	11/7/2022	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
280387	Fee-for-Service	1801033378	1801033378	1	1	GENTLE, ALBERT E JR LCSW	6/19/2014	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	695 E MEL AVENUE	None	PALM SPRINGS	CA	92262	4832	33	06065	33.84072311	-116.5401186	Riverside County
280396	Fee-for-Service	1821295247	1821295247	1	1	GIANNELLI, SILVANA M MD	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109512	41	Internal Medicine	0	In state provider	None	391 N JACINTO ST	None	HEMET	CA	92543	3118	33	06065	33.752565	-116.958687	Riverside County
280433	Fee-for-Service	1427176700	1427176700	1	1	GOH-HATTANGADI, SUZANNE MD	6/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	93905	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
280453	Fee-for-Service	1881903953	1881903953	1	1	GOLDEN, JOHN LAC	12/20/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
280473	Fee-for-Service	1487722773	1487722773	1	1	GRAFTON, KIMBERLY P MD INC	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69543	02	General Surgery	0	In state provider	None	520 JUNIPERO ST	None	SANTA BARBARA	CA	93105	4212	42	06083	34.4292679	-119.7255944	Santa Barbara County
280491	Fee-for-Service	1790838415	1790838415	1	1	GALLAGHER THOMPSON, D	8/31/1993	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
280493	Fee-for-Service	1689427411	1689427411	1	1	GALINA VARDANYAN, O.D., OPTO	5/7/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2005 W ALAMEDA AVE	None	BURBANK	CA	91506	2932	19	06037	34.15987696	-118.3232526	Los Angeles County
280494	Fee-for-Service	1366467169	1366467169	1	1	GERBER, MICHELLE MD	5/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75474	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8575 GIBBS DR	STE 101	SAN DIEGO	CA	92123	1782	37	06073	32.8103967	-117.1425692	San Diego County
280496	Fee-for-Service	1194790774	1194790774	1	1	GE0RGE, BINDU MD	11/3/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99957	08	Family Practice	0	In state provider	None	2750 E SLANSON AVE	None	HUNTINGTON PARK	CA	90255	3063	19	06037	33.98916573	-118.2210574	Los Angeles County
280528	Fee-for-Service	1356414262	1356414262	1	2	GLAZE, NIJOLE MD	11/1/1999	207R00000X	NA	Other	026	PHYSICIANS	63700	22	Pathology (M.D. only)	0	In state provider	None	1530 W 6TH ST	STE 109	CORONA	CA	92882	2784	33	06065	33.87842412	-117.5950761	Riverside County
280541	Fee-for-Service	1710087630	1710087630	1	1	GOLDHAMER, MICHAEL MD INC	1/1/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	14025	41	Internal Medicine	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2138	37	06073	32.75053781	-117.1627168	San Diego County
280547	Fee-for-Service	1245996750	1245996750	1	1	GENEOSCOPY, INC.	6/11/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2220 WELSCH INDUSTRIAL C	None	SAINT LOUIS	MO	63146	4222	00	None	38.69977061	-90.43335023	St. Louis County
280566	Fee-for-Service	1932464641	1932464641	1	1	GOLSHAN-KHALILI, SAHAND DPM	7/16/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1485 UNIVERSITY AVE	SUITE B	RIVERSIDE	CA	92507	9500	33	06065	33.97575646	-117.3439215	Riverside County
280571	Fee-for-Service	1851499800	1851499800	1	1	GOGIA, HARMOHINDER S MD	8/24/2004	207R00000X	NA	Other	026	PHYSICIANS	35075	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849909	-117.9416115	Orange County
280589	Fee-for-Service	1952321176	1952321176	1	1	GORN, ALAN H MD	1/31/1996	207RR0500X	NA	Other	026	PHYSICIANS	63295	83	Rheumatology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
280620	Fee-for-Service	1962578120	1962578120	1	1	GARG, VINOD K MD	10/12/2008	174400000X	NA	Other	026	PHYSICIANS	49049	02	General Surgery	0	In state provider	None	160 E ARTESIA ST	STE 310	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
280623	Fee-for-Service	1780016428	1780016428	1	1	GUPTA, REENA NP	8/7/2020	363LA2200X	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
280629	Fee-for-Service	1245867282	1245867282	1	1	GLAVINIC, JULIA C MD	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	180797	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
280677	Fee-for-Service	1902091481	1902091481	1	1	GESSESSE, HIRUY H MD	2/27/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	101106	-	NOT APPLICABLE	0	In state provider	None	11101 S MAIN STREET	None	LOS ANGELES	CA	90061	1925	19	06037	33.93458787	-118.2739109	Los Angeles County
280696	Fee-for-Service	1487722773	1487722773	1	1	GRAFTON, KIMBERLY P MD INC	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69543	01	General Practice	0	In state provider	None	520 JUNIPERO ST	None	SANTA BARBARA	CA	93105	4212	42	06083	34.4292679	-119.7255944	Santa Barbara County
280716	Fee-for-Service	1366467169	1366467169	1	1	GERBER, MICHELLE MD	5/20/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	75474	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8575 GIBBS DR	STE 101	SAN DIEGO	CA	92123	1782	37	06073	32.8103967	-117.1425692	San Diego County
280746	Fee-for-Service	1033127824	1033127824	1	1	GOTTFRIED, RICHARD A LMFT	10/10/2018	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12304 SANTA MONICA BLVD	SUITE 215	LOS ANGELES	CA	90025	2587	19	06037	34.03948285	-118.4656304	Los Angeles County
280750	Fee-for-Service	1356414262	1356414262	1	2	GLAZE, NIJOLE MD	11/1/1999	207R00000X	NA	Other	026	PHYSICIANS	63700	01	General Practice	0	In state provider	None	1530 W 6TH ST	STE 109	CORONA	CA	92882	2784	33	06065	33.87842412	-117.5950761	Riverside County
280757	Fee-for-Service	1053492199	1053492199	1	1	GLENN, DENIS J MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87732	41	Internal Medicine	0	In state provider	None	250 BON AIR ROAD	SUITE 5216	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
280763	Fee-for-Service	1982732277	1982732277	1	1	GAVRILYUK, IGOR M MD	2/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94422	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
280771	Fee-for-Service	1710087630	1710087630	1	1	GOLDHAMER, MICHAEL MD INC	1/1/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	14025	10	Gastroenterology (M.D. only)	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2138	37	06073	32.75053781	-117.1627168	San Diego County
280780	Fee-for-Service	1700870839	1700870839	1	1	GRIGGS, STEVEN T PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	210 S JUNIPER ST	STE 205	ESCONDIDO	CA	92025	4200	37	06073	33.12179893	-117.0778404	San Diego County
280803	Fee-for-Service	1124647235	1124647235	1	1	GYLYS, RAYMOND V MD	8/26/2024	207L00000X	NA	Other	026	PHYSICIANS	188137	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
280811	Fee-for-Service	1699814392	1699814392	1	1	GORDON, JANINE T MSW LCSW	11/30/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	23200	-	NOT APPLICABLE	0	In state provider	None	2550 E FOOTHILL BLVD	2ND FLOOR	PASADENA	CA	91107	3406	19	06037	34.14979153	-118.0979955	Los Angeles County
280864	Fee-for-Service	1306020755	1306020755	1	1	GREEN, TONSINETTA D LCSW	4/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 W 6TH ST	STE 212 D	CORONA	CA	92882	1642	33	06065	33.87790309	-117.589666	Riverside County
280881	Fee-for-Service	1720353535	1720353535	1	1	GIBRALTAR HOSPICE INC	5/13/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22141 VENTURA BLVD	SUITE 301	WOODLAND HILLS	CA	91364	5734	19	06037	34.16866225	-118.6095572	Los Angeles County
280912	Fee-for-Service	1811304462	1811304462	1	1	GUPTA, ROHAN MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145462	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
280981	Fee-for-Service	1306259114	1306259114	1	1	GUHAROY, VICTOR MD	2/14/2018	208M00000X	NA	Other	026	PHYSICIANS	139954	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
280987	Fee-for-Service	1710087630	1710087630	1	1	GOLDHAMER, MICHAEL MD INC	1/1/1979	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	14025	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4033 3RD AVE	STE 300	SAN DIEGO	CA	92103	2138	37	06073	32.75053781	-117.1627168	San Diego County
281012	Fee-for-Service	1376769646	1376769646	1	1	GENTILE, CINDY S MD	12/5/2007	207P00000X	NA	Other	026	PHYSICIANS	93632	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
281090	Fee-for-Service	1417005463	1417005463	1	1	GOLDSMITH, OLIVER A MD	9/11/1975	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	21681	41	Internal Medicine	0	In state provider	None	5937 LINDENHURST AVE	None	LOS ANGELES	CA	90036	3218	19	06037	34.06587795	-118.357232	Los Angeles County
281101	Fee-for-Service	1730529322	1730529322	1	1	GRAUE, DIANA N LAC	1/22/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
281102	Fee-for-Service	1720353535	1720353535	1	1	GIBRALTAR HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22141 VENTURA BLVD	SUITE 301	WOODLAND HILLS	CA	91364	5734	19	06037	34.16866225	-118.6095572	Los Angeles County
281122	Fee-for-Service	1386755601	1386755601	1	1	GILLAN, KAREN A	2/18/1997	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3 MEDICAL PLAZA DR	STE 220	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
281163	Fee-for-Service	1780777425	1780777425	1	1	GRIKSCHEIT, TRACY C MD	8/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96712	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
281172	Fee-for-Service	1205879509	1205879509	1	1	GARFIELD BEACH CVS, LLC	11/28/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	42136 BIG BEAR BLVD	None	BIG BEAR LAKE	CA	92315	0000	36	06071	34.24943675	-116.8833009	San Bernardino County
281191	Fee-for-Service	1427326479	1427326479	1	1	GARFIELD BEACH CVS L.L.C.	5/1/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11300 MING AVENUE	None	BAKERSFIELD	CA	93311	1300	15	06029	35.3399339	-119.1287297	Kern County
281201	Fee-for-Service	1427592633	1427592633	1	1	GALIFI, ROSA OT	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
281206	Fee-for-Service	1235103888	1235103888	1	1	GUPTA, NAVYASH MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145199	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
281290	Fee-for-Service	1588741748	1588741748	1	1	GELLER, JONATHAN M OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	25460 MEDICAL CENTER DR	STE 103	MURRIETA	CA	92562	5985	33	06065	33.5570278	-117.1862552	Riverside County
281295	Fee-for-Service	1184713372	1184713372	1	1	GASKINS, REUEL T MD	3/4/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42559	02	General Surgery	0	In state provider	None	2671 IOWA AVE	None	RIVERSIDE	CA	92507	2804	33	06065	33.98813685	-117.3398909	Riverside County
281318	Fee-for-Service	1760763445	1760763445	1	1	GRUEN, JOHANNA E PHD	12/11/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
281372	Fee-for-Service	1801159611	1801159611	1	1	GHOLIPOUR, TAHA	8/4/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	187602	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
281391	Fee-for-Service	1326381161	1326381161	1	1	GASTELUM, JENNIFER R MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135112	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
281392	Fee-for-Service	1558303800	1558303800	1	1	GAN, KAREN AI LIN MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63793	None	None	0	In state provider	None	11370 ANDERSON ST	# 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
281449	Fee-for-Service	1962495721	1962495721	1	1	GERING, SCOTT A MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	52226	28	Proctology (colon and rectal)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
281491	Fee-for-Service	1457343543	1457343543	1	1	GARG, AMUL MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83184	41	Internal Medicine	0	In state provider	None	726 4TH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
281508	Fee-for-Service	1184713372	1184713372	1	1	GASKINS, REUEL T MD	3/4/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42559	01	General Practice	0	In state provider	None	2671 IOWA AVE	None	RIVERSIDE	CA	92507	2804	33	06065	33.98813685	-117.3398909	Riverside County
281517	Fee-for-Service	1578545190	1578545190	1	1	GUY, RICHARD M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74887	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
281524	Fee-for-Service	1578225959	1578225959	1	1	GRAND, PAUL J AU	3/15/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	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
281575	Fee-for-Service	1427053693	1427053693	1	1	GRIGORIAN, BIANCA MD	6/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85318	41	Internal Medicine	0	In state provider	None	133 N ALTADENA DR	2ND FL	PASADENA	CA	91107	7325	19	06037	34.14843	-118.0986385	Los Angeles County
281600	Fee-for-Service	1255376158	1255376158	1	1	GARFIELD BEACH CVS, LLC	3/20/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7191 WARNER AVE	None	HUNTINGTON BEACH	CA	92647	5429	30	06059	33.71568846	-118.0033695	Orange County
281614	Fee-for-Service	1922360932	1922360932	1	1	GAGOLINAN, CELESTE V	3/7/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	14011 PARK AVE	None	VICTORVILLE	CA	92392	2413	36	06071	34.505647	-117.3265457	San Bernardino County
281668	Fee-for-Service	1669413571	1669413571	1	1	GARFIELD BEACH CVS LLC	12/13/2006	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	950 W FOOTHILL BLVD	None	MONROVIA	CA	91016	1916	19	06037	34.15109044	-118.0204531	Los Angeles County
281693	Fee-for-Service	1578762407	1578762407	1	1	GREGG, AMY I PHD	2/12/2016	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	500 CATHEDRAL DR	1165	APTOS	CA	95003	3405	44	06087	36.97906697	-121.8993327	Santa Cruz County
281719	Fee-for-Service	1184713372	1184713372	1	1	GASKINS, REUEL T MD	3/4/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42559	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2671 IOWA AVE	None	RIVERSIDE	CA	92507	2804	33	06065	33.98813685	-117.3398909	Riverside County
281796	Fee-for-Service	1952352668	1952352668	1	1	GUU, HUAN C MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62481	41	Internal Medicine	0	In state provider	None	1127 N AVALON BLVD	None	WILMINGTON	CA	90744	3501	19	06037	33.78567703	-118.2629206	Los Angeles County
281827	Fee-for-Service	1497177216	1497177216	1	1	GUTHRIE, DAVID J CRNA	3/21/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	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
281832	Fee-for-Service	1962630269	1962630269	1	1	GARG, SHAILESH C MD	12/20/2023	2086S0127X	NA	General Surgery	026	PHYSICIANS	180769	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
281837	Fee-for-Service	1730765603	1730765603	1	1	GAU, JONATHAN W MD	6/26/2024	390200000X	NA	Other	026	PHYSICIANS	181959	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
281861	Fee-for-Service	1467141002	1467141002	1	1	GREEN, LESLIE E BIRTH DOULA	6/7/2024	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	43	06085	0	0	None
281887	Fee-for-Service	1013095108	1013095108	1	1	GREIF, WILLIAM M MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85813	02	General Surgery	0	In state provider	None	5600 STONERIDGE DR	None	PLEASANTON	CA	94588	8501	01	06001	37.68867756	-121.8852934	Alameda County
281899	Fee-for-Service	1386694628	1386694628	1	1	GERARD HAFNER M.D.	10/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 S 48TH ST	None	LINCOLN	NE	68506	1283	00	None	40.79662742	-96.65363209	Lancaster County
282005	Fee-for-Service	1689751786	1689751786	1	1	GREICUS, LAURA A NP	10/23/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3700 EDISON ST	None	SAN MATEO	CA	94403	4462	41	06081	37.53169972	-122.2983207	San Mateo County
282020	Fee-for-Service	1457358707	1457358707	1	1	GIRITSKY, ALEXANDER S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27638	33	Thoracic Surgery	0	In state provider	None	9834 GENESEE AVE	STE 120	LA JOLLA	CA	92037	1225	37	06073	32.884074	-117.225855	San Diego County
282086	Fee-for-Service	1952791907	1952791907	1	1	GALEN INPATIENT PHYSICIANS	4/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	5974 PENTZ ROAD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
282113	Fee-for-Service	1548205446	1548205446	1	1	GARFIELD BEACH CVS, LLC	10/10/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4829 CLAIREMONT DR.	None	SAN DIEGO	CA	92117	2706	37	06073	32.83175462	-117.2052088	San Diego County
282131	Fee-for-Service	1295122497	1295122497	1	1	GUAN, JAY MD	8/30/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	144843	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
282160	Fee-for-Service	1710921127	1710921127	1	1	GRASSO, JOHN J MD	8/31/1985	207L00000X	NA	Other	026	PHYSICIANS	52753	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
282162	Fee-for-Service	1487033437	1487033437	1	1	GOWDA, ARJUN MD	5/23/2019	207R00000X	NA	Other	026	PHYSICIANS	162458	40	Pediatrics	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
282180	Fee-for-Service	1205222122	1205222122	1	1	GARG, GAURAV MD	10/17/2022	208600000X	NA	General Surgery	026	PHYSICIANS	171854	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
282226	Fee-for-Service	1457358707	1457358707	1	1	GIRITSKY, ALEXANDER S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27638	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9834 GENESEE AVE	STE 120	LA JOLLA	CA	92037	1225	37	06073	32.884074	-117.225855	San Diego County
282292	Fee-for-Service	1952791907	1952791907	1	1	GALEN INPATIENT PHYSICIANS	4/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	5974 PENTZ ROAD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
282319	Fee-for-Service	1447758966	1447758966	2	2	GROUPS - RECOVER TOGETHER CA	8/14/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	376 HARTNELL AVENUE	SUITE A	REDDING	CA	96002	1881	45	06089	40.56518339	-122.3683085	Shasta County
282358	Fee-for-Service	1487033437	1487033437	1	1	GOWDA, ARJUN MD	5/23/2019	207R00000X	NA	Other	026	PHYSICIANS	162458	77	Infectious Disease	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
282368	Fee-for-Service	1467813873	1467813873	1	3	GURMANT P SINGH MD INC	3/27/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	IALISTS	8307 BRIMHALL RD	1706	BAKERSFIELD	CA	93312	4343	15	06029	35.366481	-119.0948445	Kern County
282425	Fee-for-Service	1427202373	1427202373	1	1	GASSER, TYLER G MD	8/23/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	155432	30	Radiology	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
282531	Fee-for-Service	1972289593	1972289593	1	1	GALERO, CRISTINE JAMINE	7/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3700 GOSFORD RD	SUITE G	BAKERSFIELD	CA	93309	7694	15	06029	35.320932	-119.092064	Kern County
282536	Fee-for-Service	1083659528	1083659528	1	1	GUHA-ROY, ASIM MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62010	41	Internal Medicine	0	In state provider	None	9355 MIRA MESA BLVD	None	SAN DIEGO	CA	92126	4816	37	06073	32.91706598	-117.1235646	San Diego County
282563	Fee-for-Service	1124099510	1124099510	1	1	GILLEN, MARIJO MD	8/15/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85827	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
282573	Fee-for-Service	1952596181	1952596181	1	1	GARTNER, ANNE E DO	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10092	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
282583	Fee-for-Service	1881119030	1881119030	1	1	GARNETT, MYLEKA LMFT	1/27/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
282589	Fee-for-Service	1750049508	1750049508	1	1	GLADNEY, JOSHUA A PT	1/13/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	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
282611	Fee-for-Service	1942406533	1942406533	1	1	GARA, NAVEEN MD	7/25/2017	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	149265	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
282633	Fee-for-Service	1366490310	1366490310	1	1	GAUTAM, RAVINDRA MD INC	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56418	None	None	0	In state provider	None	555 S 7TH AVE	None	BARSTOW	CA	92311	3043	36	06071	34.894062	-117.0196215	San Bernardino County
282664	Fee-for-Service	1942437645	1942437645	1	1	GONZALEZ, DESIREE R LMFT	7/1/2022	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
282726	Fee-for-Service	1598180515	1598180515	1	1	GRACE EXTENDED & MEDICAL SER	3/1/2022	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	VICES INC	350 SOUTH OAK AVENUE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
282728	Fee-for-Service	1306198734	1306198734	1	1	GUITRON, LOUIS X NP	8/3/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	19	06037	34.100523	-118.3324855	Los Angeles County
282771	Fee-for-Service	1649370826	1649370826	1	1	GARCIA, RACHAEL M LCSW	4/4/2007	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	15525 POMERADO RD	STE E4	POWAY	CA	92064	2427	37	06073	32.99479918	-117.0579468	San Diego County
282776	Fee-for-Service	1710183116	1710183116	1	1	GRATZINGER, DITA A MD	6/27/2007	207ZP0102X	NA	Other	026	PHYSICIANS	88740	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
282807	Fee-for-Service	1932597705	1932597705	1	1	GUITRON, VIOLETA	12/23/2015	No Taxonomy Provided	NA	None	037	SPEECH 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
282810	Fee-for-Service	1841286861	1841286861	1	1	GRANDY, DENNIS W DPM	9/30/1988	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3939 J ST	STE 270	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
282813	Fee-for-Service	1114547312	1114547312	1	1	GONZALES, SAVANNAH MD	9/3/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189330	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1922 HILLHURST	STE 200	LOS ANGELES	CA	90027	2712	19	06037	34.106166	-118.2873815	Los Angeles County
282825	Fee-for-Service	1558071332	1558071332	1	1	GUERRA, MELISSA BIRTH DOULA	2/9/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
282828	Fee-for-Service	1720226533	1720226533	1	1	GOODSELL, KIM E MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77554	08	Family Practice	0	In state provider	None	401 PARADISE RD	STE E	MODESTO	CA	95351	3104	50	06099	37.62692973	-121.0131742	Stanislaus County
282865	Fee-for-Service	1851494215	1851494215	1	1	GU, RON Y MD	3/27/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	37924	41	Internal Medicine	0	In state provider	None	1850 S AZUSA AVE	STE 205	HACIENDA HEIGHTS	CA	91745	6853	19	06037	33.98895597	-117.9322797	Los Angeles County
282902	Fee-for-Service	1164665915	1164665915	1	1	GAMBINO, CHRISTINA C CRNA	9/23/2019	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
282973	Fee-for-Service	1881838001	1881838001	1	1	GOLDIN, TATYANA DO	1/29/2025	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	20788	08	Family Practice	0	In state provider	None	4520 BUSINESS CENTER DR	200	FAIRFIELD	CA	94534	6888	48	06095	38.22519621	-122.1327459	Solano County
283005	Fee-for-Service	1841639242	1841639242	1	1	GUPTA, GITIKA MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142085	41	Internal Medicine	0	In state provider	None	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735353	-121.2443415	San Joaquin County
283046	Fee-for-Service	1508273558	1508273558	2	1	GOOD SHEPHERD HOME HEALTH	8/7/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	18623 VENTURA BLVD	STE 205	TARZANA	CA	91356	6802	19	06037	34.17010548	-118.5392351	Los Angeles County
283049	Fee-for-Service	1023448511	1023448511	1	1	GROWING HEALTHY TOGETHER INC	12/30/2014	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2700 N BELLFLOWER BLVD	STE 112	LONG BEACH	CA	90815	1100	19	06037	33.805692	-118.1251805	Los Angeles County
283118	Fee-for-Service	1861410136	1861410136	1	1	GILILLAND, EDWARD	6/7/2005	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	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
283126	Fee-for-Service	1134234784	1134234784	1	1	GENUISE, PAUL 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	1501 N GILBERT RD	None	GILBERT	AZ	85234	2390	00	None	33.376113	-111.788037	Maricopa County
283130	Fee-for-Service	1679558035	1679558035	1	1	GONZALO, IRENE TAN G MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64475	41	Internal Medicine	0	In state provider	None	50 BELLEFONTAINE ST	STE 104	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
283149	Fee-for-Service	1497041164	1497041164	2	1	GIANG, ERIC L DO	12/17/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	15447	20	Orthopedic Surgery	0	In state provider	None	2116 E ORANGEBURG AVENUE	A	MODESTO	CA	95350	1159	50	06099	37.66354152	-120.958056	Stanislaus County
283184	Fee-for-Service	1720154255	1720154255	1	1	GROBLER, NICOLAAS M MD	6/4/2008	207R00000X	NA	Other	026	PHYSICIANS	89047	41	Internal Medicine	0	In state provider	None	11760 CENTRAL AVENUE	SUITE 100	CHINO	CA	91710	1923	36	06071	34.03926	-117.6896155	San Bernardino County
283226	Fee-for-Service	1235270489	1235270489	1	1	GASTROENTEROLOGY ASSOC	2/9/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF NAPA VALLEY, INC	3443 VILLA LN	STE 4	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
283231	Fee-for-Service	1649414400	1649414400	1	1	GANELIS, IRINA B MD	2/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99531	18	Ophthalmology	0	In state provider	None	3801 LAS POSAS RD	STE 112	CAMARILLO	CA	93010	1477	56	06111	34.24138914	-119.0191887	Ventura County
283234	Fee-for-Service	1679671002	1679671002	1	1	GUMINA, DEBORAH L MD	7/1/1995	208600000X	NA	General Surgery	026	PHYSICIANS	74344	None	None	0	In state provider	None	7202 N MILLBROOK AVE	STE 105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
283239	Fee-for-Service	1023448511	1023448511	1	1	GROWING HEALTHY TOGETHER INC	12/30/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2700 N BELLFLOWER BLVD	STE 112	LONG BEACH	CA	90815	1100	19	06037	33.805692	-118.1251805	Los Angeles County
283240	Fee-for-Service	1386663508	1386663508	1	1	GHODS, EHSAN DO	11/13/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	10162	None	None	0	In state provider	None	1200 B GALE WILSON	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
283264	Fee-for-Service	1881624583	1881624583	1	10	GENESISCARE OF CALIFORNIA, A	2/26/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	1211 W LA PALMA AVE	SUITE 100	ANAHEIM	CA	92801	2809	30	06059	33.84718298	-117.933758	Orange County
283272	Fee-for-Service	1275759250	1275759250	2	1	GONZALEZ, ARMANDO MD FACC	6/14/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	39725	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3838 SAN DIMAS ST	SUITE B-201	BAKERSFIELD	CA	93301	1456	15	06029	35.3946385	-119.008203	Kern County
283302	Fee-for-Service	1295038404	1295038404	1	1	GRANDVIEW FOUNDATION, INC	9/16/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1230 N MARENGO AVE &	225 GRANDVIEW ST	PASADENA	CA	91103	2217	19	06037	34.16705477	-118.1461236	Los Angeles County
283306	Fee-for-Service	1699751586	1699751586	1	1	GOURDJI, MAURICE MD	9/20/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44358	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
283317	Fee-for-Service	1952496473	1952496473	1	1	GROSS, BENNETT R MD	12/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	61266	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
283343	Fee-for-Service	1659396778	1659396778	1	1	GINSBERG, MARK H MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	29521	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
283373	Fee-for-Service	1720154255	1720154255	1	1	GROBLER, NICOLAAS M MD	6/4/2008	207R00000X	NA	Other	026	PHYSICIANS	89047	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11760 CENTRAL AVENUE	SUITE 100	CHINO	CA	91710	1923	36	06071	34.03926	-117.6896155	San Bernardino County
283391	Fee-for-Service	1215003603	1215003603	2	2	GENOMIC HEALTH INC.	2/15/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	445 N 5TH ST	1ST FLOOR	PHOENIX	AZ	92220	2274	00	None	33.453081	-112.066983	Maricopa County
283395	Fee-for-Service	1629013834	1629013834	1	1	GARY'S ALL-MED DRUGS INC	3/3/2011	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7946 N MAPLE AVE	SUITE 108	FRESNO	CA	93720	0289	10	06019	36.851454	-119.747724	Fresno County
283428	Fee-for-Service	1346811379	1346811379	1	2	GLORY HOMES, INC.	10/11/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13447 FERNGLEN CT.	None	VICTORVILLE	CA	92394	9584	36	06071	34.52412157	-117.3695151	San Bernardino County
283434	Fee-for-Service	1841208964	1841208964	1	1	GHATAN, BIJAN MD	10/1/1999	207R00000X	NA	Other	026	PHYSICIANS	44085	41	Internal Medicine	0	In state provider	None	20401 AVALON BLVD	STE B	CARSON	CA	90746	3226	19	06037	33.84655123	-118.2648105	Los Angeles County
283438	Fee-for-Service	1003879081	1003879081	1	1	GREATER LOS ANGELES	5/1/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIALYSIS CENTERS LLC	3986 S FIGUEROA ST	None	LOS ANGELES	CA	90037	1222	19	06037	34.01156896	-118.2827199	Los Angeles County
283454	Fee-for-Service	1851643282	1851643282	1	1	GUTIERREZ, RUBEN LMFT	5/30/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96985	-	NOT APPLICABLE	0	In state provider	None	11643 GLENOAKS BLVD	None	PACOIMA	CA	91331	1050	19	06037	34.28133474	-118.4198166	Los Angeles County
283473	Fee-for-Service	1316493760	1316493760	1	1	GUO, LIN OD	11/21/2017	390200000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
283510	Fee-for-Service	1205018496	1205018496	1	1	GLOVER, JEFFREY LCSW	9/15/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
283567	Fee-for-Service	1184609414	1184609414	1	1	GARCIA, JORGE A MD	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	72456	41	Internal Medicine	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
283592	Fee-for-Service	1760664130	1760664130	1	1	GOLD, YAUVANA V	12/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102752	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
283638	Fee-for-Service	1700891124	1700891124	1	1	GUTIERREZ KOVNER, VICTORIA M	1/27/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	KOVNER LCSW	595 E COLORADO BLVD	710	PASADENA	CA	91101	2039	19	06037	34.14588202	-118.1380722	Los Angeles County
283656	Fee-for-Service	1831456086	1831456086	1	1	GREWAL, MANDEEP K MD	9/4/2018	207RP1001X	NA	Pulmonology	026	PHYSICIANS	153374	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1485 RIVER PARK DR	STE 200	SACRAMENTO	CA	95815	4501	34	06067	38.599614	-121.438728	Sacramento County
283663	Fee-for-Service	1356100945	1356100945	1	1	GERBER, JAMESS H OT	4/16/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1901 W LUGONIA AVE	SUITE 240	REDLANDS	CA	92374	9703	36	06071	34.07027851	-117.218421	San Bernardino County
283683	Fee-for-Service	1750358990	1750358990	1	1	GARG, ANIT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	GARG MEDICAL CENTER	11200 SEMINOLE BLVD,	STE 307	LARGO	FL	33778	0000	00	None	27.874458	-82.78717652	Pinellas County
283701	Fee-for-Service	1124322086	1124322086	1	1	GAO, GUANGQIANG MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115654	02	General Surgery	0	In state provider	None	1940 N ORANGE GROVE AVE	None	POMONA	CA	91767	3008	19	06037	34.07889352	-117.7478982	Los Angeles County
283752	Fee-for-Service	1497707319	1497707319	1	1	GELLER, RICHARD J MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	49837	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
283768	Fee-for-Service	1437429586	1437429586	1	1	GARFIELD BEACH CVS LLC	5/7/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	38012 47TH STREET EAST	None	PALMDALE	CA	93552	3117	19	06037	34.573437	-118.044981	Los Angeles County
283775	Fee-for-Service	1386686525	1386686525	1	1	GOODMAN, CHAD J MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71868	30	Radiology	0	In state provider	None	735 GALVESTON DR	None	REDWOOD CITY	CA	94063	4722	41	06081	37.4989557	-122.2170646	San Mateo County
283858	Fee-for-Service	1194212308	1194212308	1	1	GOODELL, ALEXANDER J MD	6/19/2023	207L00000X	NA	Other	026	PHYSICIANS	163671	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
283861	Fee-for-Service	1912133612	1912133612	1	1	GANAL, JOHN V. MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119360	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	STE 8211	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
283870	Fee-for-Service	1487644118	1487644118	1	1	GREENFIELD, JON B MD INC	4/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	26989	20	Orthopedic Surgery	0	In state provider	None	434 S SAN VICENTE BLVD	None	LOS ANGELES	CA	90048	4108	19	06037	34.07053591	-118.375828	Los Angeles County
283931	Fee-for-Service	1417386053	1417386053	1	1	GOLOD, GREG AU	2/18/2022	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
283949	Fee-for-Service	1558553610	1558553610	1	1	GOODWIN, COLIN PSYD	12/30/2022	101Y00000X	NA	Other	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
283974	Fee-for-Service	1508286816	1508286816	1	1	GUERRERO, MANUEL MD	7/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168252	None	None	0	In state provider	None	300 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2594	48	06095	38.13070051	-122.237307	Solano County
283994	Fee-for-Service	1124137765	1124137765	1	1	GOFFMAN, JERRY	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4580 PALM AVE	None	RIVERSIDE	CA	92501	3950	33	06065	33.97790607	-117.3899372	Riverside County
284013	Fee-for-Service	1912147836	1912147836	1	1	GARFIELD BEACH CVS, LLC	7/29/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1954 DURFEE AVE	None	SOUTH EL MONTE	CA	91733	3711	19	06037	34.04503811	-118.0306833	Los Angeles County
284089	Fee-for-Service	1568427185	1568427185	1	1	GELB, ADRIAN W MD	4/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51367	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
284100	Fee-for-Service	1316989510	1316989510	1	1	GARFIELD BEACH CVS LLC	5/22/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5259 MISSION OAKS BLVD	None	CAMARILLO	CA	93012	5422	56	06111	34.2283357	-118.9983698	Ventura County
284162	Fee-for-Service	1073567442	1073567442	1	1	GORNIOWSKY, MICHAEL J MD	11/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	29723	08	Family Practice	0	In state provider	None	3521 LEXINGTON AVE	None	EL MONTE	CA	91731	2607	19	06037	34.07280787	-118.0394699	Los Angeles County
284173	Fee-for-Service	1922051531	1922051531	1	1	GOTHENBURG MEMORIAL HOSPITAL	10/10/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	910 20TH ST	None	GOTHENBURG	NE	69138	0469	00	None	40.93813948	-100.1534175	Dawson County
284183	Fee-for-Service	1306403043	1306403043	1	1	GARCIA, NOELLE S LMFT	5/22/2023	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
284246	Fee-for-Service	1538685946	1538685946	1	1	GHC OF SAN FRAN 68, LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1575 7TH AVE	None	SAN FRANCISCO	CA	94122	3704	38	06075	37.75895703	-122.4638827	San Francisco County
284270	Fee-for-Service	1588124713	1588124713	1	1	GHOORAY, KALA C MD	6/13/2022	208M00000X	NA	Other	026	PHYSICIANS	177993	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
284284	Fee-for-Service	1316175292	1316175292	1	1	GREEN, MICHAEL S MD	7/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142425	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
284287	Fee-for-Service	1871656538	1871656538	1	1	GENANT, JUSTIN W MD	9/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99258	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
284305	Fee-for-Service	1861480097	1861480097	1	1	GARDEN CREST CONV HOSP	10/27/1992	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	909 LUCILE AVE	None	LOS ANGELES	CA	90026	1598	19	06037	34.08552766	-118.2825511	Los Angeles County
284319	Fee-for-Service	1386405256	1386405256	1	1	GONZALEZ, SARAH E PT	1/25/2024	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
284329	Fee-for-Service	1306253257	1306253257	1	1	GARFIELD BEACH CVS LLC	1/29/2015	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1803 SOUTH HARBOR BLVD	None	ANAHEIM	CA	92802	3509	30	06059	33.80296924	-117.9154254	Orange County
284339	Fee-for-Service	1073567442	1073567442	1	1	GORNIOWSKY, MICHAEL J MD	11/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	29723	01	General Practice	0	In state provider	None	3521 LEXINGTON AVE	None	EL MONTE	CA	91731	2607	19	06037	34.07280787	-118.0394699	Los Angeles County
284386	Fee-for-Service	1235699331	1235699331	1	1	GUPTA, ABHINAV	8/13/2024	207L00000X	NA	Other	026	PHYSICIANS	182495	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
284420	Fee-for-Service	1336137603	1336137603	1	1	GANDOTRA, VISHAL MD	5/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	5701 W CHARLESTON BLVD	STE 100	LAS VEGAS	NV	89146	1256	00	None	36.15908651	-115.219719	Clark County
284429	Fee-for-Service	1053353243	1053353243	1	1	GARFIELD BEACH CVS LLC	8/10/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
284443	Fee-for-Service	1538237599	1538237599	1	1	GHATTA, MARIANNE R OD	4/23/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
284444	Fee-for-Service	1922194711	1922194711	1	1	GRAFE, MICHAEL W MD	1/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69430	20	Orthopedic Surgery	0	In state provider	None	990 SONOMA AVE	STE 8	SANTA ROSA	CA	95404	4813	49	06097	38.439729	-122.701545	Sonoma County
284445	Fee-for-Service	1801818430	1801818430	2	1	GARFIELD BEACH CVS LLC	10/27/2017	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20700 AVALON BLVD	STE 700	CARSON	CA	90746	3704	19	06037	33.8437375	-118.2632149	Los Angeles County
284451	Fee-for-Service	1124062476	1124062476	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1980 COLLEGE BLVD	None	OCEANSIDE	CA	92056	5939	37	06073	33.208524	-117.2848615	San Diego County
284475	Fee-for-Service	1871798058	1871798058	1	1	GARCIA, MAURICE M MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83386	34	Urology and Urological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
284521	Fee-for-Service	1609943836	1609943836	2	1	GRIFFITH, DON M DPM	9/16/2013	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
284579	Fee-for-Service	1497215644	1497215644	1	1	GRADE, MADELINE M MD	12/16/2022	207P00000X	NA	Other	026	PHYSICIANS	179218	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
284592	Fee-for-Service	1336137603	1336137603	1	1	GANDOTRA, VISHAL MD	5/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	5701 W CHARLESTON BLVD	STE 100	LAS VEGAS	NV	89146	1256	00	None	36.15908651	-115.219719	Clark County
284606	Fee-for-Service	1851657076	1851657076	1	1	GUNASEKARAN, SENTHIL S MD	2/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	148424	30	Radiology	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
284648	Fee-for-Service	1144660101	1144660101	1	1	GONZALES STEPHANI M	8/1/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
284679	Fee-for-Service	1841585288	1841585288	1	1	GOLD, CARL A MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134191	13	Neurology (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
284692	Fee-for-Service	1013653286	1013653286	1	1	GULLES, STP JOURNEY M NP	5/22/2022	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	37	06073	33.01539521	-117.0824934	San Diego County
284702	Fee-for-Service	1982610416	1982610416	1	1	GOLDMAN, GARY A MD	12/14/1994	207L00000X	NA	Other	026	PHYSICIANS	65951	05	Anesthesiology	0	In state provider	None	4525 QUAIL LAKES DR	None	STOCKTON	CA	95207	5257	39	06077	37.98806683	-121.3402906	San Joaquin County
284745	Fee-for-Service	1932248531	1932248531	1	1	GIBBS, DIANE E	4/13/2022	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
284808	Fee-for-Service	1376545269	1376545269	1	1	GHEISSARI, ALI MD	11/12/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72926	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2200 W 3RD ST	STE 370	LOS ANGELES	CA	90057	1939	19	06037	34.06329642	-118.2739484	Los Angeles County
284855	Fee-for-Service	1518909456	1518909456	1	1	GALDINO, GREGORY M MD	7/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81641	30	Radiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
284910	Fee-for-Service	1619900362	1619900362	1	1	GHAZVINI & JAVAHERI MD INC	3/8/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	23961 CALLE DE LA MAGDAL	STE 430	LAGUNA HILLS	CA	92653	3685	30	06059	33.60999658	-117.7126577	Orange County
284959	Fee-for-Service	1376545269	1376545269	1	1	GHEISSARI, ALI MD	11/12/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72926	33	Thoracic Surgery	0	In state provider	None	2200 W 3RD ST	STE 370	LOS ANGELES	CA	90057	1939	19	06037	34.06329642	-118.2739484	Los Angeles County
285063	Fee-for-Service	1417930520	1417930520	1	1	GREENHOLZ, JARED R MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64953	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
285076	Fee-for-Service	1093343063	1093343063	1	1	GUI, EVAN	9/1/2023	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
285088	Fee-for-Service	1023072915	1023072915	1	1	GATES, THOMAS C MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	23750	67	Endocrinology	0	In state provider	None	509 E 10TH ST	None	LONG BEACH	CA	90813	4508	19	06037	33.7790373	-118.1861816	Los Angeles County
285121	Fee-for-Service	1063447274	1063447274	1	1	GARDNER, STEPHANIE C MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99710	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
285156	Fee-for-Service	1174788004	1174788004	1	1	GOLDMAN, SETH A MD	9/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111491	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
285253	Fee-for-Service	1023072915	1023072915	1	1	GATES, THOMAS C MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	23750	30	Radiology	0	In state provider	None	509 E 10TH ST	None	LONG BEACH	CA	90813	4508	19	06037	33.7790373	-118.1861816	Los Angeles County
285260	Fee-for-Service	1689625972	1689625972	1	1	GAMEZ, CANDIDO M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64807	08	Family Practice	0	In state provider	None	5823 YORK BLVD	None	LOS ANGELES	CA	90042	2634	19	06037	34.11850913	-118.1915335	Los Angeles County
285261	Fee-for-Service	1487853263	1487853263	1	1	GALLUP, CECILY J MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108236	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
285276	Fee-for-Service	1629593736	1629593736	1	1	GUIDED RECOVERY COUNSELING,	3/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	INC.	41911 5TH STREET	103	TEMECULA	CA	92590	9259	33	06065	33.49563559	-117.1495713	Riverside County
285337	Fee-for-Service	1578590196	1578590196	1	1	GRAHAM, JOHN M MD	3/16/1998	174400000X	NA	Other	026	PHYSICIANS	64797	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
285351	Fee-for-Service	1669009593	1669009593	1	1	GALLENT, ERIN MD	1/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	188693	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
285357	Fee-for-Service	1194349639	1194349639	1	1	GASKILL, NICHOLAS MD	10/16/2023	208M00000X	NA	Other	026	PHYSICIANS	187454	None	None	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
285358	Fee-for-Service	1700860871	1700860871	1	10	GOLDEN STATE DERMATOLOGY ASS	1/20/2023	207ND0101X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OCIATES, INC.	1200 CENTRAL BLVD	STE D	BRENTWOOD	CA	94513	2227	07	06013	37.93807844	-121.6985632	Contra Costa County
285400	Fee-for-Service	1649895194	1649895194	1	2	GRASS VALLEY RADIATION ONCOL	9/17/2024	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	32	Radiation Therapy (D.O. only)	0	In state provider	None	300 SIERRA COLLEGE DR,	SUITE 150	GRASS VALLEY	CA	95945	5083	29	06057	39.23625806	-121.054471	Nevada County
285515	Fee-for-Service	1881618015	1881618015	1	1	GARCIA-LLORET, MARIA MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73213	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
285557	Fee-for-Service	1710397914	1710397914	1	1	GU, BO MD	5/18/2020	207P00000X	NA	Other	026	PHYSICIANS	167658	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
285574	Fee-for-Service	1720199722	1720199722	1	1	GOLDMAN, ERICA L MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72720	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
285575	Fee-for-Service	1346416864	1346416864	1	1	GUTIERREZ, IVAN M MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109459	02	General Surgery	0	In state provider	None	863 N DOUGLAS ST	STE 100	EL SEGUNDO	CA	90245	2801	19	06037	33.92830583	-118.3831669	Los Angeles County
285579	Fee-for-Service	1023169489	1023169489	1	1	GROVER, NEERA MD	9/30/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	53155	41	Internal Medicine	0	In state provider	None	16018 TUSCOLA RD	STE 2	APPLE VALLEY	CA	92307	1329	36	06071	34.542207	-117.269316	San Bernardino County
285626	Fee-for-Service	1821251075	1821251075	1	1	GRANT, WILLIAM G MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121467	05	Anesthesiology	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	9468	37	06073	33.12542915	-117.0764725	San Diego County
285632	Fee-for-Service	1336765908	1336765908	1	1	GIBSON, ALEXIS V LMFT	9/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2280 SUNSET DR	SUITE EE	LOS OSOS	CA	93402	4026	40	06079	35.30980192	-120.830304	San Luis Obispo County
285636	Fee-for-Service	1588928451	1588928451	1	2	GIBBONS, MATTHEW T PSYD	9/25/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	27185	-	NOT APPLICABLE	0	In state provider	None	17822 BEACH BLVD	278	HUNTINGTON BEACH	CA	92647	7180	30	06059	33.70331388	-117.9890471	Orange County
285643	Fee-for-Service	1538245162	1538245162	1	1	GRANITE POINTE EYE CARE	3/12/2007	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	9221 SIERRA COLLEGE BLVD	STE 130	ROSEVILLE	CA	95661	5919	31	06061	38.735028	-121.225764	Placer County
285652	Fee-for-Service	1417028499	1417028499	1	1	GOLDMAN, SUSAN R MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81257	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
285674	Fee-for-Service	1881618015	1881618015	1	1	GARCIA-LLORET, MARIA MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73213	03	Allergy	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
285676	Fee-for-Service	1548270515	1548270515	1	1	GOLLUB, NORMAN A MD	7/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	57693	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
285736	Fee-for-Service	1023169489	1023169489	1	1	GROVER, NEERA MD	9/30/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	53155	10	Gastroenterology (M.D. only)	0	In state provider	None	16018 TUSCOLA RD	STE 2	APPLE VALLEY	CA	92307	1329	36	06071	34.542207	-117.269316	San Bernardino County
285789	Fee-for-Service	1215553938	1215553938	1	1	GORDON, LIA K NP	8/9/2022	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
285841	Fee-for-Service	1417948571	1417948571	1	1	GUPTA, MUNISH C	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74195	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	STE 1700	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
285852	Fee-for-Service	1710404686	1710404686	1	1	GUARDIAN FLIGHT LLC	7/21/2024	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	5880 OLD AIRPORT RD	None	FAIRBANKS	AK	99709	4601	00	None	64.82821813	-147.849497	Fairbanks North Star Borough
285854	Fee-for-Service	1659806123	1659806123	1	1	GONZALES, MITZI M PHD	12/8/2023	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
285861	Fee-for-Service	1891312112	1891312112	1	1	GUTIERREZ, ILIANA MD	8/1/2023	207P00000X	NA	Other	026	PHYSICIANS	186658	None	None	0	In state provider	None	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
285872	Fee-for-Service	1811205545	1811205545	1	1	GORDON, RICHARD MD INC	6/30/1987	174400000X	NA	Other	026	PHYSICIANS	56286	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 RESEDA BLVD	STE 204	NORTHRIDGE	CA	91324	4041	19	06037	34.229988	-118.536062	Los Angeles County
285884	Fee-for-Service	1801237177	1801237177	1	1	GOLAN, JULIANE MD	11/1/2023	208C00000X	NA	General Surgery	026	PHYSICIANS	141479	None	None	0	In state provider	None	10 CONGRESS STREET	200	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
285890	Fee-for-Service	1588955595	1588955595	1	1	GODOY, ELAINE M LMFT	10/3/2023	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
285909	Fee-for-Service	1063839934	1063839934	1	1	GARCIA LORA, RAYMUNDO M MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137841	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
285914	Fee-for-Service	1235660911	1235660911	1	1	GUTIERREZ, SUSAN MD	6/3/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	172706	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
285959	Fee-for-Service	1588923684	1588923684	1	1	GHASSEMZADEH, SASSAN MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127195	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
286024	Fee-for-Service	1124585658	1124585658	1	1	GABRIELA CARE HOME INC	3/17/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1717 TAMARRON DR	None	CORONA	CA	92883	0765	33	06065	33.81619777	-117.5408061	Riverside County
286056	Fee-for-Service	1326162272	1326162272	1	1	GUNAWARDANE, MANJULA V M	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103613	41	Internal Medicine	0	In state provider	None	350 30TH ST	#411	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
286063	Fee-for-Service	1427070119	1427070119	2	1	GARFIELD BEACH CVS LLC	9/2/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ORANGETHORPE AVE	None	FULLERTON	CA	92832	2900	30	06059	33.85943952	-117.9268155	Orange County
286069	Fee-for-Service	1326642646	1326642646	1	1	GIVING HANDS HOME HEALTH	11/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	15720 VENTURA BLVD	SUITE 303	ENCINO	CA	91436	2985	19	06037	34.15524484	-118.4756687	Los Angeles County
286080	Fee-for-Service	1841486263	1841486263	1	1	GHAWI, HANI S MD	10/6/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	164666	None	None	0	In state provider	None	350 E VANDERBILT WAY	STE A	SAN BERNARDINO	CA	92408	3593	36	06071	34.06877914	-117.2773555	San Bernardino County
286090	Fee-for-Service	1295811628	1295811628	1	1	GINGERICH, RUTH G	4/30/1992	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25700 CANADA DR	None	CARMEL	CA	93923	8924	27	06053	36.54836564	-121.8964981	Monterey County
286092	Fee-for-Service	1841518990	1841518990	1	1	GUIMERA, ALLISON E L MD	10/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120463	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	STE 265	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
286096	Fee-for-Service	1922482678	1922482678	1	1	GRIFFITH PARK REHABILITATION	5/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	201 ALLEN AVENUE	None	GLENDALE	CA	91201	2803	19	06037	34.16259129	-118.3055544	Los Angeles County
286102	Fee-for-Service	1760821888	1760821888	1	2	GOODMAN, DAVID MD	10/5/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	141304	-	NOT APPLICABLE	0	In state provider	None	717 LINCOLN BLVD.	None	VENICE	CA	90291	2845	19	06037	33.99949766	-118.464069	Los Angeles County
286114	Fee-for-Service	1184409716	1184409716	1	1	GAUTAM, GAYATRI	11/16/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2251 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	0000	15	06029	35.38868165	-118.9673556	Kern County
286157	Fee-for-Service	1932273927	1932273927	1	1	GOCHIS, PAUL D MD	12/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168472	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
286168	Fee-for-Service	1427253079	1427253079	1	1	GADGIL, MEGHANA D MD	5/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128780	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
286182	Fee-for-Service	1427106210	1427106210	1	1	GAINSKI, JOANNA L MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89978	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
286186	Fee-for-Service	1447285903	1447285903	1	1	GARDNER, JEFFERY G MD	1/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
286205	Fee-for-Service	1710065552	1710065552	1	1	GAO, JEFFREY L MD	8/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80920	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
286257	Fee-for-Service	1215040845	1215040845	1	1	GRIMES, JAMES B MD	5/17/1990	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	54924	20	Orthopedic Surgery	0	In state provider	None	1921 18TH ST	None	BAKERSFIELD	CA	93301	4205	15	06029	35.37525954	-119.024586	Kern County
286271	Fee-for-Service	1770546871	1770546871	1	1	GRACIA, FRANCISCO MD	1/1/1982	174400000X	NA	Other	026	PHYSICIANS	33844	66	Emergency Medicine (Urgent Care)	0	In state provider	None	480 4TH AVE	STE 514	CHULA VISTA	CA	91910	4414	37	06073	32.63411298	-117.0816772	San Diego County
286292	Fee-for-Service	1699887018	1699887018	1	1	GREGORY S PETERSON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
286334	Fee-for-Service	1578630596	1578630596	1	1	GUPTA, SHALESH MD	9/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60189	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
286359	Fee-for-Service	1073074761	1073074761	1	1	GOYNE, CHRISTOPHER MD	9/3/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	179696	13	Neurology (M.D. only)	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
286362	Fee-for-Service	1750380820	1750380820	1	1	GLASS, JAMES D MD	1/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	54882	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
286380	Fee-for-Service	1417132812	1417132812	2	1	GLEN PARK AT GLENDALE	1/27/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	MARIPOSA ST	1220 S MARIPOSA ST	None	GLENDALE	CA	91205	3451	19	06037	34.13198762	-118.2502418	Los Angeles County
286417	Fee-for-Service	1770546871	1770546871	1	1	GRACIA, FRANCISCO MD	1/1/1982	174400000X	NA	Other	026	PHYSICIANS	33844	02	General Surgery	0	In state provider	None	480 4TH AVE	STE 514	CHULA VISTA	CA	91910	4414	37	06073	32.63411298	-117.0816772	San Diego County
286447	Fee-for-Service	1235135518	1235135518	1	1	GRADY, YOLANDA T MD INC	6/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53673	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
286451	Fee-for-Service	1285862672	1285862672	1	1	GORROW, ELENA A LCSW	2/23/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2551 SAN RAMON VALLEY BL	246	SAN RAMON	CA	94583	1664	07	06013	37.77143928	-121.9737192	Contra Costa County
286488	Fee-for-Service	1205857398	1205857398	1	1	GLEN CITY MEDICAL GRP IN	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	247 MARCH ST	None	SANTA PAULA	CA	93060	2597	56	06111	34.34910672	-119.0786704	Ventura County
286544	Fee-for-Service	1013124213	1013124213	2	1	GORDIAN MEDICAL, INC.	4/27/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	S	17595 CARTWRIGHT ROAD	None	IRVINE	CA	92614	5847	30	06059	33.68473358	-117.8433563	Orange County
286583	Fee-for-Service	1669401931	1669401931	2	1	GMD TRANSPORTATION INC	9/27/2017	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	660 MONTEREY PASS RD	STE 138A	MONTEREY PARK	CA	91754	2440	19	06037	34.05361037	-118.1505024	Los Angeles County
286587	Fee-for-Service	1699019778	1699019778	1	1	GHAEMIL, SAHAR LCSW	7/28/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
286594	Fee-for-Service	1821464033	1821464033	1	1	GRAY, CASEY	5/31/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	9100 BRENTWOOD BLVD	None	BRENTWOOD	CA	94513	4000	07	06013	37.91890165	-121.6845946	Contra Costa County
286598	Fee-for-Service	1609650928	1609650928	1	1	GODINEZ-GOMEZ, JASMINE M DOU	8/21/2023	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
286610	Fee-for-Service	1043430846	1043430846	1	1	GOLDEN VALLEY HEALTH CTR	10/15/1992	207Q00000X	NA	Adult Primary Care	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	24	06047	37.06376226	-120.860675	Merced County
286754	Fee-for-Service	1437114006	1437114006	1	1	GARAY, SUSAN C MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	73336	41	Internal Medicine	0	In state provider	None	1300 CRANE STREET	None	MENLO PARK	CA	94025	4260	41	06081	37.45264069	-122.1878743	San Mateo County
286759	Fee-for-Service	1376579664	1376579664	1	2	GULATI, RAJEEV MD	4/14/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	86583	33	Thoracic Surgery	0	In state provider	Y	1902 ROYALTY DRIVE	225	POMONA	CA	91767	3043	19	06037	34.07791925	-117.746146	Los Angeles County
286785	Fee-for-Service	1831553973	1831553973	1	1	GRAHAM, DANIELLE S MD	8/8/2018	208600000X	NA	General Surgery	026	PHYSICIANS	153264	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
286834	Fee-for-Service	1184817504	1184817504	1	1	GARNICA, ANDREA MSW LCSW	8/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	599 S BARRANCA AVE	#211	COVINA	CA	91723	2777	19	06037	34.079373	-117.881338	Los Angeles County
286868	Fee-for-Service	1477182905	1477182905	1	1	GARCIA, JORGE J MD	9/1/2023	207P00000X	NA	Other	026	PHYSICIANS	187710	None	None	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
286874	Fee-for-Service	1346285244	1346285244	1	1	GARFIELD BEACH CVS LLC	4/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	864 SWARTHMORE AVE	None	PACIFIC PALISADES	CA	90272	3605	19	06037	34.04645288	-118.5260244	Los Angeles County
286902	Fee-for-Service	1477845089	1477845089	1	1	GOWIN, KRISSTINA DO	9/24/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	23349	68	Hematology	0	In state provider	None	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	30	06059	33.65251244	-117.7317885	Orange County
286904	Fee-for-Service	1932162773	1932162773	1	1	GOLDSWORTHY, CHARLES MD	7/31/1986	207P00000X	NA	Other	026	PHYSICIANS	53691	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
286946	Fee-for-Service	1144390667	1144390667	1	1	GREY, HAROLD E LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD ROAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
286992	Fee-for-Service	1124474259	1124474259	1	1	GLAVIS-BLOOM, JUSTIN MD	8/15/2019	390200000X	NA	Other	026	PHYSICIANS	154223	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
287008	Fee-for-Service	1457797979	1457797979	1	1	GROSSMAN, HOWARD B LMFT	11/13/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15336 DEVONSHIRE ST	UNIT 6	MISSION HILLS	CA	91345	2755	19	06037	34.25726849	-118.4664285	Los Angeles County
287034	Fee-for-Service	1023654779	1023654779	1	1	GUERRERO, JOANNE NP	4/11/2024	363L00000X	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
287042	Fee-for-Service	1477845089	1477845089	1	1	GOWIN, KRISSTINA DO	9/24/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	23349	41	Internal Medicine	0	In state provider	None	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	30	06059	33.65251244	-117.7317885	Orange County
287049	Fee-for-Service	1093058513	1093058513	1	1	GERMAN, DAVID MD	12/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	159075	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
287061	Fee-for-Service	1346240447	1346240447	1	1	GARCIA,EVELYN	1/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3460 S PIONEER PKWY	None	WEST VALLEY	UT	84120	0000	00	None	40.697982	-111.9903965	Salt Lake County
287131	Fee-for-Service	1467958306	1467958306	1	1	GILANI, SARAH NP	10/8/2021	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
287187	Fee-for-Service	1093058513	1093058513	1	1	GERMAN, DAVID MD	12/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	159075	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
287226	Fee-for-Service	1518546316	1518546316	1	1	GOODWIN, MICHELLE F MD	8/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	27	Psychiatry Neurology (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
287234	Fee-for-Service	1528585460	1528585460	1	1	GARCIA, JENHI LCSW	10/22/2023	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
287263	Fee-for-Service	1962463455	1962463455	1	1	GOWDA, DEVAMANI MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	45394	41	Internal Medicine	0	In state provider	None	3 MEDICAL PLAZA DRIVE	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
287311	Fee-for-Service	1184685141	1184685141	1	1	GOODWIN, GLENDA MD, INC	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71660	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	TRINITY WOMEN'S HEALTH	7807 LAGUNA BLVD	STE 440	ELK GROVE	CA	95758	7953	34	06067	38.423736	-121.410846	Sacramento County
287313	Fee-for-Service	1891809869	1891809869	1	1	GOVE, DANA	5/23/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SOUTH VALLEY PHRMCY SERV	7496 EIGLEBERRY ST	None	GILROY	CA	95020	5712	43	06085	37.00781272	-121.5704745	Santa Clara County
287362	Fee-for-Service	1518546316	1518546316	1	1	GOODWIN, MICHELLE F MD	8/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	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
287394	Fee-for-Service	1871545822	1871545822	1	1	GOLDFARB, SARA E AU	4/28/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4300	34	06067	38.598876	-121.4502885	Sacramento County
287407	Fee-for-Service	1972663060	1972663060	1	1	GOH, YONG S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	STRAUB CLINIC & HOSPITAL	888 SOUTH KING ST	None	HONOLULU	HI	96813	0000	00	None	21.30218603	-157.8505732	Honolulu County
287433	Fee-for-Service	1205178712	1205178712	1	1	GARDINER, MICHAEL A MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124399	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
287454	Fee-for-Service	1265798508	1265798508	1	1	GHOSH, SONALI L MD	7/15/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159267	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
287459	Fee-for-Service	1013527803	1013527803	1	1	GARCIA, DENISE LMFT	11/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
287464	Fee-for-Service	1598898090	1598898090	1	1	GARG, TANU MD	4/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97733	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
287489	Fee-for-Service	1922752088	1922752088	1	1	GATHER LABS LLC	8/23/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	218 S ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	2811	19	06037	34.06440553	-118.3835984	Los Angeles County
287510	Fee-for-Service	1912500869	1912500869	1	1	GOWRING, SARAH M CRNA	12/15/2020	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
287518	Fee-for-Service	1346811379	1346811379	1	1	GLORY HOMES, INC.	3/17/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	15045 BRUCITE ROAD	None	VICTORVILLE	CA	92394	0541	36	06071	34.52391557	-117.3681631	San Bernardino County
287565	Fee-for-Service	1205178712	1205178712	1	1	GARDINER, MICHAEL A MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124399	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
287590	Fee-for-Service	1316078165	1316078165	1	1	GALDAMEZ, VIOLETA A MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50144	40	Pediatrics	0	In state provider	None	2955 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5836	19	06037	33.97333678	-118.2163277	Los Angeles County
287599	Fee-for-Service	1518398528	1518398528	1	1	GERVAIS, ALLISON LMFT	11/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
287620	Fee-for-Service	1801417811	1801417811	1	1	GJOCAJ, LIRIDON T MD	9/5/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185870	None	None	0	In state provider	None	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
287621	Fee-for-Service	1124021654	1124021654	1	1	GINSBURG, GREGORY T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74789	02	General Surgery	0	In state provider	None	1300 W 155TH ST	STE 204	GARDENA	CA	90247	4061	19	06037	33.89049013	-118.2982407	Los Angeles County
287634	Fee-for-Service	1205837192	1205837192	1	2	GROOMS, HAROLD F MD	3/23/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	36121	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2029 DIVISADERO ST	None	FRESNO	CA	93701	2013	10	06019	36.74332774	-119.7865097	Fresno County
287661	Fee-for-Service	1831114560	1831114560	1	1	GANESAN, DHANA L MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151949	41	Internal Medicine	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
287664	Fee-for-Service	1114212040	1114212040	1	1	GRANT, CHRISTOPHER W MD	10/12/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	183023	None	None	0	In state provider	None	1050 IRON POINT RD	None	FOLSOM	CA	95630	8013	34	06067	38.643309	-121.1787405	Sacramento County
287687	Fee-for-Service	1124551593	1124551593	1	1	GREWAL, HARLEEN MD	11/20/2020	390200000X	NA	Other	026	PHYSICIANS	157685	None	None	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
287691	Fee-for-Service	1043239619	1043239619	1	1	GONZALEZ, FERNANDO F MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82475	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
287703	Fee-for-Service	1205456688	1205456688	1	1	GERDTS, ETHAN A MD	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	185506	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
287711	Fee-for-Service	1952472706	1952472706	1	1	GUTGLASS, DAVID J. MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77971	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
287714	Fee-for-Service	1881688356	1881688356	2	1	GOONESINGHE, IRESHA MD	11/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	61625	41	Internal Medicine	0	In state provider	None	301 DRUMMOND AVE	None	RIDGECREST	CA	93555	3187	15	06029	35.63700649	-117.6750405	Kern County
287752	Fee-for-Service	1437326352	1437326352	1	1	GOLESTANY, KOUROSH MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105958	41	Internal Medicine	0	In state provider	None	43839 N 15TH ST WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
287832	Fee-for-Service	1265799548	1265799548	1	1	GLUCKSMAN, LINDSEY R MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130770	41	Internal Medicine	0	In state provider	None	200 ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.06481928	-118.3836235	Los Angeles County
287846	Fee-for-Service	1881688356	1881688356	2	1	GOONESINGHE, IRESHA MD	11/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	61625	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	301 DRUMMOND AVE	None	RIDGECREST	CA	93555	3187	15	06029	35.63700649	-117.6750405	Kern County
287928	Fee-for-Service	1689646796	1689646796	1	1	GRANT, GERALD A MD	8/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55884	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287936	Fee-for-Service	1295750321	1295750321	1	1	GRANT, IGOR MD	3/5/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18301	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
287959	Fee-for-Service	1588740641	1588740641	1	1	GARCIA, ALEJANDRO MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63931	06	Cardiovascular Disease (M.D. only)	0	In state provider	OJAI HEART	1901 OUTLET CENTER DR	STE 210	OXNARD	CA	93036	0666	56	06111	34.21965581	-119.1491337	Ventura County
288003	Fee-for-Service	1366459760	1366459760	1	1	GONG, RICHARD W MD	7/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116585	30	Radiology	0	In state provider	None	1867 E FIR AVE	STE 104	FRESNO	CA	93720	3808	10	06019	36.8391095	-119.7486135	Fresno County
288008	Fee-for-Service	1194875229	1194875229	1	1	GLENN, DAVID M MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	83704	None	None	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
288039	Fee-for-Service	1568407567	1568407567	1	1	GARFIELD BEACH CVS LLC	3/5/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	155 PACIFIC COAST HWY	None	HERMOSA BEACH	CA	90254	5346	19	06037	33.85609219	-118.3905708	Los Angeles County
288051	Fee-for-Service	1689646796	1689646796	1	1	GRANT, GERALD A MD	8/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55884	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
288059	Fee-for-Service	1306888508	1306888508	1	1	GARFIELD BEACH CVS LLC	11/17/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29995 ALICIA PKWY	None	LAGUNA NIGUEL	CA	92677	2090	30	06059	33.52732602	-117.7166712	Orange County
288076	Fee-for-Service	1881600732	1881600732	1	1	GRAY JERRY 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 ULUNIV ST 4TH FLOOR	None	KAILUA	HI	96734	0000	00	None	21.39646318	-157.7434882	Honolulu County
288085	Fee-for-Service	1588740641	1588740641	1	1	GARCIA, ALEJANDRO MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63931	41	Internal Medicine	0	In state provider	OJAI HEART	1901 OUTLET CENTER DR	STE 210	OXNARD	CA	93036	0666	56	06111	34.21965581	-119.1491337	Ventura County
288104	Fee-for-Service	1811384365	1811384365	1	1	GEISINGER, TERESA N NP	12/5/2018	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
288124	Fee-for-Service	1962866855	1962866855	1	1	GUDIWADA, SAI PRIYANKA MD	4/13/2020	207ZP0102X	NA	Other	026	PHYSICIANS	158281	21	Pathologic Anatomy: Clinical Pathology (D.O. 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
288156	Fee-for-Service	1235174129	1235174129	1	1	GALARIO, DAISY LYNN MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89435	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
288187	Fee-for-Service	1154409977	1154409977	1	1	GRAY, LYNDA G MD	3/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	40920	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
288216	Fee-for-Service	1043409345	1043409345	1	1	GREENWALD, LEONARD DPM	6/24/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	750 N CAPITOL AVE	STE B3	SAN JOSE	CA	95133	1941	43	06085	37.37847439	-121.8514294	Santa Clara County
288221	Fee-for-Service	1154494987	1154494987	1	1	GARFIELD BEACH CVS LLC	9/14/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10560 4S COMMONS DR	None	SAN DIEGO	CA	92127	3511	37	06073	33.01879013	-117.1110569	San Diego County
288242	Fee-for-Service	1962866855	1962866855	1	1	GUDIWADA, SAI PRIYANKA MD	4/13/2020	207ZP0102X	NA	Other	026	PHYSICIANS	158281	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
288266	Fee-for-Service	1962565093	1962565093	1	1	GARZA,OLIVIA 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	2805	00	None	32.252391	-110.8790055	Pima County
288338	Fee-for-Service	1598055923	1598055923	1	1	GASPARYAN, ANNA MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111683	02	General Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
288386	Fee-for-Service	1558407254	1558407254	1	1	GLENDALE MULTISPECIALTY	2/8/2013	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SURGERY CENTER LLC	716 W BROADWAY	None	GLENDALE	CA	91204	1010	19	06037	34.14674052	-118.269936	Los Angeles County
288433	Fee-for-Service	1467487447	1467487447	1	1	GRIFFIN, RALPH C JR MD	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143973	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
288456	Fee-for-Service	1043810997	1043810997	1	1	GARLEJO, SHURREN T LMFT	11/8/2023	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
288463	Fee-for-Service	1285095182	1285095182	1	1	GREEN, DEANNA L MD	3/20/2020	207R00000X	NA	Other	026	PHYSICIANS	165296	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
288503	Fee-for-Service	1114367042	1114367042	1	1	GIBREEL, WALEED MD	7/16/2019	208200000X	NA	General Surgery	026	PHYSICIANS	160579	24	Plastic 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
288511	Fee-for-Service	1699073890	1699073890	1	1	GUERRERO, ANGELICA LMFT	5/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16820 PONDEROSA LN	None	RIVERSIDE	CA	92504	6228	33	06065	33.87622866	-117.3694523	Riverside County
288540	Fee-for-Service	1295092146	1295092146	1	1	GLASSY, MATTHEW S MD	10/1/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	130479	06	Cardiovascular Disease (M.D. 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
288616	Fee-for-Service	1306008768	1306008768	1	1	GARSA, ADAM A MD	5/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125500	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
288652	Fee-for-Service	1295092146	1295092146	1	1	GLASSY, MATTHEW S MD	10/1/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	130479	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
288661	Fee-for-Service	1396748547	1396748547	1	1	GALILEO SURGERY CENTER	3/6/2008	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LP	1001 E FOOTHILL BLVD	None	SAN LUIS OBISPO	CA	93405	1885	40	06079	35.29403951	-120.667311	San Luis Obispo County
288678	Fee-for-Service	1881308823	1881308823	1	1	GO, CAROLINE A	10/10/2023	363LF0000X	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
288744	Fee-for-Service	1740221654	1740221654	1	1	GARFIELD BEACH CVS, LLC	3/14/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12717 GLENOAKS BLVD	None	SYLMAR	CA	91342	4749	19	06037	34.30064057	-118.4407623	Los Angeles County
288764	Fee-for-Service	1750476826	1750476826	1	1	GREEN, EMILY A MD	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114053	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
288785	Fee-for-Service	1710359740	1710359740	1	1	GRANAT, ANNA MD	1/24/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139047	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
288819	Fee-for-Service	1124512124	1124512124	1	1	GUNTHER, MATTHEW MD	9/27/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163672	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
288850	Fee-for-Service	1215086822	1215086822	1	1	GUO, AGHEE Y OD	3/28/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
288856	Fee-for-Service	1699710491	1699710491	1	1	GARFIELD BEACH CVS, LLC	9/30/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3800 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3602	19	06037	33.92778368	-118.1982493	Los Angeles County
288891	Fee-for-Service	1023009834	1023009834	1	1	GAUERKE, STEVEN J MD	3/22/2023	207ZP0105X	NA	Other	026	PHYSICIANS	151388	None	None	0	In state provider	None	7592 METROPOLITAN DR	STE 405-407	SAN DIEGO	CA	92108	4428	37	06073	32.77772014	-117.1575637	San Diego County
288902	Fee-for-Service	1245265487	1245265487	1	1	GOFF, DAVID R MD	7/3/1997	207L00000X	NA	Other	026	PHYSICIANS	75226	05	Anesthesiology	0	In state provider	None	5469 KEARNY VILLA RD	STE 302	SAN DIEGO	CA	92123	1159	37	06073	32.83298834	-117.1388725	San Diego County
289052	Fee-for-Service	1871229203	1871229203	1	1	GONZALEZ, DALANA NP	10/1/2024	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
289126	Fee-for-Service	1184245557	1184245557	1	1	GONZALEZ, ALMA	5/3/2024	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
289158	Fee-for-Service	1295971984	1295971984	1	1	GREGORY, AMANDA L PHD	11/19/2021	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
289163	Fee-for-Service	1871674127	1871674127	1	1	GRACE SIAN PHILLIPS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY	NE STE 100	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
289165	Fee-for-Service	1205094026	1205094026	1	1	GLASGOW, ANDREW M MD	1/8/2021	207L00000X	NA	Other	026	PHYSICIANS	163103	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
289206	Fee-for-Service	1184612251	1184612251	1	1	GOLDBERG, NEIL J DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	None	2632 N 20TH ST	None	PHOENIX	AZ	85006	1339	00	None	33.478101	-112.039623	Maricopa County
289212	Fee-for-Service	1376269241	1376269241	1	1	GUILKEY, CYNTHIA D	10/1/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
289250	Fee-for-Service	1720032790	1720032790	1	1	GOOD SAMARITAN HOSP, LP	2/1/1999	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2425 SAMARITAN DR	None	SAN JOSE	CA	95124	3985	43	06085	37.25111017	-121.9465891	Santa Clara County
289253	Fee-for-Service	1962428805	1962428805	1	1	GARDNER, JOSH A OD	7/11/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
289307	Fee-for-Service	1710114772	1710114772	1	1	GOWDA, ABHISHEK MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116395	25	Physical Medicine and Rehabilitation	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
289319	Fee-for-Service	1508813452	1508813452	1	1	GREMMELS, DAVID B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDRENS HEALTH CARE	2525 CHICAGO AVE S	None	MINNEAPOLIS	MN	55404	0000	00	None	44.95652346	-93.26250787	Hennepin County
289342	Fee-for-Service	1376595207	1376595207	1	1	GERSTEIN, DOUGLAS MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	24353	18	Ophthalmology	0	In state provider	None	1460 N CAMINO ALTO	STE 201	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
289444	Fee-for-Service	1114420304	1114420304	1	1	GUPTA, KHUSHBOO MD	10/1/2024	207U00000X	NA	Other	026	PHYSICIANS	188189	42	Nuclear Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
289472	Fee-for-Service	1023196763	1023196763	1	1	GONZALEZ, DANIEL A MD	7/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61294	08	Family Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
289479	Fee-for-Service	1508921784	1508921784	1	1	GROSS, GARY L MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	17962	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
289528	Fee-for-Service	1700840170	1700840170	1	1	GUPTA, AMIT MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77329	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
289621	Fee-for-Service	1477833291	1477833291	1	1	GILLISS, BRIAN M MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119145	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
289665	Fee-for-Service	1265877831	1265877831	1	1	GOLTIAO, DARREN H MD	8/6/2018	207L00000X	NA	Other	026	PHYSICIANS	136612	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
289748	Fee-for-Service	1013237064	1013237064	1	1	GILLIS, ARTHA J MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	119203	26	Psychiatry (child)	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
289808	Fee-for-Service	1891711529	1891711529	1	1	GEILER, CRAIG R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	70140	41	Internal Medicine	0	In state provider	None	335 EL DORADO ST	STE 6	MONTEREY	CA	93940	4624	27	06053	36.59168391	-121.892381	Monterey County
289836	Fee-for-Service	1730202722	1730202722	1	1	GERACI, TIMOTHY J MD	12/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87611	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
289881	Fee-for-Service	1689615569	1689615569	1	1	GARFIELD BEACH CVS LLC	5/2/2007	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2791 AGOURA RD	None	THOUSAND OAKS	CA	91361	3101	56	06111	34.15068671	-118.8255597	Ventura County
289910	Fee-for-Service	1164780573	1164780573	1	1	GREENVILLE RANCHERIA	3/13/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	343 OAK STREET	None	RED BLUFF	CA	96080	0343	52	06103	40.17616563	-122.2349564	Tehama County
289915	Fee-for-Service	1558461095	1558461095	1	1	GRIMLEY, MARGARET J MD	8/5/2014	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50335	26	Psychiatry (child)	0	In state provider	None	1287 FULTON RD	None	SANTA ROSA	CA	95401	4923	49	06097	38.45043	-122.7715245	Sonoma County
289920	Fee-for-Service	1578761755	1578761755	1	1	GANDHI, NANDINI G MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118195	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
289934	Fee-for-Service	1114127685	1114127685	1	1	GHOLVE, PURUSHOTTAM A MD	1/8/2018	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	151265	20	Orthopedic Surgery	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
289946	Fee-for-Service	1245525120	1245525120	1	1	GOODSTEIN, MONICA E MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151157	02	General Surgery	0	In state provider	None	280 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
289975	Fee-for-Service	1851634745	1851634745	1	1	GAUFIN, THAIDRA A MD	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134177	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
289979	Fee-for-Service	1164780573	1164780573	1	1	GREENVILLE RANCHERIA	3/13/2013	No Taxonomy Provided	NA	None	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	343 OAK STREET	None	RED BLUFF	CA	96080	0343	52	06103	40.17616563	-122.2349564	Tehama County
289987	Fee-for-Service	1447452719	1447452719	1	1	GAMBLE, SEAN J MD	10/21/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	94547	40	Pediatrics	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
289993	Fee-for-Service	1891896874	1891896874	1	1	GADWAY, KRISTEN H OT	2/27/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11795 EDUCATION ST	STE 100	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
290001	Fee-for-Service	1831978196	1831978196	1	1	GOMES DE OLIVEIRA, PEDRO M M	10/18/2024	207YS0012X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	D	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
290038	Fee-for-Service	1528396587	1528396587	1	1	GASPAR, EILEEN R MD	11/16/2010	207R00000X	NA	Other	026	PHYSICIANS	108331	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
290053	Fee-for-Service	1336243724	1336243724	2	2	GARCIA GAYDA YODY MD	1/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	53218	01	General Practice	0	In state provider	None	123 EAST F STEET	UNIT F	WILMINGTON	CA	90744	4516	19	06037	33.77717687	-118.2614243	Los Angeles County
290108	Fee-for-Service	1336243724	1336243724	2	2	GARCIA GAYDA YODY MD	1/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	53218	40	Pediatrics	0	In state provider	None	123 EAST F STEET	UNIT F	WILMINGTON	CA	90744	4516	19	06037	33.77717687	-118.2614243	Los Angeles County
290180	Fee-for-Service	1194371716	1194371716	1	1	GARCIA NAVA, JESSICA LCSW	7/15/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
290202	Fee-for-Service	1831487438	1831487438	1	1	GOENJIAN, HAIG A MD	1/22/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	123098	-	NOT APPLICABLE	0	In state provider	None	447 N EL MOLINO AVE	None	PASADENA	CA	91101	1403	19	06037	34.15365596	-118.1370318	Los Angeles County
290214	Fee-for-Service	1619107083	1619107083	1	1	GEVORGYAN, GOHAR MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	106174	08	Family Practice	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
290218	Fee-for-Service	1427049071	1427049071	1	1	GREENSPAN, SCOTT H MD	5/31/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53125	01	General Practice	0	In state provider	None	3160 RED HILL AVE	None	COSTA MESA	CA	92626	3402	30	06059	33.68024793	-117.8734988	Orange County
290219	Fee-for-Service	1851703334	1851703334	1	1	GULLO, JAMES MD	7/1/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	165172	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
290234	Fee-for-Service	1619541893	1619541893	1	1	GEVORGIAN, HRANT MD	6/26/2024	207P00000X	NA	Other	026	PHYSICIANS	None	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
290383	Fee-for-Service	1821119561	1821119561	1	1	GALLARDO, CARY W MD	1/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93432	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
290424	Fee-for-Service	1164880688	1164880688	1	1	GELIN, MELISSA LAC	8/22/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	515 ALAMEDA AVE	STE C	SALINAS	CA	93901	4024	27	06053	36.65997494	-121.6486999	Monterey County
290431	Fee-for-Service	1093759367	1093759367	1	1	GARFIELD BEACH CVS LLC	12/8/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	211 W BASE LINE RD	None	RIALTO	CA	92376	3305	36	06071	34.12132052	-117.3728385	San Bernardino County
290467	Fee-for-Service	1427060425	1427060425	1	1	GARRETT, JERRY S MD	12/5/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	27670	34	Urology and Urological Surgery	0	In state provider	None	14935 RINALDI ST	None	MISSION HILLS	CA	91345	1206	19	06037	34.27904221	-118.4583902	Los Angeles County
290504	Fee-for-Service	1003262239	1003262239	1	1	GATEWAY CENTER OF MONTEREY	12/5/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COUNTY INC	840 CONGRESS AVE	None	PACIFIC GROVE	CA	93950	4811	27	06053	36.61463985	-121.9245439	Monterey County
290586	Fee-for-Service	1265520993	1265520993	1	2	GOODMAN, DANIEL F MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	53124	18	Ophthalmology	0	In state provider	A MEDICAL GROUP INC	2211 BUSH ST	2ND FLR	SAN FRANCISCO	CA	94115	3121	38	06075	37.78693072	-122.434011	San Francisco County
290609	Fee-for-Service	1346409455	1346409455	1	1	GARCIA BONILLA, JULIO C MD	3/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104897	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
290631	Fee-for-Service	1508833120	1508833120	1	1	GARABEDIAN, MATTHEW J MD	4/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93277	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
290639	Fee-for-Service	1114373537	1114373537	1	1	GHAFFARIAN, LALEH DO	6/21/2019	207P00000X	NA	Other	026	PHYSICIANS	16775	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
290674	Fee-for-Service	1942460001	1942460001	1	1	GUPTA, GAUREE MD	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104683	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
290725	Fee-for-Service	1528158169	1528158169	1	1	GUREL, OKYANUS	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54318	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
290728	Fee-for-Service	1699247254	1699247254	1	1	GENESIS NON EMERGENCY MEDICA	8/20/2021	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	L TRANSPORTATION INC	4949 BUCKLEY WAY	STE 103	BAKERSFIELD	CA	93309	4880	15	06029	35.33866564	-119.0541714	Kern County
290769	Fee-for-Service	1881624583	1881624583	1	8	GENESISCARE OF CALIFORNIA, A	2/24/2020	2085R0001X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORPORATION	860 PARKVIEW DRIVE N	None	EL SEGUNDO	CA	90245	4914	19	06037	33.928299	-118.385181	Los Angeles County
290773	Fee-for-Service	1114099868	1114099868	1	1	GAGE, BLONDELL A MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	83240	13	Neurology (M.D. only)	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
290818	Fee-for-Service	1295154672	1295154672	1	1	GOLDOME HEALTHCARE INC	6/25/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	82411	01	General Practice	0	In state provider	None	3191 W TEMPLE AVE	190	POMONA	CA	91768	3228	19	06037	34.04617287	-117.8042325	Los Angeles County
290844	Fee-for-Service	1639274772	1639274772	1	1	GEE, SHERFONG DO	12/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7634	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
290848	Fee-for-Service	1275968091	1275968091	1	1	GUTIERREZ, CHRISTOPHER A	6/9/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27350 IRIS AVE	MOB 1	MORENO VALLEY	CA	92555	4802	33	06065	33.897402	-117.1860255	Riverside County
290921	Fee-for-Service	1275669475	1275669475	1	1	GRAND TERRACE PSYCH INC	1/1/2000	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CALIFORNIA BEHAVIORAL	721 NEVADA ST	STE 203	REDLANDS	CA	92373	8051	36	06071	34.061715	-117.2174795	San Bernardino County
290929	Fee-for-Service	1508827718	1508827718	1	1	GORDON, ORA K MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63343	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
290935	Fee-for-Service	1669491429	1669491429	1	1	GRAFF, JEREMY E MD	1/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85534	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
290953	Fee-for-Service	1003851908	1003851908	1	1	GARFIELD BEACH CVS, LLC	2/24/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1015 N. SAN FERNANDO BLV	None	BURBANK	CA	91504	4329	19	06037	34.18792537	-118.3184297	Los Angeles County
290955	Fee-for-Service	1881639680	1881639680	2	1	GARFIELD BEACH CVS, LLC	12/16/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2419 WORKMAN ST.	None	LOS ANGELES	CA	90031	2319	19	06037	34.07400629	-118.2143879	Los Angeles County
290972	Fee-for-Service	1023119013	1023119013	1	1	GREENE, KIRSTEN L MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77556	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
290988	Fee-for-Service	1023055316	1023055316	1	1	GREENSPAN, ADAM MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	31793	30	Radiology	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
291008	Fee-for-Service	1184088783	1184088783	1	1	GRAETZ, RILEY M MD	2/4/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158731	40	Pediatrics	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
291013	Fee-for-Service	1003477548	1003477548	1	2	GOODWAY TRANSPORTATION INC	1/12/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	11871 SHELDON ST	UNIT D	SUN VALLEY	CA	91352	1582	19	06037	34.2406343	-118.391947	Los Angeles County
291051	Fee-for-Service	1528344504	1528344504	1	1	GANNON, ETHEL M LMFT	11/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11110 LOS ALAMITOS BLVD	STE 204	LOS ALAMITOS	CA	90720	3602	30	06059	33.801516	-118.0717825	Orange County
291078	Fee-for-Service	1669881082	1669881082	1	1	GOULD, ALYSON H LMFT	10/16/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5005 LA MART DR	STE 100 B7	RIVERSIDE	CA	92507	8901	33	06065	33.959493	-117.3322255	Riverside County
291136	Fee-for-Service	1902901564	1902901564	1	1	GATEWAY OPTOMETRIC CNTR	6/8/2004	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3371 G ST	STE A	MERCED	CA	95340	0964	24	06047	37.32534037	-120.4692822	Merced County
291194	Fee-for-Service	1033517867	1033517867	1	1	GONZALEZ, BENEDICTE OD	9/14/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1206 E 17TH ST	STE 101	SANTA ANA	CA	92701	2641	30	06059	33.75983651	-117.8539425	Orange County
291217	Fee-for-Service	1174794796	1174794796	1	1	GALLAGHER, KATHERINE M MD	11/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110830	40	Pediatrics	0	In state provider	None	5700 TELEGRAPH AVE	STE 100	OAKLAND	CA	94609	1710	01	06001	37.84323585	-122.2614659	Alameda County
291221	Fee-for-Service	1881243939	1881243939	1	1	GLENDALE HOME HEALTH INC	9/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2600 FOOTHILL BLVD	STE 207	LA CRESCENTA	CA	91214	4579	19	06037	34.22121465	-118.2352382	Los Angeles County
291233	Fee-for-Service	1205377553	1205377553	1	1	GREGORY, DAVID J DO	8/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	19371	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
291247	Fee-for-Service	1740284249	1740284249	1	1	GUPTA, SMITA MD	6/21/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	134136	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
291373	Fee-for-Service	1104289040	1104289040	1	1	GODDARD, BROOK MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	160800	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
291388	Fee-for-Service	1164485595	1164485595	1	1	GEORGE RAPPARD MD INC	10/18/2005	2085R0204X	NA	Other	026	PHYSICIANS	63419	30	Radiology	0	In state provider	None	5757 WILSHIRE BLVD	SUITE M-111	LOS ANGELES	CA	90036	3635	19	06037	34.0624504	-118.3534253	Los Angeles County
291392	Fee-for-Service	1679515829	1679515829	1	1	GARFIN, STEVEN R MD	10/17/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	29309	20	Orthopedic Surgery	0	In state provider	None	7920 FROST ST	STE 402	SAN DIEGO	CA	92123	2735	37	06073	32.80027449	-117.153846	San Diego County
291399	Fee-for-Service	1528013018	1528013018	3	1	GOY WOLFGANG	9/25/2017	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
291403	Fee-for-Service	1790827640	1790827640	1	1	GOTLIB, JASON R MD	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60833	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
291421	Fee-for-Service	1619051976	1619051976	1	1	GOLDMAN, ABRAHAM MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69060	05	Anesthesiology	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
291431	Fee-for-Service	1861688269	1861688269	1	1	GARDNER, ERIC J PSYD	9/6/2019	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
291434	Fee-for-Service	1427090869	1427090869	1	1	GRAVES, HOWARD C MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	31649	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
291445	Fee-for-Service	1801944871	1801944871	1	1	GATTU, RADHARANI MD	3/5/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48023	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
291451	Fee-for-Service	1902358682	1902358682	1	1	GUZMAN, ROBERTO A	7/14/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3655 FOOTHILL	None	PASADENA	CA	91107	3121	19	06037	34.15021123	-118.0751811	Los Angeles County
291471	Fee-for-Service	1205657566	1205657566	1	1	GROUNDED BEGINNINGS LLC	11/7/2024	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	33	06065	0	0	None
291516	Non-Physician Medical Practitioner	None	1548531684	0	0	GATES, CRISTINA G	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	17990 PESANTE RD	None	SALINAS	CA	93907	1509	00	06000	36.77690787	-121.6609814	Monterey County
291528	Non-Physician Medical Practitioner	None	1669817961	0	0	GUZMAN, FRANCISCO R NP	12/3/2013	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
291570	Non-Physician Medical Practitioner	None	1215456017	0	0	GONZALEZ, EZEQUIEL A NP	12/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1141 ROSE AVE	None	SELMA	CA	93662	3241	00	06000	36.56881144	-119.5985344	Fresno County
291573	Non-Physician Medical Practitioner	None	1831367432	0	0	GUASTELLA, DOLLIE	11/13/2024	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
291607	Non-Physician Medical Practitioner	None	1558466219	0	0	GROS, JENNIFER A	10/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	00	06000	33.9670722	-118.3439911	Los Angeles County
291610	Non-Physician Medical Practitioner	None	1407576275	0	0	GRANADOS, CAROLINA PA-C	1/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	969 S. SANTA FE AVE	A	VISTA	CA	92083	6910	00	06000	33.1927833	-117.2316819	San Diego County
291625	Non-Physician Medical Practitioner	None	1720503030	0	0	GREENWOOD, JANET E	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9 COSENZA	None	LAGUNA NIGUEL	CA	92677	9005	00	06000	33.51831387	-117.6952032	Orange County
291700	Non-Physician Medical Practitioner	None	1376274910	0	0	GJERSTAD, CAROLINE D	8/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	615 OCEAN ST	None	SANTA CRUZ	CA	95060	4005	00	06000	36.97734512	-122.0204895	Santa Cruz County
291719	Non-Physician Medical Practitioner	None	1932454469	0	0	GARCIA, DALAN D	1/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	214 18TH ST SE	None	HICKORY	NC	28602	1363	00	06000	35.731791	-81.30933	Catawba County
291807	Non-Physician Medical Practitioner	None	1740613819	0	0	GIESZL, TERESA G 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	328 W LEWIS ST	None	SAN DIEGO	CA	92103	1924	00	06000	32.75186649	-117.1670816	San Diego County
291815	Non-Physician Medical Practitioner	None	1528462058	0	0	GUNVILLE, BRITTANY A PA-C	6/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
291852	Non-Physician Medical Practitioner	None	1356879878	0	0	GARUBA, IZIEGBE NP	6/5/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6025 LEDGEFERN CIRCLE	None	SAN RAMON	CA	94582	9187	00	06000	37.774278	-121.9304925	Contra Costa County
291864	Non-Physician Medical Practitioner	None	1790049146	0	0	GUIANG, ISABELLE 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	13056 LEAWOOD ST	None	VICTORVILLE	CA	92392	0578	00	06000	34.48741366	-117.394292	San Bernardino County
291874	Non-Physician Medical Practitioner	None	1457386765	0	0	GORDON, TATE W	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	341 SOUTH GRAND COURT	None	VISALIA	CA	93292	7437	00	06000	36.327636	-119.245923	Tulare County
291878	Non-Physician Medical Practitioner	None	1861042939	0	0	GUNADI, NICOLE C NP	1/1/2020	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
291906	Non-Physician Medical Practitioner	None	1538214705	0	0	GENSLER, KATHARINE	7/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
291944	Non-Physician Medical Practitioner	None	1578506614	0	0	GINGRICH, JENNIFER L	1/5/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	865 PETERSEN RANCH RD	None	TEMPLETON	CA	93465	8784	00	06000	35.55801452	-120.714723	San Luis Obispo County
291945	Non-Physician Medical Practitioner	None	1386407567	0	0	GLORIA, RAINIER NP	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	525 GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	00	06000	34.06794352	-118.1229278	Los Angeles County
292055	Non-Physician Medical Practitioner	None	1891154225	0	0	GALANG, IRMA M NP	6/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8631 RANCHO VISTA	None	PARAMOUNT	CA	90723	4581	00	06000	33.8939935	-118.1482515	Los Angeles County
292078	Non-Physician Medical Practitioner	None	1952028334	0	0	GARRIDO COTE, ESMERALDA PA-C	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	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
292094	Non-Physician Medical Practitioner	None	1649251455	0	0	GILCHRIST, WENDI C NP	6/16/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3519 HEROIC DRIVE	None	RANCHO PALOS VERD	CA	90275	6107	00	06000	33.73409454	-118.3421346	Los Angeles County
292185	Non-Physician Medical Practitioner	None	1316445216	0	0	GOLDEN, EMILY K NP	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	7272 BALLINGER AVE	None	SAN DIEGO	CA	92119	1348	00	06000	32.81297124	-117.0156258	San Diego County
292212	Non-Physician Medical Practitioner	None	1043213705	0	0	GONZALEZ, TAMMY LEE	7/28/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	550 W CYPRESS AVE	None	REEDLEY	CA	93654	2096	00	06000	36.60787518	-119.4523704	Fresno County
292248	Non-Physician Medical Practitioner	None	1578877148	0	0	GREEN, JANICE LYNN	4/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7471 N FRESNO ST	None	FRESNO	CA	93720	2457	00	06000	36.84632065	-119.783885	Fresno County
292259	Non-Physician Medical Practitioner	None	1992759484	0	0	GELENTER, APRIL KELLY	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	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94143	0001	00	06000	37.78475261	-122.43973	San Francisco County
292300	Non-Physician Medical Practitioner	None	1568892917	0	0	GOULD, REGINA H	6/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6 LORAINE CT	None	SAN FRANCISCO	CA	94118	4216	00	06000	37.78031384	-122.4570044	San Francisco County
292319	Non-Physician Medical Practitioner	None	1316700909	0	0	GALANG, CHRISTINA M	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	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
292356	Non-Physician Medical Practitioner	None	1306944723	0	0	GARAY, ALVARO R	8/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	213 COASTAL LANE	None	WATERFORD	CA	95386	0077	00	06000	37.63726555	-120.7457535	Stanislaus County
292368	Non-Physician Medical Practitioner	None	1093314601	0	0	GONZALEZ, GLORIA A CNM	12/16/2020	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	None	DAVIS	CA	95616	6201	00	06000	38.56287659	-121.7715536	Yolo County
292370	Non-Physician Medical Practitioner	None	1730500620	0	0	GLASSER, WILLIAM D NP	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	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
292406	Non-Physician Medical Practitioner	None	1942366281	0	0	GONZALEZ, YOODIY A	10/7/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	822 N GAREY AVE	None	POMONA	CA	91767	4616	00	06000	34.06563676	-117.7509698	Los Angeles County
292448	Non-Physician Medical Practitioner	None	1720534613	0	0	GRAY, KAREN A NP	7/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	16371 W ADAMS STREET	None	GOODYEAR	AZ	85338	2708	00	06000	33.447825	-112.411134	Maricopa County
292458	Non-Physician Medical Practitioner	None	1720710163	0	0	GUINTO, NOAH REY A 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	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	00	06000	34.42887662	-119.7237878	Santa Barbara County
292516	Non-Physician Medical Practitioner	None	1689032815	0	0	GHOTRA, JAGNOHAN K NP	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26024 OHARA LN	None	STEVENSON RANCH	CA	91381	4418	00	06000	34.39233087	-118.5886222	Los Angeles County
292524	Non-Physician Medical Practitioner	None	1588038244	0	0	GUILLEN, JESSICA MARIE	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	4903 W PICO BLVD	STE 1	LOS ANGELES	CA	90019	4262	00	06000	34.04804329	-118.3435512	Los Angeles County
292534	Non-Physician Medical Practitioner	None	1386800860	0	0	GYSBERS, ERIN L	12/4/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1990 MESA DR	None	COLTON	CA	92324	9714	00	06000	34.03738214	-117.2715136	San Bernardino County
292537	Non-Physician Medical Practitioner	None	1093757361	0	0	GIRAGOSIAN, SHERRI L NP	8/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4422 Y STREET	None	SACRAMENTO	CA	95817	2220	00	06000	38.551941	-121.454136	Sacramento County
292544	Non-Physician Medical Practitioner	None	1821600214	0	0	GUTLAY, KIRSTEN MICHELE NP	1/12/2023	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	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
292585	Non-Physician Medical Practitioner	None	1740757939	0	0	GEWARGES, RENEE M NP	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	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
292598	Non-Physician Medical Practitioner	None	1841356227	0	0	GARCIA, WALTER JOSEPH	5/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	00	06000	38.39008977	-121.9378499	Solano County
292607	Non-Physician Medical Practitioner	None	1538524749	0	0	GIANNANDREA, KATELYN NP	2/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2003 N PEPPERTREE ST	None	VISALIA	CA	93291	8864	00	06000	36.347139	-119.354148	Tulare County
292640	Non-Physician Medical Practitioner	None	1780148064	0	0	GEORGE, JASON L PA-C	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	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14847323	-122.2180997	Tehama County
292653	Non-Physician Medical Practitioner	None	1144625179	0	0	GELLER, MICHAEL PA	7/8/2020	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
292668	Non-Physician Medical Practitioner	None	1972283869	0	0	GALLEGOS, LAURA Y 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
292671	Non-Physician Medical Practitioner	None	1023129293	0	0	GUIZADO, ROY A	11/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6590 MONTE CARLO PL	None	RANCHO CUCAMONGA	CA	91701	9015	00	06000	34.13436447	-117.54775	San Bernardino County
292687	Non-Physician Medical Practitioner	None	1801425145	0	0	GONZALEZ, ALPHA S NP	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	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
292688	Non-Physician Medical Practitioner	None	1043262611	0	0	GIORDANO, STEVEN M 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	3745 MAUNA LOA STREET	None	BREA	CA	92823	6328	00	06000	33.90980496	-117.8448579	Orange County
292690	Non-Physician Medical Practitioner	None	1881212728	0	0	GREENE, KAITLYN M PA	3/29/2023	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
292721	Non-Physician Medical Practitioner	None	1972844157	0	0	GOODGE, ANNA L NP	1/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1285 BRANCH MILL RD	None	ARROYO GRANDE	CA	93420	5211	00	06000	35.12695898	-120.5517738	San Luis Obispo County
292742	Non-Physician Medical Practitioner	None	1700155363	0	0	GUZMAN, SHANNON M 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	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
292788	Non-Physician Medical Practitioner	None	1922167857	0	0	GO, NELLIE VERZOSA	6/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1053 R ST	None	FRESNO	CA	93721	1312	00	06000	36.74038639	-119.7827527	Fresno County
292810	Non-Physician Medical Practitioner	None	1184202426	0	0	GONZALEZ, JOHAN-R L PA	12/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 SPANOS CT	STE 125	MODESTO	CA	95355	2814	00	06000	37.66975543	-120.9724048	Stanislaus County
292821	Non-Physician Medical Practitioner	None	1255823191	0	0	GOEN, LAURA L 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	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
292827	Non-Physician Medical Practitioner	None	1356736631	0	0	GARCIA, MICHAEL	10/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	360 S LOLA LN	None	PAHRUMP	NV	89048	0884	00	06000	36.214524	-116.025615	Nye County
292828	Non-Physician Medical Practitioner	None	1912946567	0	0	GASTELUM, GINA ROSE	6/26/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	884 MARY LN	None	MCKINLEYVILLE	CA	95519	3822	00	06000	40.93254346	-124.1178307	Humboldt County
292831	Non-Physician Medical Practitioner	None	1982240206	0	0	GOMEZ, LYDIA J NP	6/29/2020	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
292844	Non-Physician Medical Practitioner	None	1538186457	0	0	GRINNELL, PATRICIA LYNN	12/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	110 LYNCH CREEK WAY STE	None	PETALUMA	CA	94954	2337	00	06000	38.25171165	-122.6351052	Sonoma County
292908	Non-Physician Medical Practitioner	None	1134371180	0	0	GIBSON, CHERYL L NP	12/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2117 SPRING CREEK DR	None	SANTA ROSA	CA	95405	6647	00	06000	38.44179	-122.688747	Sonoma County
292945	Non-Physician Medical Practitioner	None	1568891729	0	0	GINTHER, ROBERT J	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	3366 SOUTH WEST	None	FRESNO	CA	93706	9781	00	06000	36.684936	-119.8245915	Fresno County
292979	Non-Physician Medical Practitioner	None	1043726359	0	0	GAMBREL, KYLE B	3/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1069 CRYER COURT	UNIT 102	HENDERSON	NV	89002	1082	00	06000	35.99028408	-114.9290732	Clark County
292989	Non-Physician Medical Practitioner	None	1104196203	0	0	GRUBIC, VESNA NP	7/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	168 N CLARK DR	APT 3	BEVERLY HILLS	CA	90211	1744	00	06000	34.06895008	-118.3846919	Los Angeles County
292999	Non-Physician Medical Practitioner	None	1760400972	0	0	GIMA, JEAN MICHIKO	2/15/2006	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	#214,365,530,420,120	LOS ANGELES	CA	90095	0000	00	06000	34.06527974	-118.4462792	Los Angeles County
293035	Non-Physician Medical Practitioner	None	1508024373	0	0	GYORE, VICTORIA I NP	7/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6375 MCCLELLAN WAY	None	BUENA PARK	CA	90620	1521	00	06000	33.85164264	-118.021795	Orange County
293048	Non-Physician Medical Practitioner	None	1720156755	0	0	GATTONI, LEA L PA	6/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	00	06000	34.44509477	-119.7186392	Santa Barbara County
293063	Non-Physician Medical Practitioner	None	1275836249	0	0	GOMEZ, LUISANA	1/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	629 W VERMONT AVENUE	APT 14B	ANAHEIM	CA	92805	5036	00	06000	33.82137939	-117.9176187	Orange County
293072	Non-Physician Medical Practitioner	None	1659462182	0	0	GARNEAU, LOUIS KENNETH	2/24/2009	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
293099	Non-Physician Medical Practitioner	None	1578680237	0	0	GIRARD, FRANCINE NP	9/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35 TIMBERLINE	None	IRVINE	CA	92604	3033	00	06000	33.68980353	-117.7875311	Orange County
293107	Non-Physician Medical Practitioner	None	1093021693	0	0	GABRIEL, EVETTE B PA	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	3152 N MILLBROOK AVE	SUITE C	FRESNO	CA	93703	1400	00	06000	36.779166	-119.7634925	Fresno County
293108	Non-Physician Medical Practitioner	None	1366225393	0	0	GRAY, LOUISE M PA	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	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
293130	Non-Physician Medical Practitioner	None	1316618036	0	0	GOMEZ, JULIUS C PA-C	11/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	00	06000	38.67049812	-121.7238394	Yolo County
293139	Non-Physician Medical Practitioner	None	1952961831	0	0	GARCIA-CRUZ, DANIELA PA	10/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
293140	Non-Physician Medical Practitioner	None	1700323227	0	0	GLICK, NICOLE M NP	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	12566 VALLEY VIEW ST	None	GARDEN GROVE	CA	92845	0000	00	06000	33.78049752	-118.0307808	Orange County
293145	Non-Physician Medical Practitioner	None	1801346069	0	0	GARCIA, MARIA A NP	12/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5654 W EVERETT AVE	None	FRESNO	CA	93722	2267	00	06000	36.84847623	-119.8914227	Fresno County
293227	Non-Physician Medical Practitioner	None	1194811083	0	0	GANDHI, MORENA 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	811 E 11TH ST	STE 102	UPLAND	CA	91786	7274	00	06000	34.1034335	-117.6398415	San Bernardino County
293247	Non-Physician Medical Practitioner	None	1437644572	0	0	GILL, AMREEN PA	8/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2300 CAMINO RAMON	None	SAN RAMON	CA	94583	1354	00	06000	37.77580025	-121.9664884	Contra Costa County
293253	Non-Physician Medical Practitioner	None	1508365271	0	0	GONZALEZ, GISELA PA-C	9/16/2021	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
293307	Non-Physician Medical Practitioner	None	1639325178	0	0	GALINDO, OSCAR	12/31/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7643 ATLANTIC AVE	None	CUDAHY	CA	90201	1704	00	06000	33.96585232	-118.18712	Los Angeles County
293337	Non-Physician Medical Practitioner	None	1043685654	0	0	GEORGE, HEATHER M NP	3/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41540 WINCHESTER	None	TEMECULA	CA	92590	4877	00	06000	33.52069117	-117.1653103	Riverside County
293348	Non-Physician Medical Practitioner	None	1063502110	0	0	GALLEGOS, BONNIE JO	11/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 SERENO DR	KAISER PERMANENTE VALLEJ	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
293360	Non-Physician Medical Practitioner	None	1437265105	0	0	GAUTHREAUX, HEIDI ANN	8/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	00	06000	34.03717616	-117.2046115	San Bernardino County
293371	Non-Physician Medical Practitioner	None	1457389215	0	0	GUERRA, CYNTHIA M	10/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2511 LOGAN ST	None	SELMA	CA	93662	3012	00	06000	36.570951	-119.613866	Fresno County
293384	Non-Physician Medical Practitioner	None	1518481266	0	0	GOULD, EMILY NP	8/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	00	06000	32.7921973	-117.1571251	San Diego County
293407	Non-Physician Medical Practitioner	None	1003052721	0	0	GALPERIN, VADIM	4/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5059 YORK BLVD	None	LOS ANGELES	CA	90042	1713	00	06000	34.12112726	-118.2049283	Los Angeles County
293481	Non-Physician Medical Practitioner	None	1508407594	0	0	GRAY, LINDSAY L NP	1/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	670 SIERRA ROSE DR	None	RENO	NV	89511	2072	00	06000	39.4735137	-119.7995156	Washoe County
293482	Non-Physician Medical Practitioner	None	1669137402	0	0	GO, ADRIEL J NP	11/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	809 SYLVAN AVE	SUITE 500A	MODESTO	CA	95350	1500	00	06000	37.68900616	-120.9836976	Stanislaus County
293485	Non-Physician Medical Practitioner	None	1053480756	0	0	GRSKOVIC, SVETKA	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	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
293496	Non-Physician Medical Practitioner	None	1235722398	0	0	GONZALES, AMPORA L 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	33494 OAK GLEN RD	None	YUCAIPA	CA	92399	2057	00	06000	34.03255442	-117.0737219	San Bernardino County
293500	Non-Physician Medical Practitioner	None	1205478450	0	0	GUILLEN, KATHLEEN R PA	6/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	00	06000	33.12288368	-117.3058276	San Diego County
293511	Non-Physician Medical Practitioner	None	1336262070	0	0	GIANNINI, JOHN R	12/11/2018	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	SUITE 408	LOS ANGELES	CA	90017	3905	00	06000	34.05270508	-118.2641005	Los Angeles County
293562	Non-Physician Medical Practitioner	None	1235287707	0	0	GHAVIM, TAYEBEH E	3/20/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12722 GOETHE PL	None	GRANADA HILLS	CA	91344	1419	00	06000	34.30180822	-118.5106941	Los Angeles County
293614	Non-Physician Medical Practitioner	None	1629054309	0	0	GOSS, STEVEN	9/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2139 E BEECHWOOD AVE	None	FRESNO	CA	93720	0340	00	06000	36.8383165	-119.7441	Fresno County
293619	Non-Physician Medical Practitioner	None	1831292184	0	0	GUERRERO, LAURA	1/3/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7777 B MILLIKEN AVE. #36	None	RANCHO CUCAMONGA	CA	91730	0000	00	06000	34.10843256	-117.5570865	San Bernardino County
293621	Non-Physician Medical Practitioner	None	1679963441	0	0	GOLDBERG, ANA PA	10/6/2023	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
293705	Non-Physician Medical Practitioner	None	1811130883	0	0	GARRETT, ELISE S NP	5/13/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2880 CHESTERFIELD DR	None	SANTA CRUZ	CA	95062	5402	00	06000	36.9555373	-121.9753618	Santa Cruz County
293752	Non-Physician Medical Practitioner	None	1790322618	0	0	GARCIA, JENNIFER A NP	1/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
293829	Non-Physician Medical Practitioner	None	1134499908	0	0	GARRETT, MARY B	2/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 EAST CHAPEL STREET	SUITE 2	SANTA MARIA	CA	93454	4607	00	06000	34.9542915	-120.424455	Santa Barbara County
293852	Non-Physician Medical Practitioner	None	1568405983	0	0	GAMBLE, LISA KATHLEEN	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
293906	Non-Physician Medical Practitioner	None	1972971422	0	0	GONZALEZ, MONICA NP	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3324 S THOMAS ST	None	VISALIA	CA	93292	4502	00	06000	36.300303	-119.2851675	Tulare County
293920	Non-Physician Medical Practitioner	None	1326344268	0	0	GRAY, AMALIA CNM	5/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 DOYLE PARK	STE 103	SANTA ROSA	CA	95405	4559	00	06000	38.44332	-122.6985255	Sonoma County
293922	Non-Physician Medical Practitioner	None	1689850745	0	0	GUELMAN, LORI RENEE	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	900 BLAKE WILBUR DR	ROOM W2001, MC 5358	PALO ALTO	CA	94304	2201	00	06000	37.43563834	-122.1767991	Santa Clara County
293959	Non-Physician Medical Practitioner	None	1457601676	0	0	GARZA, HEATHER L NP	12/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	628 U STREET	None	RIO LINDA	CA	95673	1439	00	06000	38.704671	-121.450788	Sacramento County
293970	Non-Physician Medical Practitioner	None	1942601430	0	0	GONZALEZ, GABRIELLE PA	3/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	00	06000	34.072245	-117.4319685	San Bernardino County
294013	Non-Physician Medical Practitioner	None	1821153420	0	0	GUENTHER, JEANELL G NP	10/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8400 SUN HARBOR RD	None	BAKERSFIELD	CA	93312	4901	00	06000	35.40314454	-119.0955973	Kern County
294040	Non-Physician Medical Practitioner	None	1639746209	0	0	GESCHLECHT, JOSEPH PA-C	12/12/2023	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
294055	Non-Physician Medical Practitioner	None	1235901612	0	0	GALDAMEZ, BRIAN S PA-C	12/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	00	06000	33.91571158	-117.4549231	Riverside County
294065	Non-Physician Medical Practitioner	None	1134734635	0	0	GUTIERREZ, JENNA NP	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	45 CASTRO STREET	SUITE 421	SAN FRANCISCO	CA	94114	1010	00	06000	37.76829732	-122.4357056	San Francisco County
294148	Non-Physician Medical Practitioner	None	1093018764	0	0	GALLARES, ANDRE	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	6645 ALVARADO RD	SUITE 4000	SAN DIEGO	CA	92120	5208	00	06000	32.7772577	-117.0575222	San Diego County
294151	Non-Physician Medical Practitioner	None	1184963928	0	0	GRACE, OBRIEN	2/8/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	00	06000	38.76553806	-121.2497067	Placer County
294199	Non-Physician Medical Practitioner	None	1598259897	0	0	GARCIA SABORIO, OLGA E 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	11757 DOWNEY AVE	None	DOWNEY	CA	90241	4976	00	06000	33.93364054	-118.1375403	Los Angeles County
294206	Non-Physician Medical Practitioner	None	1063859783	0	0	GLENN-MCDOWELL, ASHLEY R	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	13332 CARDINAL RIDGE RD	UNIT H	CHINO HILLS	CA	91709	1239	00	06000	34.01099289	-117.7442373	San Bernardino County
294210	Non-Physician Medical Practitioner	None	1578103800	0	0	GARCIA, GRYANEROLL R NP	8/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1686 BARTON ROAD	None	REDLANDS	CA	92373	7761	00	06000	34.04833901	-117.2120103	San Bernardino County
294216	Non-Physician Medical Practitioner	None	1801334230	0	0	GREENWOOD, JULIA H NP	3/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1056 POMONA AVE	None	ALBANY	CA	94706	2338	00	06000	37.88551144	-122.290244	Alameda County
294229	Non-Physician Medical Practitioner	None	1992972186	0	0	GASKA, BARTHOLOMEW J NP	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	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
294239	Non-Physician Medical Practitioner	None	1609968783	0	0	GRIFFIN, SIMONE W	4/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1617 MADISON LANE SE	None	CONYERS	GA	30013	2968	00	06000	33.5873358	-83.99489814	Rockdale County
294249	Non-Physician Medical Practitioner	None	1134601529	0	0	GARVIN, CHELSEA R NP	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
294266	Non-Physician Medical Practitioner	None	1295047413	0	0	GALDAMEZ, WILLIAM U	1/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	704 ALLSTON WAY	None	BREA	CA	92821	2300	00	06000	33.93072433	-117.8948242	Orange County
294274	Non-Physician Medical Practitioner	None	1205210309	0	0	GRIGORIAN-AVAKIAN, MARINE M	8/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15338 MESA VIEW AVE	None	FRIANT	CA	93626	9780	00	06000	36.95376418	-119.7223555	Fresno County
294316	Non-Physician Medical Practitioner	None	1275586752	0	0	GAYOBA, ESTHER T	5/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5207 ARDEN WAY	None	CARMICHAEL	CA	95608	6000	00	06000	38.595699	-121.343049	Sacramento County
294318	Non-Physician Medical Practitioner	None	1679848550	0	0	GOMEZ, ANGELA N	11/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1714 CASTRO ST	None	MARTINEZ	CA	94553	2529	00	06000	38.01106249	-122.1319859	Contra Costa County
294324	Non-Physician Medical Practitioner	None	1477758316	0	0	GLEN, TERRY D	12/15/2007	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	MEDICAL OFFICE BLDG, 1ST	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
294343	Non-Physician Medical Practitioner	None	1497883607	0	0	GRIVAS, GEROME ALONZO	7/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3175 LENOX PARK BLVD STE	None	MEMPHIS	TN	38115	4256	00	06000	35.06211	-89.84195602	Shelby County
294373	Non-Physician Medical Practitioner	None	1700875952	0	0	GUTIERREZ, ADRIANA	2/10/2009	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	FIRST FLOOR ENDOSCOPY SU	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
294385	Non-Physician Medical Practitioner	None	1710500848	0	0	GHOHESTANI-BOJD, SARA 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	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	00	06000	38.12188356	-121.285872	San Joaquin County
294390	Non-Physician Medical Practitioner	None	1730467051	0	0	GARCIA, LULU	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	330 JADE CIR	None	VALLEJO	CA	94590	8187	00	06000	38.07091117	-122.2351834	Solano County
294439	Non-Physician Medical Practitioner	None	1467874768	0	0	GUILFOYLE, KARA E NP	2/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13355 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	5802	00	06000	33.91091877	-118.3527745	Los Angeles County
294440	Non-Physician Medical Practitioner	None	1104931872	0	0	GROVER, PAUL K	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	274 W AVENIDA DE LAS FLO	None	THOUSAND OAKS	CA	91360	1803	00	06000	34.2126417	-118.8843937	Ventura County
294465	Non-Physician Medical Practitioner	None	1063869881	0	0	GEISEL, BLAKEN A	8/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	00	06000	40.14921426	-122.2216794	Tehama County
294478	Non-Physician Medical Practitioner	None	1013317767	0	0	GIOVANNETTI, ERIN R NP	8/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4602 SIERRA MORENA AVE	None	CARLSBAD	CA	92010	2835	00	06000	33.15709386	-117.3124897	San Diego County
294482	Non-Physician Medical Practitioner	None	1053094193	0	0	GARCIA, LUIS NP	9/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3524 TORRANCE BLVD	SUITE 101	TORRANCE	CA	90503	4821	00	06000	33.8355	-118.3472955	Los Angeles County
294496	Non-Physician Medical Practitioner	None	1952657702	0	0	GADADOSS, PADMAJA 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	1410 GEORGIA STREET	None	TUSTIN	CA	92782	1758	00	06000	33.714189	-117.819027	Orange County
294520	Non-Physician Medical Practitioner	None	1528578713	0	0	GOMEZ, LESLIE N	5/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
294535	Non-Physician Medical Practitioner	None	1346715018	0	0	GILBOY, JULIANNE C PA-C	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	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	00	06000	33.9760587	-117.3800672	Riverside County
294587	Non-Physician Medical Practitioner	None	1962967695	0	0	GUILLEN, ELIZABETH NP	2/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3109 VIA BREVE	None	MONTEBELLO	CA	90640	2204	00	06000	34.02598251	-118.1369282	Los Angeles County
294620	Non-Physician Medical Practitioner	None	1114037579	0	0	GRANT-DOUGHERTY, CAROL LUISA	5/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43839 15TH ST W	None	LANCASTER	CA	93534	4756	00	06000	34.678791	-118.156867	Los Angeles County
294631	Non-Physician Medical Practitioner	None	1285955310	0	0	GREENMAN, NANCY K NP	9/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1763 VIA ROJAS	None	TEMPLETON	CA	93465	3823	00	06000	35.54143907	-120.7379034	San Luis Obispo County
294634	Non-Physician Medical Practitioner	None	1437863495	0	0	GEORGHIOU, SOFIA C PA	10/4/2023	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
294639	Non-Physician Medical Practitioner	None	1689676306	0	0	GONZALEZ, HECTOR C	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
294649	Non-Physician Medical Practitioner	None	1740969948	0	0	GILLESPIE, LIZABETH NP	7/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	00	06000	38.1206163	-121.2858323	San Joaquin County
294651	Non-Physician Medical Practitioner	None	1568423317	0	0	GRIJALVA, RITA M NP	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
294686	Non-Physician Medical Practitioner	None	1316637846	0	0	GLEASON, ASHLEY L NP	6/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1060 W SIERRA AVE	STE 105	FRESNO	CA	93711	2063	00	06000	36.83009575	-119.8099386	Fresno County
294693	Non-Physician Medical Practitioner	None	1790971992	0	0	GUNN, GREGORY ALLEN O	2/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	SUITE 560	LA JOLLA	CA	92037	1229	00	06000	32.882913	-117.226341	San Diego County
294694	Non-Physician Medical Practitioner	None	1710561642	0	0	GIRON, JEFFREY A NP	8/25/2021	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
294714	Non-Physician Medical Practitioner	None	1700125440	0	0	GRANT, KATHLEEN PA	11/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
294749	Non-Physician Medical Practitioner	None	1770514689	0	0	GOODALE, JEFFREY L PA	12/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18210 YORBA LINDA BLVD	SUITE 404	YORBA LINDA	CA	92886	4060	00	06000	33.8883981	-117.8154098	Orange County
294758	Non-Physician Medical Practitioner	None	1578589388	0	0	GERTSCH, ANITA S NP	4/1/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8374 LAKE MCCUMBER ROAD	None	SHINGLETOWN	CA	96088	9580	00	06000	40.52473082	-121.7477198	Shasta County
294792	Non-Physician Medical Practitioner	None	1063828671	0	0	GADLER, TRACIE L NP	2/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7655 SEATTLE DRIVE	None	LA MESA	CA	91941	7893	00	06000	32.7517327	-117.0333514	San Diego County
294794	Non-Physician Medical Practitioner	None	1992152037	0	0	GAMBOA, CINDY	1/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6031 APPLECROSS DR	None	RIVERSIDE	CA	92507	6493	00	06000	33.94317767	-117.303852	Riverside County
294840	Non-Physician Medical Practitioner	None	1669772760	0	0	GALLEGOS, ROBERT ANDREW	10/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	716 E MISSION BLVD	SUITE D	POMONA	CA	91766	7203	00	06000	34.05523981	-117.743173	Los Angeles County
294872	Non-Physician Medical Practitioner	None	1134445646	0	0	GARIBAY, BRENDA D	11/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7024 MEADOW RIDGE	None	CORONA	CA	92880	7236	00	06000	33.96031386	-117.5808346	Riverside County
294888	Non-Physician Medical Practitioner	None	1205229465	0	0	GRECO, SHEENA NP	10/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7407 LOUSIE AVE	None	LAKE BALBOA	CA	91406	2426	00	06000	34.205004	-118.5098565	Los Angeles County
294914	Non-Physician Medical Practitioner	None	1861003220	0	0	GODINEZ, SERGIO V PA-C	9/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	81715 DR CARREON BLVD	None	INDIO	CA	92201	5564	00	06000	33.7073825	-116.2385415	Riverside County
294935	Non-Physician Medical Practitioner	None	1013671882	0	0	GONZALEZ, IRASEMA PA-C	11/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3095 OLD CONEJO RD	None	THOUSAND OAKS	CA	91320	2130	00	06000	34.18969088	-118.9412876	Ventura County
294958	Non-Physician Medical Practitioner	None	1568139772	0	0	GORDILLO MILLER, LAUREN O NP	1/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
294995	Non-Physician Medical Practitioner	None	1912379223	0	0	GROVES, HEATHER L	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	10830 BROXDEN JCT AVE	None	LAS VEGAS	NV	89166	5133	00	06000	36.30579216	-115.3323242	Clark County
295023	Non-Physician Medical Practitioner	None	1861796609	0	0	GUTIERREZ, CELIA	11/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2222 S MAIN ST	None	SANTA ANA	CA	92707	3220	00	06000	33.717168	-117.867929	Orange County
295061	Non-Physician Medical Practitioner	None	1982720140	0	0	GILL, JULIE L	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	7992 MISSION VISTA DR	None	SAN DIEGO	CA	92120	1568	00	06000	32.81290429	-117.0681477	San Diego County
295072	Non-Physician Medical Practitioner	None	1144905597	0	0	GETMANSKIY, BORIS	8/21/2023	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
295112	Non-Physician Medical Practitioner	None	1982120671	0	0	GUTIERREZ, VIRIDIANA J PA	11/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5333 HOLLISTER AVE	STE 195	SANTA BARBARA	CA	93111	2341	00	06000	34.43491982	-119.8105484	Santa Barbara County
295113	Non-Physician Medical Practitioner	None	1598500027	0	0	GAROFALO, ETHAN PA-C	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	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	00	06000	40.57267376	-122.3643496	Shasta County
295122	Non-Physician Medical Practitioner	None	1184174765	0	0	GRIJALVA, CRISTAL 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	840 E PALM DR	None	HANFORD	CA	93230	2315	00	06000	36.36023309	-119.6338618	Kings County
295132	Non-Physician Medical Practitioner	None	1922517994	0	0	GARCIA, ENRIQUE O PA-C	10/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
295141	Non-Physician Medical Practitioner	None	1619255577	0	0	GRUBENSKY, LINDSAY T NP	8/29/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5048 MOUNT FRISSELL DR	None	SAN DIEGO	CA	92117	4810	00	06000	32.82171331	-117.1866586	San Diego County
295211	Non-Physician Medical Practitioner	None	1700697604	0	0	GRIGORIAN, MOLLY NP	3/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	00	06000	34.137603	-118.101464	Los Angeles County
295229	Non-Physician Medical Practitioner	None	1639221070	0	0	GARCIA, TORI NP	1/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1149 PORTOLA MEADOWS RD	APT 223	LIVERMORE	CA	94551	6641	00	06000	37.69251547	-121.7770538	Alameda County
295264	Non-Physician Medical Practitioner	None	1053931386	0	0	GRIFFO, JENNIFER L CNP	3/15/2021	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
295271	Non-Physician Medical Practitioner	None	1770037277	0	0	GARCIA, SARAH I	1/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16016 BABOCK ST	APT 13	SAN DIEGO	CA	92127	7619	00	06000	33.01990675	-117.132049	San Diego County
295277	Non-Physician Medical Practitioner	None	1215745419	0	0	GUTIERREZ, ISAAC PA-C	4/15/2025	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
295280	Non-Physician Medical Practitioner	None	1821645110	0	0	GEARY, MADELYN M PA	3/3/2022	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
295286	Non-Physician Medical Practitioner	None	1548874407	0	0	GUZMAN, KELLY C PA-C	11/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
295328	Non-Physician Medical Practitioner	None	1366942229	0	0	GUEVARRA, RAQUEL B RN PNP	5/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3203 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5831	00	06000	33.97264641	-118.2101997	Los Angeles County
295408	Non-Physician Medical Practitioner	None	1730254848	0	0	GILMARTIN, JENNIFER	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2350 GEARY BLVD	CARDIOLOGY 2ND FLOOR	SAN FRANCISCO	CA	94115	3305	00	06000	37.78305866	-122.4421313	San Francisco County
295412	Non-Physician Medical Practitioner	None	1548545494	0	0	GONZALEZ, KYLA J NP	7/23/2020	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
295425	Non-Physician Medical Practitioner	None	1578791653	0	0	GONZALEZ, MARGARITA PA-C	12/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
295470	Non-Physician Medical Practitioner	None	1962527366	0	0	GARRETT, ANITA S PA	3/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9330 STOCKDALE HWY	400	BAKERSFIELD	CA	93311	3614	00	06000	35.35452946	-119.106351	Kern County
295484	Non-Physician Medical Practitioner	None	1336321116	0	0	GARCIA, MANUEL VALADEZ	12/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	217 W KERN AVE	None	MC FARLAND	CA	93250	1360	00	06000	35.67801221	-119.2297708	Kern County
295524	Non-Physician Medical Practitioner	None	1588480651	0	0	GROVEMAN, AHARON NP	2/1/2025	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
295526	Non-Physician Medical Practitioner	None	1295717288	0	0	GREEN, ELAINE MARIE	3/6/2009	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
295562	Non-Physician Medical Practitioner	None	1538168067	0	0	GARN, KAREN S	7/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1409 25TH AVE	None	SAN FRANCISCO	CA	94122	3317	00	06000	37.76113856	-122.4834252	San Francisco County
295596	Non-Physician Medical Practitioner	None	1063459683	0	0	GILLESPIE, SHANNON MICHELLE	9/8/2007	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
295615	Non-Physician Medical Practitioner	None	1225398688	0	0	GEBHARD, JEAN T.	10/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2874 N CARSON ST	SUITE200	CARSON CITY	NV	89706	0251	00	06000	39.185271	-119.7710595	Consolidated Municipality of Carson City
295617	Non-Physician Medical Practitioner	None	1902861438	0	0	GLATTHAAR, ROBERT J	2/14/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	369 SILVER LAKE DR	None	CHICO	CA	95973	5834	00	06000	39.76565703	-121.8791696	Butte County
295646	Non-Physician Medical Practitioner	None	1467498956	0	0	GJEDSTED, VIRGINIA S	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	1701 DIVISADERO ST 5TH F	None	SAN FRANCISCO	CA	94143	0001	00	06000	37.78553106	-122.4399475	San Francisco County
295663	Non-Physician Medical Practitioner	None	1396194841	0	0	GALICIA, CASEY C R	7/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	855 MARGARET LANE	None	WALNUT	CA	91789	4548	00	06000	34.0293136	-117.8819054	Los Angeles County
295690	Non-Physician Medical Practitioner	None	1265958623	0	0	GUO, XIAOFEI 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	11331 ELLIOTT AVE	25	EL MONTE	CA	91732	3379	00	06000	34.05857774	-118.0293258	Los Angeles County
295704	Non-Physician Medical Practitioner	None	1467987586	0	0	GEBAUER, HEATHER C PA	10/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5291 ROCKY MOUNTAIN PLAC	None	RANCHO CUCAMONGA	CA	91737	6822	00	06000	34.15806855	-117.5813833	San Bernardino County
295745	Non-Physician Medical Practitioner	None	1750648184	0	0	GALLAGHER, KINDAL A PA-C	9/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	00	06000	37.35228637	-121.9754073	Santa Clara County
295764	Non-Physician Medical Practitioner	None	1164920849	0	0	GOMEZ, LARRY NP	7/8/2019	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
295772	Non-Physician Medical Practitioner	None	1356776355	0	0	GROSSMAN, JAMES PA	4/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	00	06000	38.421135	-122.752008	Sonoma County
295773	Non-Physician Medical Practitioner	None	1861857260	0	0	GALLEGOS, ERICA L 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	7374 SILKWOOD LN	None	HIGHLAND	CA	92346	6225	00	06000	34.11922408	-117.1528798	San Bernardino County
295819	Non-Physician Medical Practitioner	None	1124634118	0	0	GALURA, MARIA C NP	2/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1711 W TEMPLE ST	1050	LOS ANGELES	CA	90026	5421	00	06000	34.06891181	-118.2638033	Los Angeles County
295827	Non-Physician Medical Practitioner	None	1306076476	0	0	GROSSI, GINA ANALISA	2/23/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2403 CASTILLO ST STE 202	None	SANTA BARBARA	CA	93105	5316	00	06000	34.43053648	-119.7243139	Santa Barbara County
295838	Non-Physician Medical Practitioner	None	1780203653	0	0	GARCIA, FRANCO D PA	12/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
295858	Non-Physician Medical Practitioner	None	1487604427	0	0	GARCIA, MARTHA	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	17095 MAIN ST	None	HESPERIA	CA	92345	6004	00	06000	34.41984761	-117.2904344	San Bernardino County
295868	Non-Physician Medical Practitioner	None	1174284855	0	0	GHOSH, LILLIAN 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	2975 N SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	00	06000	34.28924598	-118.7439214	Ventura County
295883	Non-Physician Medical Practitioner	None	1417970757	0	0	GROSS, SUSAN V	3/2/2007	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
295904	Non-Physician Medical Practitioner	None	1992177182	0	0	GUTH, CARA A PA-C	1/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3910 VISTA WAY	106	OCEANSIDE	CA	92056	4513	00	06000	33.18382239	-117.2937426	San Diego County
295912	Non-Physician Medical Practitioner	None	1790253672	0	0	GILL, NAVDEEP K PA-C	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	1851 NORTH LOMBARD	STE 100	OXNARD	CA	93030	8230	00	06000	34.2183512	-119.1493247	Ventura County
295917	Non-Physician Medical Practitioner	None	1356864540	0	0	GABRILLO, JOSEPHINE J NP	11/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1705 28TH ST	None	BAKERSFIELD	CA	93301	1902	00	06000	35.38477999	-119.0215335	Kern County
295932	Non-Physician Medical Practitioner	None	1205228012	0	0	GLASGOW, CATHERINE L NP	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15183 OAK RANCH DR	None	VISALIA	CA	93292	9372	00	06000	36.35749156	-119.2348769	Tulare County
295947	Non-Physician Medical Practitioner	None	1821514811	0	0	GREWAL, SIMRAN	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	11868 MOORPARK ST	UNIT B	STUDIO CITY	CA	91604	2140	00	06000	34.15033716	-118.3913222	Los Angeles County
295950	Non-Physician Medical Practitioner	None	1558828178	0	0	GOHEL, TEJSHRI NP	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	1100 TRANCAS ST	STE 209	NAPA	CA	94558	2909	00	06000	38.32316569	-122.2981938	Napa County
295990	Non-Physician Medical Practitioner	None	1316711773	0	0	GONZALEZ, JULIA 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	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
296007	Non-Physician Medical Practitioner	None	1669682217	0	0	GALARZA-ADAMS, MONICA PA-C	10/9/2024	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
296018	Non-Physician Medical Practitioner	None	1962983734	0	0	GARCIA, YVETTE M 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	8635 FIRESTONE BLVD	STE 100	DOWNEY	CA	90241	5242	00	06000	33.93691837	-118.1265474	Los Angeles County
296032	Non-Physician Medical Practitioner	None	1487149092	0	0	GUTIERREZ, MERCEDES D NP	11/25/2020	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
296041	Non-Physician Medical Practitioner	None	1215351705	0	0	GOLETA NEIGHBORHOOD CLINIC	6/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	334 S PATTERSON AVE	SUITE 203	GOLETA	CA	93111	2400	00	06000	34.43376368	-119.8092445	Santa Barbara County
296077	Non-Physician Medical Practitioner	None	1063419653	0	0	GREENE, CAROL V	7/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18321 CLARK ST	None	TARZANA	CA	91356	3501	00	06000	34.16979433	-118.5312303	Los Angeles County
296126	Non-Physician Medical Practitioner	None	1780132324	0	0	GEISSLER, JILLIAN D NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
296140	Non-Physician Medical Practitioner	None	1487858247	0	0	GARAVENTA, ALICIA MARIE	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	990 CAUGHLIN XING	None	RENO	NV	89519	0631	00	06000	39.50134061	-119.8595718	Washoe County
296143	Non-Physician Medical Practitioner	None	1669634713	0	0	GILLINGHAM, MAI X	1/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	110 ANITA RD	APT 3	BURLINGAME	CA	94010	3072	00	06000	37.57940646	-122.3401596	San Mateo County
296246	Non-Physician Medical Practitioner	None	1508432030	0	0	GARDHOUSE, CHRISTOPHER G PA-C	10/4/2021	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
296305	Non-Physician Medical Practitioner	None	1659672939	0	0	GAITHO, ZELLUYAH W	3/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6720 PLACID ST	None	LAS VEGAS	NV	89119	3541	00	06000	36.06732466	-115.1589453	Clark County
296336	Non-Physician Medical Practitioner	None	1528008117	0	0	GOOD, CORRINNE I	10/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
296348	Non-Physician Medical Practitioner	None	1871877506	0	0	GARVEY, ROBERTA L	6/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4553 HARBOR VISTA BLVD	APT B	KLAMATH FALLS	OR	97601	8310	00	06000	42.26314268	-121.8074559	Klamath County
296349	Non-Physician Medical Practitioner	None	1285115360	0	0	GREER, JAYME L NP	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	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
296357	Non-Physician Medical Practitioner	None	1699889659	0	0	GURNEY, PATRICIA LOUISE	10/12/2004	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
296363	Non-Physician Medical Practitioner	None	1750479374	0	0	GRAHAM, BILLY D	1/14/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3470 LONGVIEW AVE	None	REDDING	CA	96001	0147	00	06000	40.58673227	-122.4227856	Shasta County
296379	Non-Physician Medical Practitioner	None	1710234737	0	0	GAURA, MORGAN	8/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	00	06000	40.57278686	-122.3958519	Shasta County
296385	Non-Physician Medical Practitioner	None	1891118477	0	0	GUITIERREZ, CHRISTINE M NP	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	23251 CAROLDALE AVE	None	CARSON	CA	90745	4611	00	06000	33.81439124	-118.2842858	Los Angeles County
296412	Non-Physician Medical Practitioner	None	1265269377	0	0	GUSTAFSON, APRIL-DAWN NP	12/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5887 BROCKTON AVE	STE A	RIVERSIDE	CA	92506	1858	00	06000	33.96266399	-117.3956871	Riverside County
296435	Non-Physician Medical Practitioner	None	1104873074	0	0	GIPSH, KATHERINE	12/11/2012	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
296448	Non-Physician Medical Practitioner	None	1588118145	0	0	GABON, HENRY B	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	1135 S SUNSET AVE	STE 200	WEST COVINA	CA	91790	3937	00	06000	34.06215064	-117.9453997	Los Angeles County
296458	Non-Physician Medical Practitioner	None	1134148521	0	0	GOFORTH, JENNIFER M NP	4/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11793 DRY CREEK LN	None	BROWNS VALLEY	CA	95918	9710	00	06000	39.30415067	-121.3918832	Yuba County
296472	Non-Physician Medical Practitioner	None	1033240833	0	0	GARRISON, STACY	8/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4601 DALE RD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
296478	Non-Physician Medical Practitioner	None	1144256983	0	0	GRACIANO, SHAWN LOUISE	7/9/2005	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
296508	Non-Physician Medical Practitioner	None	1992494447	0	0	GRANT, ANDREW L PA-C	9/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4001 J STREET	None	SACRAMENTO	CA	95819	3626	00	06000	38.570526	-121.4521695	Sacramento County
296527	Non-Physician Medical Practitioner	None	1821136326	0	0	GHNAIM, SUSAN	7/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
296538	Non-Physician Medical Practitioner	None	1245902733	0	0	GOLDEN, KRISTIN PA-C	1/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	00	06000	34.14950866	-118.2311155	Los Angeles County
296609	Non-Physician Medical Practitioner	None	1699296863	0	0	GOON, STEPHEN C NP	10/14/2020	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
296627	Non-Physician Medical Practitioner	None	1760241962	0	0	GOODMAN, DOMINIQUE S PA-C	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	1700 COFFEE RD	None	MODESTO	CA	95355	2803	00	06000	37.668645	-120.9756715	Stanislaus County
296636	Non-Physician Medical Practitioner	None	1790288389	0	0	GRIGGS, JONNA L PA-C	5/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
296667	Non-Physician Medical Practitioner	None	1801122478	0	0	GRACZYK, SYLWIA ANGELICA	5/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7391 W CHARLESTON BLVD	SUITE 140	LAS VEGAS	NV	89117	1577	00	06000	36.15908224	-115.2528371	Clark County
296700	Non-Physician Medical Practitioner	None	1588384325	0	0	GOMEZ, COURTNEY NP	10/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6155 CORNERSTONE CT E	220	SAN DIEGO	CA	92121	4736	00	06000	32.89582335	-117.1880966	San Diego County
296708	Non-Physician Medical Practitioner	None	1578049128	0	0	GILL, HARMEET NP	4/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
296728	Non-Physician Medical Practitioner	None	1609499326	0	0	GRIFFIN, NATALIE R PA-C	9/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 HEGENBERGER RD	STE 100	OAKLAND	CA	94621	1452	00	06000	37.7350428	-122.1976624	Alameda County
296734	Non-Physician Medical Practitioner	None	1962127795	0	0	GUZMAN, ABIGAIL NP	1/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11306 MOUNTAIN VIEW	A	LOMA LINDA	CA	92354	3832	00	06000	34.047513	-117.243647	San Bernardino County
296748	Non-Physician Medical Practitioner	None	1669928644	0	0	GARIBAY, JULIO A NP	7/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1715 SOUTH CEDAR AVENUE	None	FRESNO	CA	93702	4331	00	06000	36.725625	-119.7546225	Fresno County
296749	Non-Physician Medical Practitioner	None	1922780667	0	0	GOMEZ, BRENDA NP	11/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11865 FIRESTONE BLVD	None	NORWALK	CA	90650	2902	00	06000	33.9118292	-118.0799635	Los Angeles County
296761	Non-Physician Medical Practitioner	None	1972847770	0	0	GALLO, CHRISTINE J NP	5/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4617 FREEPORT BLVD	SUITE B	SACRAMENTO	CA	95822	2015	00	06000	38.533311	-121.4939295	Sacramento County
296781	Non-Physician Medical Practitioner	None	1861448102	0	0	GREEN, JAIME M	7/6/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	00	06000	38.66314048	-121.794696	Yolo County
296787	Non-Physician Medical Practitioner	None	1952647851	0	0	GUNKLE, CHERYSH K NP	7/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1408 BANKS AVENUE	None	NAPA	CA	94559	1552	00	06000	38.306128	-122.2725939	Napa County
296797	Non-Physician Medical Practitioner	None	1700827342	0	0	GREENING, JENNIFER L	8/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 SANTA MARGUARITA DR	None	APTOS	CA	95003	4813	00	06000	36.96867535	-121.8819346	Santa Cruz County
296798	Non-Physician Medical Practitioner	None	1184142259	0	0	GARRISON, ASHLEY M PA-C	9/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4140 JADE STREET	STE 102	CAPITOLA	CA	95010	3956	00	06000	36.97026148	-121.9638195	Santa Cruz County
296838	Non-Physician Medical Practitioner	None	1033193610	0	0	GOLDEN VALLEY HEALTH CENTER	11/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 FLORIDA AVE	SUITE B	MODESTO	CA	95350	4437	00	06000	37.666053	-120.996222	Stanislaus County
296848	Non-Physician Medical Practitioner	None	1376956912	0	0	GAMMEL, MELANIE R PA-C	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	1036 SANBORN AVENUE	APARTMENT 107	LOS ANGELES	CA	90029	3196	00	06000	34.09116123	-118.2811487	Los Angeles County
296872	Non-Physician Medical Practitioner	None	1396471082	0	0	GARWOOD, WESLEY P PA	4/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6620 COYLE AVE	STE 212	CARMICHAEL	CA	95608	6337	00	06000	38.66751	-121.310028	Sacramento County
296907	Non-Physician Medical Practitioner	None	1215352109	0	0	GARCIA CASTRO, MIGUEL NP	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	16007 VICTORY BLVD	APT B	LAKE BALBOA	CA	91406	6466	00	06000	34.18664349	-118.481823	Los Angeles County
296930	Non-Physician Medical Practitioner	None	1285987909	0	0	GILGUT, RICHARD C	11/30/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1171 GREEN TERRACE	None	DAVIS	CA	95618	6373	00	06000	38.54350614	-121.7213598	Yolo County
296948	Non-Physician Medical Practitioner	None	1427495167	0	0	GOODENOW, TODD N NP	2/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1504 28 STREET	APT B	SACRAMENTO	CA	95816	6416	00	06000	38.568096	-121.4719605	Sacramento County
296953	Non-Physician Medical Practitioner	None	1295754752	0	0	GUSTAVSON, PAUL RUSSELL	3/11/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1806 CIRCLE DR	None	EUREKA	CA	95501	2772	00	06000	40.79197353	-124.1285897	Humboldt County
296956	Non-Physician Medical Practitioner	None	1801843792	0	0	GUMAS, ELIZABETH R	3/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2299 BACON ST	None	CONCORD	CA	94520	2050	00	06000	37.98199042	-122.0349518	Contra Costa County
296973	Non-Physician Medical Practitioner	None	1346812815	0	0	GOYDEN, JOSHUA P PA	1/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 E 13TH STREET	None	MERCED	CA	95341	6250	00	06000	37.29309532	-120.4748791	Merced County
296986	Non-Physician Medical Practitioner	None	1174729768	0	0	GALSTJAN, VAZRIK	12/27/2010	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	#116	BURBANK	CA	91505	4806	00	06000	34.1577056	-118.329779	Los Angeles County
297025	Non-Physician Medical Practitioner	None	1912043407	0	0	GRESHAM, PATRICIA M NP	9/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	913 N HARVARD AVENUE	None	CLOVIS	CA	93611	7049	00	06000	36.84687484	-119.707089	Fresno County
297029	Non-Physician Medical Practitioner	None	1780333211	0	0	GELBART, CHELSEA A 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	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	00	06000	37.69819004	-122.0873124	Alameda County
297099	Non-Physician Medical Practitioner	None	1316620297	0	0	GARRISON, HILLARY NP	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	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	00	06000	38.49639719	-122.7501553	Sonoma County
297117	Non-Physician Medical Practitioner	None	1386272904	0	0	GREENHILL, COLIN P PA-C	3/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
297123	Non-Physician Medical Practitioner	None	1891125753	0	0	GEVORKIAN, DAVID	4/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 MONTEREY ROAD	APT 12	GLENDALE	CA	91206	2065	00	06000	34.15744512	-118.2508595	Los Angeles County
297153	Non-Physician Medical Practitioner	None	1417521402	0	0	GISTAND, GLORIA G	8/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27200 CALAROGA	None	HAYWARD	CA	94545	4339	00	06000	37.63347961	-122.0897735	Alameda County
297176	Non-Physician Medical Practitioner	None	1285201616	0	0	GOODS, KAITLIN PA-C	2/9/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
297183	Non-Physician Medical Practitioner	None	1962452888	0	0	GONZALEZ, ZENITH A NP	11/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	103 YANKTON ST	None	FOLSOM	CA	95630	8139	00	06000	38.64744	-121.1765895	Sacramento County
297189	Non-Physician Medical Practitioner	None	1891723870	0	0	GUMBERT, AMANDA W	5/9/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1714 SHIRE AVENUE	None	OCEANSIDE	CA	92057	5723	00	06000	33.24722216	-117.251968	San Diego County
297202	Non-Physician Medical Practitioner	None	1053399030	0	0	GUADIANA, NANETTE GAY	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	2210 E ILLINOIS AVE	SUITE 406	FRESNO	CA	93701	2125	00	06000	36.74500687	-119.7846885	Fresno County
297224	Non-Physician Medical Practitioner	None	1932143195	0	0	GARCIA, CARLOS BENJAMIN	5/25/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14359 PIONEER BLVD STE A	None	NORWALK	CA	90650	4850	00	06000	33.90057	-118.0826075	Los Angeles County
297266	Non-Physician Medical Practitioner	None	1669548780	0	0	GABERTAN-TENAZAS, SHARON M	3/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13648 PALM ST	None	CERRITOS	CA	90703	1024	00	06000	33.87584853	-118.0404585	Los Angeles County
297267	Non-Physician Medical Practitioner	None	1871904151	0	0	GERENDASH, BENJAMIN S NP	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	1450 BEVERLY DR	APT 306	LOS ANGELES	CA	90035	3073	00	06000	34.05357	-118.3953615	Los Angeles County
297306	Non-Physician Medical Practitioner	None	1952926289	0	0	GUEVARRA, BERNADET V NP	10/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	00	06000	37.72851602	-122.4296638	San Francisco County
297356	Non-Physician Medical Practitioner	None	1578934865	0	0	GARCIA, LOUIE C NP	2/7/2022	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
297387	Non-Physician Medical Practitioner	None	1629107636	0	0	GONZALEZ, LAUREN 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	7059 BERGAMOT AVENUE	None	MOORPARK	CA	93021	5066	00	06000	34.30110063	-118.8693356	Ventura County
297388	Non-Physician Medical Practitioner	None	1184372278	0	0	GUYNES, ANTUELA NP	3/28/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30495 CANWOOD	101	AGOURA HILLS	CA	91301	4331	00	06000	34.14698794	-118.7853623	Los Angeles County
297390	Non-Physician Medical Practitioner	None	1952472151	0	0	GROOM, TAMMI E	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	821 E COUNTRY VIEW CIR	None	FRESNO	CA	93730	0726	00	06000	36.88752169	-119.7668835	Fresno County
297403	Non-Physician Medical Practitioner	None	1013538776	0	0	GIONTA, ALEXANDRA N PA	11/1/2020	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
297429	Non-Physician Medical Practitioner	None	1164568366	0	0	GHANGAS, MANJIT KAUR	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	1425 S MAIN ST	1425 SOUTH MAIN STREET	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
297466	Non-Physician Medical Practitioner	None	1013690858	0	0	GALINDO, SABRINA	8/21/2023	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
297481	Non-Physician Medical Practitioner	None	1093293524	0	0	GOFF, SAMANTHA W PA	3/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
297497	Non-Physician Medical Practitioner	None	1336427798	0	0	GARBER, BEVERLY BOVEY	9/8/2011	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 STE 7	None	SACRAMENTO	CA	95817	2207	00	06000	38.55204	-121.455387	Sacramento County
297501	Non-Physician Medical Practitioner	None	1871153783	0	0	GARCIA, ZULEMA PA	11/18/2019	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
297555	Non-Physician Medical Practitioner	None	1225439391	0	0	GRAHAM, LACY J NP	1/6/2019	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
297562	Non-Physician Medical Practitioner	None	1043534571	0	0	GILILLAND, SUSAN	8/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	850 E LATHAM AVE	SUITE 204	HEMET	CA	92543	4391	00	06000	33.74941446	-116.963559	Riverside County
297583	Non-Physician Medical Practitioner	None	1255737847	0	0	GORYNSKI, PETER J	11/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3956 TEXAS ST	UNIT 3	SAN DIEGO	CA	92104	6438	00	06000	32.74957034	-117.1388306	San Diego County
297597	Non-Physician Medical Practitioner	None	1861519365	0	0	GOLDMAN, SHERRY S	6/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 10TH ST	None	MANHATTAN BEACH	CA	90266	5410	00	06000	33.88420735	-118.407856	Los Angeles County
297639	Non-Physician Medical Practitioner	None	1528796448	0	0	GHANEIAN, AFSAN PA-C	10/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	00	06000	33.56635084	-117.1823956	Riverside County
297666	Non-Physician Medical Practitioner	None	1639227523	0	0	GEZALYAN, AMBARTSUM Y	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	14246 VALERIO ST	None	VAN NUYS	CA	91405	1453	00	06000	34.20479449	-118.4439105	Los Angeles County
297742	Non-Physician Medical Practitioner	None	1548643000	0	0	GARFIELD HEALTH CENTER	1/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 S ATLANTIC BLVD STE	None	MONTEREY PARK	CA	91754	3845	00	06000	34.05382447	-118.1363489	Los Angeles County
297750	Non-Physician Medical Practitioner	None	1366175002	0	0	GEORGE, KIMBERLY CNM	3/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	00	06000	37.36893518	-122.0779448	Santa Clara County
297783	Non-Physician Medical Practitioner	None	1558689968	0	0	GUGINO, DANA CLAIRE	1/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	841 KUHN DRIVE	#200	CHULA VISTA	CA	91914	4523	00	06000	32.65289649	-116.9665862	San Diego County
297813	Non-Physician Medical Practitioner	None	1114922192	0	0	GASTROENTEROLOGY ASSOCIATES	12/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1825 SONOMA ST	None	REDDING	CA	96001	2519	00	06000	40.5756004	-122.3928987	Shasta County
297830	Non-Physician Medical Practitioner	None	1043715444	0	0	GIALLANZO, PATTI 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	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	92597	2168	00	06000	37.92643968	-122.0521822	Contra Costa County
297832	Non-Physician Medical Practitioner	None	1558591701	0	0	GERSTL, HEATHER L PA	11/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	00	06000	34.55800153	-118.0488825	Los Angeles County
297849	Non-Physician Medical Practitioner	None	1184933871	0	0	GUERTIN, LISA	11/30/2011	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	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
297864	Non-Physician Medical Practitioner	None	1063575512	0	0	GREGOVICH, JENNIFER ANN	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	39400 PASEO PADRA PARKWA	EMBARCADERO BUILDING, GE	FREMONT	CA	94538	2310	00	06000	37.55102172	-121.9759026	Alameda County
297888	Non-Physician Medical Practitioner	None	1699016014	0	0	GEPILANO, DARCY 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	9461 HOLLOW SPRINGS WAY	None	ELK GROVE	CA	95624	4076	00	06000	38.415717	-121.339476	Sacramento County
297895	Non-Physician Medical Practitioner	None	1407371941	0	0	GRIGG, ROBERT D PA-C	9/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 SPRINGFIELD DR	None	CHICO	CA	95928	6340	00	06000	39.73422459	-121.8042177	Butte County
297922	Non-Physician Medical Practitioner	None	1811398969	0	0	GARCIA, MERLIENAIDA L NP	1/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	533 SOMERSET ST	None	SAN FRANCISCO	CA	94134	1738	00	06000	37.72497101	-122.4068385	San Francisco County
297967	Non-Physician Medical Practitioner	None	1548980170	0	0	GARCIA, MARIA E PA	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	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	00	06000	38.463381	-121.416183	Sacramento County
297976	Non-Physician Medical Practitioner	None	1306623335	0	0	GOMEZ, GABRIELA PA	4/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	0000	00	06000	34.158213	-118.328112	Los Angeles County
297991	Non-Physician Medical Practitioner	None	1750566410	0	0	GALVEZ TRISTAN, AMALIA ESMERALDA	1/29/2008	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
298003	Non-Physician Medical Practitioner	None	1144636291	0	0	GOLETA NEIGHBORHOOD DENTAL CLINIC	10/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	164 KINMAN AVE	None	GOLETA	CA	93117	3481	00	06000	34.436277	-119.8222815	Santa Barbara County
298005	Non-Physician Medical Practitioner	None	1235228594	0	0	GUZMAN, EUGENE G JR	4/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22275 TARA PL	None	SALINAS	CA	93908	8756	00	06000	36.60133504	-121.6449351	Monterey County
298012	Non-Physician Medical Practitioner	None	1205991353	0	0	GUO, WEI LING	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	2725 CAPITOL AVE	SUITE 300	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
298024	Non-Physician Medical Practitioner	None	1528690278	0	0	GREEN, ERIN E NP	1/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2321 HARRISON AVE	STE S	EUREKA	CA	95501	3216	00	06000	40.786857	-124.1396125	Humboldt County
298033	Non-Physician Medical Practitioner	None	1144804550	0	0	GLOUDEMANS, HOLLY A NP	2/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	00	06000	34.06736471	-118.3763201	Los Angeles County
298065	Non-Physician Medical Practitioner	None	1235893645	0	0	GENTRY, EMILY R PA-C	8/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39141 CIVIC CENTER DR	STE 335	FREMONT	CA	94538	5831	00	06000	37.55436307	-121.9764708	Alameda County
298103	Non-Physician Medical Practitioner	None	1316929896	0	0	GOODWILL, BETH	6/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8170 LAGUNA BLVD	SUITE 210	ELK GROVE	CA	95758	7901	00	06000	38.421054	-121.405365	Sacramento County
298120	Non-Physician Medical Practitioner	None	1043387368	0	0	GRAY, JAMES O	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	811 GARNET ST	None	REDONDO BEACH	CA	90277	3420	00	06000	33.84056465	-118.3795728	Los Angeles County
298151	Non-Physician Medical Practitioner	None	1174802698	0	0	GILLAN, LAUREN RAE	1/10/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11480 BROOKSHIRE AVE	SUITE 309	DOWNEY	CA	90241	5018	00	06000	33.93622932	-118.1311752	Los Angeles County
298261	Non-Physician Medical Practitioner	None	1730860115	0	0	GRAY, EMILY PA	10/16/2023	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
298301	Non-Physician Medical Practitioner	None	1922661594	0	0	GONZALEZ, SERGIO NP	5/29/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	00	06000	35.39052148	-119.0070765	Kern County
298401	Non-Physician Medical Practitioner	None	1922770874	0	0	GRANT, ZANE NP	3/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1655 S WESTERN AVE	None	LOS ANGELES	CA	90006	5801	00	06000	34.042653	-118.3090565	Los Angeles County
298404	Non-Physician Medical Practitioner	None	1205504479	0	0	GLIVAR, MEREDITH A NP	4/14/2022	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	2405	00	06000	32.99706	-117.05544	San Diego County
298415	Non-Physician Medical Practitioner	None	1265007819	0	0	GONZALEZ, NICOLETTE PA-C	10/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1740 ROSECRANS ST	None	SAN DIEGO	CA	92106	1928	00	06000	32.72903913	-117.2254885	San Diego County
298432	Non-Physician Medical Practitioner	None	1831872357	0	0	GRIJALVA, WILIAN CNP	11/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	330 OXFORD ST	STE 106	CHULA VISTA	CA	91911	3118	00	06000	32.60985611	-117.0691868	San Diego County
298447	Non-Physician Medical Practitioner	None	1003367939	0	0	GONZALES, CHRISTOPHER G CNP	4/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
298489	Non-Physician Medical Practitioner	None	1790432110	0	0	GONZALEZ, KEVIN PA-C	3/21/2023	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
298574	Non-Physician Medical Practitioner	None	1669258992	0	0	GREY, MAYRA J NP	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	11735 FIRESTONE BLVD	None	NORWALK	CA	90650	2808	00	06000	33.91353706	-118.0831749	Los Angeles County
298589	Non-Physician Medical Practitioner	None	1831440866	0	0	GELBART, DAVID C	9/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3717 E ANGELINA DR	None	KINGMAN	AZ	86409	2375	00	06000	35.262567	-113.985981	Mohave County
298618	Non-Physician Medical Practitioner	None	1457095424	0	0	GARDNER, MATTHEW R PA	6/14/2023	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
298639	Non-Physician Medical Practitioner	None	1912310020	0	0	GORYL, ERIN K NP	6/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	724 SALEM CT	None	SAN DIEGO	CA	92109	7009	00	06000	32.78509104	-117.2534838	San Diego County
298644	Non-Physician Medical Practitioner	None	1467801381	0	0	GRANT, SERENA F PA	7/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.85429563	-117.8166478	Orange County
298655	Non-Physician Medical Practitioner	None	1205266749	0	0	GILBERT, MEGAN E NP	1/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4361 S SQUIRES LANE	None	GILBERT	AZ	85297	1205	00	06000	33.271011	-111.7732365	Maricopa County
298672	Non-Physician Medical Practitioner	None	1336220482	0	0	GREEN, GRETA D NP	2/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	217 WHISPERING GATES CT	None	SIMI VALLEY	CA	93065	8240	00	06000	34.23568397	-118.787923	Ventura County
298674	Non-Physician Medical Practitioner	None	1275090698	0	0	GONZALEZ, GEORGINA	6/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298675	Non-Physician Medical Practitioner	None	1457880387	0	0	GRANDE, WHITTNEY S NP	10/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	19517 N 53RD AVENUE	None	GLENDALE	AZ	85308	5040	00	06000	33.662151	-112.1739165	Maricopa County
298685	Non-Physician Medical Practitioner	None	1255881561	0	0	GOODREAU, SARAH D 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	2490 HOSPITAL DRIVE	SUITE 102	MOUNTAIN VIEW	CA	94040	4124	00	06000	37.369827	-122.0818185	Santa Clara County
298688	Non-Physician Medical Practitioner	None	1811703036	0	0	GEORGE, JEWEL J NP	2/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5137 GOLDEN FOOTHILL PKW	STE 120	EL DORADO HLS	CA	95762	9671	00	06000	38.63972246	-121.0689815	El Dorado County
298708	Non-Physician Medical Practitioner	None	1205449832	0	0	GARCIA, AUTUMN NP	8/13/2020	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
298717	Non-Physician Medical Practitioner	None	1730172313	0	0	GOLDSTEIN, ROBYNN	8/16/2007	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	SUITE 770	LOS ANGELES	CA	90024	6970	00	06000	34.06544724	-118.4459249	Los Angeles County
298725	Non-Physician Medical Practitioner	None	1649665480	0	0	GARCIA, BAUDELIA NP	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2222 ELTON AVE	None	BAKERSFIELD	CA	93306	3331	00	06000	35.38605282	-118.9662647	Kern County
298774	Non-Physician Medical Practitioner	None	1437499704	0	0	GARVIN, JOSEPH M NP	1/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2444 HEATHERWOOD COURT	None	ESCONDIDO	CA	92026	4015	00	06000	33.16984948	-117.083534	San Diego County
298778	Non-Physician Medical Practitioner	None	1912411687	0	0	GJERDE, LARS 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	261 SELBY RANCH RD	APT 3	SACRAMENTO	CA	95864	5854	00	06000	38.571714	-121.381758	Sacramento County
298800	Non-Physician Medical Practitioner	None	1013685932	0	0	GRAVANIS, AVITAL PA-C	7/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
298808	Non-Physician Medical Practitioner	None	1851836894	0	0	GRAVA, KIMBERLY G NP	2/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 S. BUENA VISTA ST.	SUITE 100	BURBANK	CA	91505	4570	00	06000	34.15978726	-118.3289164	Los Angeles County
298814	Non-Physician Medical Practitioner	None	1932231701	0	0	GUTIERREZ, MICHAEL ANTHONY MANALANG	8/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
298822	Non-Physician Medical Practitioner	None	1730407479	0	0	GLENNON, CECELIA SHEPHERD	10/3/2012	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
298888	Non-Physician Medical Practitioner	None	1043789159	0	0	GALINDO, LAURA A NP	11/15/2019	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
298909	Non-Physician Medical Practitioner	None	1437865581	0	0	GALINDO-CARMICHAEL, ROSA NP	1/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2339 W CLEVELAND AVE	STE 101	MADERA	CA	93637	8753	00	06000	36.97466548	-120.085749	Madera County
298915	Non-Physician Medical Practitioner	None	1164945564	0	0	GOMEZ, ENRIQUE D NP	2/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E CESAR E CHAVEZ AV	SUITE 356	LOS ANGELES	CA	90033	2425	00	06000	34.05112725	-118.2173921	Los Angeles County
298940	Non-Physician Medical Practitioner	None	1811380660	0	0	GARCIA, LAUREN PA-C	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	00	06000	34.21700406	-119.1582582	Ventura County
298949	Non-Physician Medical Practitioner	None	1871708859	0	0	GALLARDO, ANDRE V	1/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18800 DELAWARE ST	SUITE 1100	HUNTINGTON BEACH	CA	92648	1959	00	06000	33.68911733	-117.9931535	Orange County
298952	Non-Physician Medical Practitioner	None	1811392475	0	0	GRINDLER, JENNIFER	9/8/2024	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
298958	Non-Physician Medical Practitioner	None	1679919492	0	0	GROSS, DAISY CAROLINA DIAZ	8/27/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	730 WELCH RD	None	PALO ALTO	CA	94304	1503	00	06000	37.43731858	-122.1746139	Santa Clara County
298966	Non-Physician Medical Practitioner	None	1548819634	0	0	GREEN, HENRIETTA A PA-C	10/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	00	06000	34.09938951	-117.421272	San Bernardino County
299025	Non-Physician Medical Practitioner	None	1508939919	0	0	GIBSON, JOYCE	5/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	00	06000	37.4246225	-121.8944566	Santa Clara County
299036	Non-Physician Medical Practitioner	None	1316006786	0	0	GONZALEZ, CELINA CNM	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	1902 PARK AVE	STE 327	LOS ANGELES	CA	90026	7031	00	06000	34.07609154	-118.2615239	Los Angeles County
299124	Non-Physician Medical Practitioner	None	1891878740	0	0	GORALKA, MELISSA	10/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1858 HEIDELBERG DR	None	LIVERMORE	CA	94550	3113	00	06000	37.66342992	-121.7697596	Alameda County
299141	Non-Physician Medical Practitioner	None	1225676737	0	0	GADELOV, IVELINA PA-C	11/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
299146	Non-Physician Medical Practitioner	None	1336773332	0	0	GALLAGHER, ANNA A NP	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	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
299155	Non-Physician Medical Practitioner	None	1821525270	0	0	GENUALDI, CARLY J	4/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 CRANBERRY DR	None	CUPERTINO	CA	95014	4926	00	06000	37.31041462	-122.048072	Santa Clara County
299166	Non-Physician Medical Practitioner	None	1861681652	0	0	GAGNON, TIMOTHY JAMES	11/21/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
299209	Non-Physician Medical Practitioner	None	1316637770	0	0	GRYPARIS, EVANGELIA	6/7/2024	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
299221	Non-Physician Medical Practitioner	None	1750630679	0	0	GALLAGHER, LISA M NP	8/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	330 CASTRO ST	APT A	SAN FRANCISCO	CA	94114	1556	00	06000	37.76362339	-122.4353209	San Francisco County
299251	Non-Physician Medical Practitioner	None	1184359077	0	0	GIST, TRAVIS 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	4601 DALE ROAD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
299281	Non-Physician Medical Practitioner	None	1659042521	0	0	GAO, JOY NP	3/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8851 CENTER DR	STE 603	LA MESA	CA	91942	3063	00	06000	32.78189749	-117.0075062	San Diego County
299289	Non-Physician Medical Practitioner	None	1598323248	0	0	GERALDI, ALEXANDER PA	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	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
299294	Non-Physician Medical Practitioner	None	1083482160	0	0	GENJOYAN, TATIANA NP	2/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1442 FOOTHILL BLVD	None	LA CANADA FLINTRI	CA	91011	2107	00	06000	34.20871102	-118.2096542	Los Angeles County
299321	Non-Physician Medical Practitioner	None	1093000341	0	0	GUSTAFSON, LISA ANNE	8/19/2011	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	ROOM HC029	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
299336	Non-Physician Medical Practitioner	None	1275931529	0	0	GARCIA, RICHARD NP	1/31/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 W F ST	None	ONTARIO	CA	91762	3205	00	06000	34.06932	-117.6542865	San Bernardino County
299356	Non-Physician Medical Practitioner	None	1518365998	0	0	GORMAN, JODI M NP	8/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2229 TRAFALGAR PL	None	OAKLAND	CA	94611	3246	00	06000	37.82260566	-122.2086102	Alameda County
299379	Non-Physician Medical Practitioner	None	1144957978	0	0	GARCIA, ALLISON PA	3/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 CESAR E CHAVEZ AVE	SUITE 535	LOS ANGELES	CA	90033	2464	00	06000	34.05112725	-118.2173921	Los Angeles County
299380	Non-Physician Medical Practitioner	None	1104171685	0	0	GUTIERREZ, RIGOBERTO	9/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6200 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	2098	00	06000	33.94408654	-117.4540622	Riverside County
299404	Non-Physician Medical Practitioner	None	1306402532	0	0	GAGNON, JUSTIN F PA-C	12/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
299454	Non-Physician Medical Practitioner	None	1780956003	0	0	GUDINO, ANA M NP	10/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	316 CROSS ST	None	WOODLAND	CA	95695	3913	00	06000	38.67203053	-121.778442	Yolo County
299492	Non-Physician Medical Practitioner	None	1184357303	0	0	GUTIERREZ, HECTOR NP	5/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 W BONITA AVE	STE 100	POMONA	CA	91767	1865	00	06000	34.09639602	-117.750267	Los Angeles County
299508	Non-Physician Medical Practitioner	None	1366200891	0	0	GILL, TALWINDER NP	5/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	480 DEL NORTE AVE	None	YUBA CITY	CA	95991	4125	00	06000	39.14337536	-121.6202241	Sutter County
299518	Non-Physician Medical Practitioner	None	1487636932	0	0	GALL, ELIZABETH F NP	3/2/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1717 39TH ST	None	SACRAMENTO	CA	95816	6724	00	06000	38.561571	-121.457169	Sacramento County
299523	Non-Physician Medical Practitioner	None	1376925974	0	0	GOODMAN, MEAGAN L NP	5/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7415 CHARMANT DR	2506	SAN DIEGO	CA	92122	5014	00	06000	32.86492336	-117.2290595	San Diego County
299537	Non-Physician Medical Practitioner	None	1679055057	0	0	GILBERT, JENNA E PA-C	1/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	00	06000	33.12123297	-117.1199417	San Diego County
299570	Non-Physician Medical Practitioner	None	1740664523	0	0	GEORGE, AMEEKA CNP	12/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
299607	Non-Physician Medical Practitioner	None	1538677489	0	0	GRENIER, KELLIE G	5/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17712 NEFF RANCH RD	None	YORBA LINDA	CA	92886	9013	00	06000	33.8728545	-117.82557	Orange County
299609	Non-Physician Medical Practitioner	None	1184381014	0	0	GOLDSBY, MEGAN	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	18200 YORBA LINDA BLVD	SUITE 250	YORBA LINDA	CA	92886	4044	00	06000	33.88842824	-117.8154698	Orange County
299622	Non-Physician Medical Practitioner	None	1003512773	0	0	GARINGAN, GISELLE A PA	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	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
299626	Non-Physician Medical Practitioner	None	1003532904	0	0	GAETH, LEAH	2/24/2025	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
299746	Non-Physician Medical Practitioner	None	1033617568	0	0	GANAGA, SVETLANA	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	1560 HEADLANE RD	None	WEST SACRAMENTO	CA	95691	5156	00	06000	38.5573054	-121.527266	Yolo County
299749	Non-Physician Medical Practitioner	None	1760046353	0	0	GIRON, CHARLES PA-C	8/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1225 WILSHIRE BOULEVARD	None	LOS ANGELES	CA	90017	1901	00	06000	34.05358988	-118.2661119	Los Angeles County
299830	Non-Physician Medical Practitioner	None	1316593304	0	0	GOMES, ALIENA PA	10/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1517 KNICKERBOCKER	None	STOCKTON	CA	95210	3119	00	06000	38.02415455	-121.2934722	San Joaquin County
299842	Non-Physician Medical Practitioner	None	1164946992	0	0	GRIFFIN, DOMINIQUE NP	4/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
299851	Non-Physician Medical Practitioner	None	1801984679	0	0	GARRETT, LIANA NP	1/26/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7677 CENTER AVE	SUITE 214	HUNTINGTON BEACH	CA	92647	3074	00	06000	33.736257	-117.995535	Orange County
299854	Non-Physician Medical Practitioner	None	1750161048	0	0	GHABRIAL, GERELTUYA E NP	1/30/2024	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 B100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
299871	Non-Physician Medical Practitioner	None	1265262919	0	0	GRACIANO, ALANA NP	9/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10890 THORNMINT RD	202	SAN DIEGO	CA	92127	2402	00	06000	33.01658024	-117.0992159	San Diego County
299874	Non-Physician Medical Practitioner	None	1811919962	0	0	GONZALES, RACHEL CAZARES	4/12/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3840 WATT AVE BLDG E	None	SACRAMENTO	CA	95821	2640	00	06000	38.635776	-121.380534	Sacramento County
299881	Non-Physician Medical Practitioner	None	1790478634	0	0	GONZALEZ, EVELINA NP	9/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
299889	Non-Physician Medical Practitioner	None	1780329938	0	0	GHABOUR, LYDIA T PA	3/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
299911	Non-Physician Medical Practitioner	None	1013929066	0	0	GOMEZ, SONIA B	10/2/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2740 GRANT ST	None	CONCORD	CA	94520	2265	00	06000	37.98580944	-122.0385574	Contra Costa County
299915	Non-Physician Medical Practitioner	None	1316393010	0	0	GOLDEN VALLEY HEALTH CENTERS	12/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1920 MEMORIAL DRIVE	None	CERES	CA	95307	1827	00	06000	37.600146	-120.961042	Stanislaus County
299965	Non-Physician Medical Practitioner	None	1598134892	0	0	GARCIA, SARAH 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
299968	Non-Physician Medical Practitioner	None	1922664085	0	0	GILLILAND, MORGAN A NP	8/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3101 CLAYTON RD	None	CONCORD	CA	94519	2732	00	06000	37.97361195	-122.0217913	Contra Costa County
299978	Non-Physician Medical Practitioner	None	1770998445	0	0	GLORIA, JOANNE MARIE D	9/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	814 MARYANN DR	STE 6	SANTA CLARA	CA	95050	5057	00	06000	37.34193421	-121.9668513	Santa Clara County
299985	Non-Physician Medical Practitioner	None	1558728717	0	0	GUEVARA-GALAN, JESSICA L NP	5/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 LAGUNA RD	STE 100	FULLERTON	CA	92835	3634	00	06000	33.89326085	-117.9300987	Orange County
300038	Non-Physician Medical Practitioner	None	1114980471	0	0	GARCIA, IRMA NP	4/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 W LEGION ROAD	STE 105	BRAWLEY	CA	92227	7754	00	06000	32.95996012	-115.5538196	Imperial County
300060	Non-Physician Medical Practitioner	None	1629189659	0	0	GEHRING, JANE CORBETT	1/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3260 KERNER BLVD	None	SAN RAFAEL	CA	94901	4861	00	06000	37.96081282	-122.501833	Marin County
300069	Non-Physician Medical Practitioner	None	1053035592	0	0	GILL, HARJEET NP	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	761 WEST SHAW AVE	None	CLOVIS	CA	93612	3217	00	06000	36.80859652	-119.7268065	Fresno County
300125	Non-Physician Medical Practitioner	None	1619206067	0	0	GOCHANGCO, JOHN E	3/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4140 JADE STREET	SUITE 100	CAPITOLA	CA	95010	3901	00	06000	36.97026148	-121.9638195	Santa Cruz County
300127	Non-Physician Medical Practitioner	None	1255384475	0	0	GREAR MANN, MELISSA P CNM	1/31/2018	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
300142	Non-Physician Medical Practitioner	None	1558814921	0	0	GASCA, JASMINE Y	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	6202 N MUSCATEL AVE	None	SAN GABRIEL	CA	91776	2627	00	06000	34.11148043	-118.0772317	Los Angeles County
300174	Non-Physician Medical Practitioner	None	1326305418	0	0	GRIGG, JANETTE LEE	10/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	625 S FAIR OAKS AVE	325	PASADENA	CA	91105	2613	00	06000	34.134894	-118.1504155	Los Angeles County
300180	Non-Physician Medical Practitioner	None	1154694339	0	0	GALLAGHER, ELIZABETH H NP	9/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10245 E INDIGO DR	None	SCOTTSDALE	AZ	85255	8684	00	06000	33.639417	-111.860298	Maricopa County
300183	Non-Physician Medical Practitioner	None	1932179868	0	0	GRENIER, CHARLES C	8/6/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	218 MOUNTAIN VIEW AVE	None	SANTA CRUZ	CA	95062	3614	00	06000	36.96896204	-122.0098223	Santa Cruz County
300184	Non-Physician Medical Practitioner	None	1467548339	0	0	GADEA, WILLIAM E PA	9/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	00	06000	39.13306148	-121.6140103	Sutter County
300192	Non-Physician Medical Practitioner	None	1447317201	0	0	GONZALEZ, JASON D PA-C	10/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
300205	Non-Physician Medical Practitioner	None	1528563582	0	0	GARSULA, LALAINE A NP	9/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
300241	Non-Physician Medical Practitioner	None	1841681632	0	0	GILLAN, SHEA E PA-C	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	325 GELLERT BLVD	None	DALY CITY	CA	94015	2613	00	06000	37.66753085	-122.4686194	San Mateo County
300244	Non-Physician Medical Practitioner	None	1558908368	0	0	GONZALES, JOE A NP	8/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 W LEGION ROAD	STE 105	BRAWLEY	CA	92227	7754	00	06000	32.95996012	-115.5538196	Imperial County
300246	Non-Physician Medical Practitioner	None	1003662081	0	0	GREEN, GABRIELLE NP	5/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
300265	Non-Physician Medical Practitioner	None	1841362837	0	0	GAUSEPOHL, MARY 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	24910 LAS BRISAS ROAD	STE 106	MURRIETA	CA	92562	4010	00	06000	33.57522424	-117.1828078	Riverside County
300303	Non-Physician Medical Practitioner	None	1336961861	0	0	GOLDING, JORDAN PA	3/28/2025	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
300307	Non-Physician Medical Practitioner	None	1356331573	0	0	GABRIELSON, MARY J 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	117 OXFORD DR	None	MORAGA	CA	94556	1721	00	06000	37.82096741	-122.1240444	Contra Costa County
300315	Non-Physician Medical Practitioner	None	1841321817	0	0	GRECO, PATRICIA M NP	7/3/2019	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
300344	Non-Physician Medical Practitioner	None	1053757922	0	0	GRAFF, JENNIFER L NP	8/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	846 BOND PL	None	WINDSOR	CA	95492	8850	00	06000	38.55379466	-122.8060829	Sonoma County
300357	Non-Physician Medical Practitioner	None	1609445014	0	0	GRAYDON, CASSIE	10/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	150 W. WASHINGTON STREET	None	SAN DIEGO	CA	92103	2005	00	06000	32.74999225	-117.1647027	San Diego County
300363	Non-Physician Medical Practitioner	None	1790337079	0	0	GAROL, ALEXA PA	6/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
300369	Non-Physician Medical Practitioner	None	1558634337	0	0	GRAHAM, MEREDITH CATHERINE	4/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
300417	Non-Physician Medical Practitioner	None	1922552819	0	0	GRANILLO, TERRI A PA	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6756 COLOMA WY	None	RIVERSIDE	CA	92509	1437	00	06000	34.01523219	-117.4273027	Riverside County
300431	Non-Physician Medical Practitioner	None	1023161684	0	0	GONZALEZ, ENRIQUE JOSE	9/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4755 CESAR CHAVEZ AVE #A	None	LOS ANGELES	CA	90022	1200	00	06000	34.0406247	-118.1628543	Los Angeles County
300439	Non-Physician Medical Practitioner	None	1972179711	0	0	GALANG, MARPHYROSE D NP	11/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	06000	36.143271	-115.1254975	Clark County
300447	Non-Physician Medical Practitioner	None	1326046848	0	0	GARLICK, KATHY 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	888 LAKESIDE VLG COMMONS	None	CHICO	CA	95928	3979	00	06000	39.750084	-121.7934327	Butte County
300451	Non-Physician Medical Practitioner	None	1275799066	0	0	GARCIA, MARTHA CECILIA	3/13/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5015 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3116	00	06000	34.02129255	-118.1613094	Los Angeles County
300462	Non-Physician Medical Practitioner	None	1700035896	0	0	GRIFFIN, AMANDA C	8/25/2024	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
300470	Non-Physician Medical Practitioner	None	1184984759	0	0	GARCIA, RYAN L	10/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34491 SALINAS PLACE	None	FREMONT	CA	94555	3309	00	06000	37.5701448	-122.0440148	Alameda County
300473	Non-Physician Medical Practitioner	None	1124064548	0	0	GRANT, JED DONALD	1/27/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8764 SHARMEAD WAY	None	FAIR OAKS	CA	95628	6338	00	06000	38.647152	-121.231755	Sacramento County
300477	Non-Physician Medical Practitioner	None	1578226783	0	0	GRAY, SAKINAH 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	1700 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	5608	00	06000	34.05159882	-118.4385447	Los Angeles County
300525	Non-Physician Medical Practitioner	None	1124195995	0	0	GOODSPEED, BRENT E	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	618 WEATHERSTONE WAY	None	SAN MARCOS	CA	92078	1095	00	06000	33.09826128	-117.1779296	San Diego County
300532	Non-Physician Medical Practitioner	None	1427426618	0	0	GHEORGHIU, VLAD NP	7/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
300537	Non-Physician Medical Practitioner	None	1912280421	0	0	GILL, PARDIP KAUR NP	12/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	57475 29 PALMS HWY	SUITE 101	YUCCA VALLEY	CA	92284	2906	00	06000	34.1245864	-116.4103407	San Bernardino County
300539	Non-Physician Medical Practitioner	None	1457739021	0	0	GAVRANICH, MADELINE A NP	2/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	206 44TH ST	None	MANHATTAN BEACH	CA	90266	3013	00	06000	33.90504146	-118.4207069	Los Angeles County
300589	Non-Physician Medical Practitioner	None	1831717982	0	0	GOPSILL, SARA NP	6/29/2024	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
300590	Non-Physician Medical Practitioner	None	1235246083	0	0	GUZMAN, MARIA D	10/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	927 ROSEWOOD DR	None	SAN MATEO	CA	94401	4214	00	06000	37.56087665	-122.3179752	San Mateo County
300652	Non-Physician Medical Practitioner	None	1265466635	0	0	GRAY, JENNIFER ANDRO	4/29/2004	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
300700	Non-Physician Medical Practitioner	None	1811390370	0	0	GUTOWSKI, ANDREW	3/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1874 ERIE ST	None	SAN DIEGO	CA	92110	3509	00	06000	32.7798222	-117.2037857	San Diego County
300704	Non-Physician Medical Practitioner	None	1629727219	0	0	GOODGION, DOUGLAS PA-C	8/30/2022	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
300712	Non-Physician Medical Practitioner	None	1225072390	0	0	GOFF, JEANINE L NP	9/15/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	295 N OAKBANK DR	None	GLENDORA	CA	91741	1807	00	06000	34.13967482	-117.8834855	Los Angeles County
300734	Non-Physician Medical Practitioner	None	1659730778	0	0	GARCIA, TEDAYSHIA NP	7/30/2019	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
300793	Non-Physician Medical Practitioner	None	1871865972	0	0	GEORGE, TOBIAS J	11/27/2024	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
300808	Non-Physician Medical Practitioner	None	1568592574	0	0	GRIMMETT, MELODY 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	23834 BOX CANYON RD	None	WEST HILLS	CA	91304	1203	00	06000	34.23887764	-118.6462901	Los Angeles County
300826	Non-Physician Medical Practitioner	None	1760752596	0	0	GHODSIAN, ANAHITA	6/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 VETERAN AVE	None	LOS ANGELES	CA	90025	5709	00	06000	34.04644474	-118.4380521	Los Angeles County
300829	Non-Physician Medical Practitioner	None	1053329029	0	0	GUADRON-HERNANDEZ, LILIANA E	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	29261 N LAS PALMAS CT	None	VALENCIA	CA	91354	1544	00	06000	34.46956744	-118.5653253	Los Angeles County
300858	Non-Physician Medical Practitioner	None	1518743343	0	0	GALASSI, ADRIAN	12/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
300871	Non-Physician Medical Practitioner	None	1811461106	0	0	GONZALEZ, LARISSA M 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	705 W. LA VETA AVE	SUITE 111	ORANGE	CA	92868	4447	00	06000	33.78062272	-117.8600738	Orange County
300884	Non-Physician Medical Practitioner	None	1497996953	0	0	GROODE, TAMRA L NP	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	614 ALMA AVE	None	OAKLAND	CA	94610	3806	00	06000	37.80432121	-122.2389066	Alameda County
300889	Non-Physician Medical Practitioner	None	1457634008	0	0	GIBSON, ROBERT N	3/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20732 HUNTER LANE	None	HUNTINGTON BEACH	CA	92646	6412	00	06000	33.66148064	-117.9601727	Orange County
300942	Non-Physician Medical Practitioner	None	1841664000	0	0	GREGG, DANIELLE M 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	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
300968	Non-Physician Medical Practitioner	None	1639587579	0	0	GENTRY, JULIE C 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	212 BEECH AVE	None	GREENFIELD	CA	93927	5348	00	06000	36.33180096	-121.2298259	Monterey County
301001	Non-Physician Medical Practitioner	None	1578090254	0	0	GERBER, JEREMY M	8/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11852 MOUNT VERNON AVE	APT 679	GRAND TERRACE	CA	92313	8330	00	06000	34.038036	-117.316332	San Bernardino County
301013	Non-Physician Medical Practitioner	None	1780134882	0	0	GOUNDER, KARISHMA CNP	2/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3814 AUBURN BLVD	SUITE 72	SACRAMENTO	CA	95821	2123	00	06000	38.639034	-121.375305	Sacramento County
301049	Non-Physician Medical Practitioner	None	1437611191	0	0	GALOYO, RUBIE NP	2/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 MUNZER ST	STE C	SHAFTER	CA	93263	2042	00	06000	35.50077392	-119.2765035	Kern County
301101	Non-Physician Medical Practitioner	None	1982344651	0	0	GURU, AMREEN 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	1600 CREEKSIDE DR	STE 2400	FOLSOM	CA	95630	3485	00	06000	38.669994	-121.147488	Sacramento County
301131	Non-Physician Medical Practitioner	None	1811662588	0	0	GOODWIN, JOY K PA-C	9/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22840 SOLEDAD CANYON RD	None	SAUGUS	CA	93510	2630	00	06000	34.4217426	-118.5364625	Los Angeles County
301135	Non-Physician Medical Practitioner	None	1447984752	0	0	GONCALVES, KASSIE	4/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
301153	Non-Physician Medical Practitioner	None	1902264021	0	0	GONZALEZ, BRIANA T	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	138 MOSS AVE	None	OAKLAND	CA	94611	5427	00	06000	37.82125729	-122.254087	Alameda County
301194	Non-Physician Medical Practitioner	None	1689697278	0	0	GONZALEZ, JESUS	9/19/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14906 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	3409	00	06000	33.8979564	-118.1600565	Los Angeles County
301198	Non-Physician Medical Practitioner	None	1558312108	0	0	GROBLEWSKI, JOHN P	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	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	00	06000	34.06891181	-118.2638033	Los Angeles County
301201	Non-Physician Medical Practitioner	None	1376691295	0	0	GASKINS, DEBORAH J	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	1842 KNOXVILLE AVE	None	LONG BEACH	CA	90815	3437	00	06000	33.78988101	-118.1041901	Los Angeles County
301232	Non-Physician Medical Practitioner	None	1336900372	0	0	GATELY, JESSICA NP	9/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2333 FOOTHILL BLVD	None	LA VERNE	CA	91750	3027	00	06000	34.11220804	-117.7613999	Los Angeles County
301256	Non-Physician Medical Practitioner	None	1073766101	0	0	GAUTHIER, ANTHONY R	8/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6009 BRIERCREST AVENUE	None	LAKEWOOD	CA	90713	1017	00	06000	33.8639961	-118.1231352	Los Angeles County
301264	Non-Physician Medical Practitioner	None	1730351669	0	0	GREEN, RUTH S	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	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
301280	Non-Physician Medical Practitioner	None	1891176434	0	0	GUSTAFSON, MELISSA S NP	7/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1219 EDGEWOOD ROAD	None	REDWOOD CITY	CA	94062	2728	00	06000	37.482488	-122.2561567	San Mateo County
301313	Non-Physician Medical Practitioner	None	1376050823	0	0	GIOVANELLI, ANDREA R	5/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 DERBY AVE	UNIT 405	OAKLAND	CA	94601	2866	00	06000	37.77183001	-122.2318176	Alameda County
301364	Non-Physician Medical Practitioner	None	1275995607	0	0	GILLESPIE, CRYSTAL R PA-C	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10174 MASON AVE	None	CHATSWORTH	CA	91311	3301	00	06000	34.255611	-118.5798115	Los Angeles County
301366	Non-Physician Medical Practitioner	None	1922249077	0	0	GOLDEN VALLEY HEALTH CENTERS	6/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 W. MAIN ST	None	TURLOCK	CA	95380	3411	00	06000	37.4926695	-120.862917	Stanislaus County
301367	Non-Physician Medical Practitioner	None	1700284486	0	0	GOURLEY, CHERYL R	6/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	115 POST STREET	None	LIBBY	MT	59923	1200	00	06000	48.398706	-115.540641	Lincoln County
301370	Non-Physician Medical Practitioner	None	1962805408	0	0	GARRETT, SARAH A PA	4/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.85429563	-117.8166478	Orange County
301373	Non-Physician Medical Practitioner	None	1689435430	0	0	GRAVES, ANNA PA-C	11/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2375 S MELROSE DR	None	VISTA	CA	92081	8788	00	06000	33.14409946	-117.2417711	San Diego County
301446	Non-Physician Medical Practitioner	None	1508371873	0	0	GOVIND, PRATIK S PA-C	7/16/2020	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
301488	Non-Physician Medical Practitioner	None	1215171905	0	0	GUEVARA, LISSETTE V NP	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	1616 FAIR OAKS AVE	APT 2	SOUTH PASADENA	CA	91030	4733	00	06000	34.10694	-118.1503025	Los Angeles County
301496	Non-Physician Medical Practitioner	None	1003015413	0	0	GOODFRIEND-REANO, EVA L	8/16/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2216 MCGEE AVE	None	BERKELEY	CA	94703	1632	00	06000	37.86765926	-122.2771927	Alameda County
301521	Non-Physician Medical Practitioner	None	1477665602	0	0	GHOSH, RAE-LYNN MICHELLE	1/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 WEST FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
301560	Non-Physician Medical Practitioner	None	1043310295	0	0	GOODHUE, CATHERINE JOY	1/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	MS #90	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
301602	Non-Physician Medical Practitioner	None	1528096070	0	0	GRIFFIN-VALERI, JENNIFER	8/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
301624	Non-Physician Medical Practitioner	None	1780790782	0	0	GRISMORE, LYNN SOARES	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	7373 WEST LN	OB/GYN B	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
301629	Non-Physician Medical Practitioner	None	1336692813	0	0	GANSBERG, TRACI N NP	12/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	27193 N POE VALLEY	None	KLAMATH FALLS	OR	97603	2636	00	06000	42.1609693	-121.4580436	Klamath County
301639	Non-Physician Medical Practitioner	None	1619584232	0	0	GRABOWSKI, FELICIA H NP	10/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	00	06000	36.98191238	-121.9975767	Santa Cruz County
301642	Non-Physician Medical Practitioner	None	1154409654	0	0	GARRISON, ROSE A	3/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3063 CRAPE MYRTLE CIR	None	CHINO HILLS	CA	91709	4236	00	06000	33.96606634	-117.7374778	San Bernardino County
301704	Non-Physician Medical Practitioner	None	1548739295	0	0	GABAY, RUTH NP	9/17/2024	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
301715	Non-Physician Medical Practitioner	None	1780935445	0	0	GRANDINETTE, BRITANIE A	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3351 DUCKHORN DR	APT 1222	SACRAMENTO	CA	95834	2637	00	06000	38.628585	-121.523697	Sacramento County
301756	Non-Physician Medical Practitioner	None	1467096149	0	0	GRIFFIN, BRITTANY PA-C	12/27/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	208 CONCOURSE BLVD	STE 1	SANTA ROSA	CA	95403	8120	00	06000	38.51255309	-122.7884839	Sonoma County
301758	Non-Physician Medical Practitioner	None	1144920612	0	0	GONZALEZ, DANIEL PA-C	6/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 E BONITA AVE	BLDG 9	POMONA	CA	91767	1923	00	06000	34.097913	-117.7474635	Los Angeles County
301774	Non-Physician Medical Practitioner	None	1548918840	0	0	GOMEZ, ALLYSON NP	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	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
301787	Non-Physician Medical Practitioner	None	1699265678	0	0	GARCIA, GENEVIEVE I PA	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
301824	Non-Physician Medical Practitioner	None	1245506526	0	0	GRAY, JONELLE B NP	6/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25105 GLASGOW DR	None	STEVENSON RNH	CA	91381	1720	00	06000	34.38358983	-118.5772656	Los Angeles County
301836	Non-Physician Medical Practitioner	None	1750642013	0	0	GUAN, BIN	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	4635 FREEPORT BLVD	STE. D	SACRAMENTO	CA	95822	0000	00	06000	38.532735	-121.494069	Sacramento County
301851	Non-Physician Medical Practitioner	None	1659135614	0	0	GONZALEZ-GOMEZ, DANIEL	2/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
301865	Non-Physician Medical Practitioner	None	1306220405	0	0	GONZALEZ, KATHERINE J K NP	8/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11359 N VIA MILANO WAY	None	FRESNO	CA	93730	8829	00	06000	36.90045485	-119.7551455	Fresno County
301876	Non-Physician Medical Practitioner	None	1184049793	0	0	GREATER FRESNO HEALTH ORGANIZATION	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	4011 N MARKS AVE	None	FRESNO	CA	93722	4555	00	06000	36.794691	-119.8443365	Fresno County
301883	Non-Physician Medical Practitioner	None	1215487780	0	0	GARZA, DIANA E 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
301890	Non-Physician Medical Practitioner	None	1891029492	0	0	GERSH, ANDREA NP	2/6/2020	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
301908	Non-Physician Medical Practitioner	None	1548329865	0	0	GUSLIKOV, ELENA NP	1/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3171 GRIZZLEY BAY	None	WEST SACRAMENTO	CA	95691	5825	00	06000	38.5379759	-121.5629985	Yolo County
301954	Non-Physician Medical Practitioner	None	1942678263	0	0	GOMONIT, CONSUELO NP	1/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8215 VAN NUYS BLVD	SUITE 210-204	PANORAMA CITY	CA	91402	4833	00	06000	34.22026244	-118.4488066	Los Angeles County
301957	Non-Physician Medical Practitioner	None	1417103581	0	0	GIRARD, ANNE MARIE K	8/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2250 COOLEY PL	None	PASADENA	CA	91104	4419	00	06000	34.16333349	-118.103832	Los Angeles County
301961	Non-Physician Medical Practitioner	None	1689897902	0	0	GORE, THEODORA	10/6/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3633 MLK,JR BLVD SUITE #	None	LYNWOOD	CA	90262	0000	00	06000	33.93010498	-118.2018728	Los Angeles County
301969	Non-Physician Medical Practitioner	None	1942245972	0	0	GREENBERG, DAVID H	4/20/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	444 E HUNTINGTON DR	SUITE 300	ARCADIA	CA	91006	6203	00	06000	34.14015049	-118.021113	Los Angeles County
301979	Non-Physician Medical Practitioner	None	1396016093	0	0	GERLACH, MARIE E	10/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21041 MONISHA	None	LAKE FOREST	CA	92630	6425	00	06000	33.65752709	-117.6767114	Orange County
302002	Non-Physician Medical Practitioner	None	1417961228	0	0	GAINES-DILLARD, NANCY L NP	3/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2047 EAST STEPHENS PLACE	None	CHANDLER	AZ	85225	8270	00	06000	33.309882	-111.8060325	Maricopa County
302004	Non-Physician Medical Practitioner	None	1215276720	0	0	GRIFFEN, SHARI K	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	5351 SAN VICENTE BLVD AP	None	LOS ANGELES	CA	90019	2727	00	06000	34.05322053	-118.352181	Los Angeles County
302010	Non-Physician Medical Practitioner	None	1831599752	0	0	GALLI, KOKOE PA	9/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
302045	Non-Physician Medical Practitioner	None	1538768221	0	0	GUARNEROS, JUDITH NP	11/3/2022	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
302062	Non-Physician Medical Practitioner	None	1144906579	0	0	GEYER, BROOKE	10/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 MERCY AVENUE	None	MERCED	CA	95340	8319	00	06000	37.33875148	-120.467457	Merced County
302095	Non-Physician Medical Practitioner	None	1205976180	0	0	GOLDEN, SHERI L PA	3/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	00	06000	37.925712	-122.021856	Contra Costa County
302110	Non-Physician Medical Practitioner	None	1194488114	0	0	GARGANO, NICOLE E NP	3/6/2023	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
302129	Non-Physician Medical Practitioner	None	1205229804	0	0	GARCIA, JENNIFER M	5/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1548 NOB HILL DRIVE	None	ESCONDIDO	CA	92026	2005	00	06000	33.14555932	-117.0872917	San Diego County
302132	Non-Physician Medical Practitioner	None	1245947183	0	0	GREEN, TIFFANY 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	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	00	06000	34.13396893	-118.1528162	Los Angeles County
302203	Non-Physician Medical Practitioner	None	1578031761	0	0	GUILLEN, CATHERINE	2/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3109 VIA BREVE	None	MONTEBELLO	CA	90640	2204	00	06000	34.02598251	-118.1369282	Los Angeles County
302233	Non-Physician Medical Practitioner	None	1104998541	0	0	GRANT-ACQUAH, JULIE N.	11/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	SUITE 560	LA JOLLA	CA	92037	1224	00	06000	32.882913	-117.226341	San Diego County
302239	Non-Physician Medical Practitioner	None	1770244550	0	0	GEOLINA, TARYN M NP	3/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	00	06000	32.80027449	-117.153846	San Diego County
302256	Non-Physician Medical Practitioner	None	1164930640	0	0	GAMBETTI, ALICIA N NP	5/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2161 GILL DR	None	CONCORD	CA	94520	2232	00	06000	37.98348375	-122.038402	Contra Costa County
302264	Non-Physician Medical Practitioner	None	1346679149	0	0	GEORGIEVA, DILYANA T NP	12/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2169 BENTON STREET	None	SANTA CLARA	CA	95050	4541	00	06000	37.34633486	-121.9615799	Santa Clara County
302296	Non-Physician Medical Practitioner	None	1750391348	0	0	GUERRERO, BRENDA M	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	16035 CAMINITO AIRE PURO	None	SAN DIEGO	CA	92128	3557	00	06000	33.00478857	-117.0646598	San Diego County
302328	Non-Physician Medical Practitioner	None	1750329009	0	0	GREY, GARRY	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	2116 GREENHORN CREEK CIR	None	PLUMAS LAKE	CA	95961	9044	00	06000	39.01562902	-121.5538989	Yuba County
302329	Non-Physician Medical Practitioner	None	1477216117	0	0	GRANNEMAN, NATASHA J PA-C	2/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29995 TECHNOLOGY	202	MURRIETA	CA	92563	2632	00	06000	33.56041691	-117.1370428	Riverside County
302346	Non-Physician Medical Practitioner	None	1205832763	0	0	GARCIA, PETER JOHN	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	7014 N WHITNEY AVE	STE A	FRESNO	CA	93720	0155	00	06000	36.83834474	-119.7423213	Fresno County
302351	Non-Physician Medical Practitioner	None	1003459850	0	0	GILLETT, JASMINE PA-C	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	200 MEDICAL PLAZA	STE B265	LOS ANGELES	CA	90024	0000	00	06000	34.06527974	-118.4462792	Los Angeles County
302352	Non-Physician Medical Practitioner	None	1144500398	0	0	GRUWELL, HOLLY M NP	1/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
302356	Non-Physician Medical Practitioner	None	1306878533	0	0	GREEN, GEOFFREY RILEY	10/21/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 WEST STEWART DRIVE	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
302385	Non-Physician Medical Practitioner	None	1003448010	0	0	GO LEGASPI, JOY L NP	3/9/2022	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
302398	Non-Physician Medical Practitioner	None	1578075867	0	0	GILBERT, LISA NP	2/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17957 SALMONBERRY WAY	None	SAN BERNARDINO	CA	92407	0451	00	06000	34.18198684	-117.4147729	San Bernardino County
302399	Non-Physician Medical Practitioner	None	1881621167	0	0	GRUND-EPLEY, KATHLEEN PATRICIA	4/29/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2377 S 22ND DR	None	YUMA	AZ	85364	8865	00	06000	32.6844	-114.6468735	Yuma County
302421	Non-Physician Medical Practitioner	None	1407064314	0	0	GOODMAN, LINDA	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
302430	Non-Physician Medical Practitioner	None	1598056392	0	0	GRINDLE, SILVIA SUSANA	9/9/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13525 MIDLAND RD	SUITE F	POWAY	CA	92064	4771	00	06000	32.96071787	-117.0362705	San Diego County
302438	Non-Physician Medical Practitioner	None	1215921333	0	0	GLEASON, COLLEEN M	8/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5319 W HILLSDALE AVE	None	VISALIA	CA	93291	5118	00	06000	36.329139	-119.3500755	Tulare County
302494	Non-Physician Medical Practitioner	None	1386163236	0	0	GEORGIS, MARTHA PA-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	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
302501	Non-Physician Medical Practitioner	None	1174972707	0	0	GOKHALE, ANJANA 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	761 BLUE SAGE DR	None	SUNNYVALE	CA	94086	6515	00	06000	37.36808182	-122.01635	Santa Clara County
302541	Non-Physician Medical Practitioner	None	1356430532	0	0	GREENE, MICHAEL D	11/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	70305 MOTTLE CIRCLE	None	RANCHO MIRAGE	CA	92270	2441	00	06000	33.77715188	-116.4357871	Riverside County
302549	Non-Physician Medical Practitioner	None	1659646792	0	0	GINGER, KRISTEN S 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	424 ALYSSUM WAY	None	OCEANSIDE	CA	92057	8561	00	06000	33.21864365	-117.3079821	San Diego County
302560	Non-Physician Medical Practitioner	None	1093219321	0	0	GALHOTRA, ANITA NP	4/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2644 RAINIER CT	None	UNION CITY	CA	94587	4923	00	06000	37.58234026	-122.0275962	Alameda County
302568	Non-Physician Medical Practitioner	None	1316555030	0	0	GIANNELLA, SARAH NP	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	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
302575	Non-Physician Medical Practitioner	None	1043869738	0	0	GRAVES, SHELLIE D NP	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	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
302599	Non-Physician Medical Practitioner	None	1336323153	0	0	GOEKEN, CAROL A NP	6/8/2018	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	SUITE 370	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
302619	Non-Physician Medical Practitioner	None	1205137189	0	0	GLENOAKS IMAGING PROFESSIONALS INC	2/22/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1731 W GLENOAKS BLVD	SUITE 101 & SUITE 102	GLENDALE	CA	91201	1599	00	06000	34.17201073	-118.2907193	Los Angeles County
302620	Non-Physician Medical Practitioner	None	1487963674	0	0	GALVAN, VERONICA M	8/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	562 JOYCE COURT	None	WATSONVILLE	CA	95076	3354	00	06000	36.92463436	-121.7416817	Santa Cruz County
302644	Non-Physician Medical Practitioner	None	1427633205	0	0	GARNER, JESSICA NP	5/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8330 RED OAK ST	201	RANCHO CUCAMONGA	CA	91730	0602	00	06000	34.10217525	-117.5693231	San Bernardino County
302658	Non-Physician Medical Practitioner	None	1083650212	0	0	GOMEZ, MILAGROS A PA	2/25/2020	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
302660	Non-Physician Medical Practitioner	None	1659867489	0	0	GOLDSTEIN, MITCHELL M NP	11/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28744 JARDINERAS DRIVE	None	SANTA CLARITA	CA	91354	3097	00	06000	34.45995658	-118.5626778	Los Angeles County
302687	Non-Physician Medical Practitioner	None	1457733966	0	0	GOYA, MARK T PA	10/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	00	06000	34.55800153	-118.0488825	Los Angeles County
302702	Non-Physician Medical Practitioner	None	1326417536	0	0	GEORGE, CLARA M NP	11/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	690 30TH AVENUE	None	SAN MATEO	CA	94403	3266	00	06000	37.5337307	-122.3162831	San Mateo County
302721	Non-Physician Medical Practitioner	None	1043777832	0	0	GAISSERT, CATHERINE PA	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	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
302731	Non-Physician Medical Practitioner	None	1881746196	0	0	GUILLEN, ROBERTO C	3/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18812 SALT LAKE PLACE	None	NORTHRIDGE	CA	91326	2433	00	06000	34.27052594	-118.5436744	Los Angeles County
302733	Non-Physician Medical Practitioner	None	1831560721	0	0	GIN, KIMBERLY A	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	580 W MAIN ST	APT 222	ALHAMBRA	CA	91801	3370	00	06000	34.09237113	-118.132749	Los Angeles County
302740	Non-Physician Medical Practitioner	None	1467103689	0	0	GONZALEZ, ERIKA M NP	6/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	00	06000	38.664027	-121.7933505	Yolo County
302751	Non-Physician Medical Practitioner	None	1861550071	0	0	GUTIERREZ, LAURA M	7/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2910 TILDEN DR	None	ROSEVILLE	CA	95661	7925	00	06000	38.73358346	-121.2334455	Placer County
302760	Non-Physician Medical Practitioner	None	1750039624	0	0	GROSSMAN, TAYLOR Y PA-C	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	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	00	06000	34.27904453	-118.459944	Los Angeles County
302765	Non-Physician Medical Practitioner	None	1356811343	0	0	GALANG, ERIKA PA-C	2/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
302798	Non-Physician Medical Practitioner	None	1508345430	0	0	GERRISH, HEATHER PA-C	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	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	00	06000	36.74333844	-119.7831874	Fresno County
302800	Non-Physician Medical Practitioner	None	1861701666	0	0	GERAGHTY, KRISTEN MARIE	1/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	UCLA MEDL CNTR ONCOLOGY	BOX 956956, STE 120, 200	LOS ANGELES	CA	90095	6956	00	06000	34.06531814	-118.44621	Los Angeles County
302814	Non-Physician Medical Practitioner	None	1386987204	0	0	GOOD, CHRISTOPHER S PA-C	10/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 BUTTE STREET	None	REDDING	CA	96001	0852	00	06000	40.5853603	-122.3869865	Shasta County
302815	Non-Physician Medical Practitioner	None	1851374466	0	0	GILBOY, JOSEPH E	7/3/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	00	06000	33.6617581	-117.7736362	Orange County
302855	Non-Physician Medical Practitioner	None	1760837314	0	0	GALURA, FRANCIS E PA	5/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
302876	Non-Physician Medical Practitioner	None	1326203373	0	0	GEORGIS, TRACY NP	1/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3816 WOODRUFF AVE	STE 401	LONG BEACH	CA	90808	2146	00	06000	33.828102	-118.1165525	Los Angeles County
302929	Non-Physician Medical Practitioner	None	1306088646	0	0	GATEWOOD, DENISE V NP	6/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5012 HAYTER AVE	None	LAKEWOOD	CA	90712	3130	00	06000	33.84929759	-118.1460867	Los Angeles County
302933	Non-Physician Medical Practitioner	None	1962976019	0	0	GLOVER, ANDREA L NP	2/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12196 DUNLAP PLACE	None	CHINO	CA	91710	2330	00	06000	34.03186099	-117.6964354	San Bernardino County
302957	Non-Physician Medical Practitioner	None	1851806301	0	0	GREGOR, ADINA R NP	9/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5825 KANAN RD	B	AGOURA HILLS	CA	91301	1651	00	06000	34.15592291	-118.7563824	Los Angeles County
302972	Non-Physician Medical Practitioner	None	1154889327	0	0	GUEVARRA, ROSE-ANN PA	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1043 ELM AVENUE	104	LONG BEACH	CA	90813	3244	00	06000	33.779655	-118.1880065	Los Angeles County
303001	Non-Physician Medical Practitioner	None	1194832634	0	0	GILLIAN, JAMES K	2/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1225 HERMES AVE	None	ENCINITAS	CA	92024	1609	00	06000	33.07032027	-117.3019118	San Diego County
303016	Non-Physician Medical Practitioner	None	1710052857	0	0	GARRETT, FLORENCE	5/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6387	00	06000	37.36777579	-122.0276404	Santa Clara County
303055	Non-Physician Medical Practitioner	None	1790131407	0	0	GJURGEVICH, ANA M NP	5/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	923 ALTA VISTA DR	None	ALTADENA	CA	91001	1736	00	06000	34.19589388	-118.130563	Los Angeles County
303066	Non-Physician Medical Practitioner	None	1801019062	0	0	GUPTA-BUDHWANI, UPASNA	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	3230 ROBERTS AVE	None	CULVER CITY	CA	90232	7417	00	06000	34.02892109	-118.377401	Los Angeles County
303115	Non-Physician Medical Practitioner	None	1134278914	0	0	GENTRY, REBECCA S NP	12/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	524 GRANITE HLS	None	SIMI VALLEY	CA	93065	0009	00	06000	34.23016727	-118.8094036	Ventura County
303129	Non-Physician Medical Practitioner	None	1649937707	0	0	GEVORGYAN, SEDA PA	2/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1131 W 6TH ST	250	ONTARIO	CA	91762	1108	00	06000	34.084404	-117.6717015	San Bernardino County
303138	Non-Physician Medical Practitioner	None	1336299973	0	0	GANZHORN, SUSAN	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	600 MAIN ST	None	SOLEDAD	CA	93960	2533	00	06000	36.43281182	-121.3243597	Monterey County
303164	Non-Physician Medical Practitioner	None	1184189201	0	0	GRYMCHAN, LINA PA-C	7/25/2019	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
303195	Non-Physician Medical Practitioner	None	1790864478	0	0	GRELL, YOLANDA Z	2/5/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1214 RADBARD ST	None	CARSON	CA	90746	1646	00	06000	33.87119611	-118.251151	Los Angeles County
303216	Non-Physician Medical Practitioner	None	1154672608	0	0	GALLEGO, MARIA J T NP	4/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9208 HALLMARK PLACE	None	VALLEJO	CA	94591	8597	00	06000	38.13411777	-122.2099821	Solano County
303237	Non-Physician Medical Practitioner	None	1053794776	0	0	GONZALEZ MARTINEZ, MONICA	10/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	260 HOLM RD	None	WATSONVILLE	CA	95076	2422	00	06000	36.92126674	-121.7885642	Santa Cruz County
303250	Non-Physician Medical Practitioner	None	1467781948	0	0	GOSSELIN, SUSAN M NP	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	2891 61ST STREET	None	SACRAMENTO	CA	95817	2521	00	06000	38.54772	-121.434003	Sacramento County
303252	Non-Physician Medical Practitioner	None	1073794152	0	0	GUARDADO, ESTHER	1/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S IDAHO ST	100	LA HABRA	CA	90631	0000	00	06000	33.927525	-117.959216	Orange County
303319	Non-Physician Medical Practitioner	None	1093962326	0	0	GASKINS, BENJAMIN T	8/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6604 KIMBERLY AVE	None	BAKERSFIELD	CA	93308	3917	00	06000	35.4101605	-119.076255	Kern County
303342	Non-Physician Medical Practitioner	None	1861874398	0	0	GHAUSSY, OLIVIA S NP	9/27/2017	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
303360	Non-Physician Medical Practitioner	None	1194246041	0	0	GREEN, KYLE P	4/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
303362	Non-Physician Medical Practitioner	None	1194208744	0	0	GUZMAN, ASHLEY B NP	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	974 W FOOTHILL BLVD	None	UPLAND	CA	91786	3728	00	06000	34.106562	-117.6651435	San Bernardino County
303404	Non-Physician Medical Practitioner	None	1942550132	0	0	GOODLIFFE, LORI F NP	6/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	560 COHASSET RD	None	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
303408	Non-Physician Medical Practitioner	None	1063602589	0	0	GISSLOW, PATRICK J	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	492 3RD AVE	None	SAN FRANCISCO	CA	94118	3207	00	06000	37.77949146	-122.4609192	San Francisco County
303446	Non-Physician Medical Practitioner	None	1477223212	0	0	GALE, MIANNA 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	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
303448	Non-Physician Medical Practitioner	None	1932550340	0	0	GILL, GURSHARAN K PA-C	1/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
303477	Non-Physician Medical Practitioner	None	1902538101	0	0	GUINVARCH, BRANDON	4/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	00	06000	36.66552031	-121.6439174	Monterey County
303483	Non-Physician Medical Practitioner	None	1902203359	0	0	GULAPA, ARCEL L 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	2325 LEGGETT LANE	None	FULLERTON	CA	92833	1557	00	06000	33.89576353	-117.9663857	Orange County
303486	Non-Physician Medical Practitioner	None	1467094953	0	0	GIANNI, MONICA T NP	1/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7291 BOULDER AVE	STE 2-C	HIGHLAND	CA	92346	6900	00	06000	34.12169346	-117.1953693	San Bernardino County
303549	Non-Physician Medical Practitioner	None	1184980674	0	0	GARZA, EDGAR PA-C	9/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24799 ALICIA PKWY	None	LAGUNA HILLS	CA	92653	4618	00	06000	33.60163541	-117.6914361	Orange County
303589	Non-Physician Medical Practitioner	None	1396364048	0	0	GIVERTZ, DESSERE H PA-C	5/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	00	06000	36.83626596	-119.7674879	Fresno County
303620	Non-Physician Medical Practitioner	None	1497993802	0	0	GUTALE, ILYAS A	12/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	8760 W PATRICK LANE	AOT 2034	LAS VEGAS	NV	89148	5310	00	06000	36.079614	-115.28271	Clark County
303655	Non-Physician Medical Practitioner	None	1144730151	0	0	GONZALEZ, LAUREN 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	7059 BERGAMOT AVENUE	None	MOORPARK	CA	93021	5066	00	06000	34.30110063	-118.8693356	Ventura County
303669	Non-Physician Medical Practitioner	None	1437624103	0	0	GARMENDIA, MANUEL A PA	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	525 EAST PLAZA DR	STE 304	SANTA MARIA	CA	93465	9747	00	06000	34.9373822	-120.4296004	Santa Barbara County
303670	Non-Physician Medical Practitioner	None	1881792984	0	0	GETTINGER, THERESA MARIE	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	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	00	06000	37.38946454	-122.0815711	Santa Clara County
303674	Non-Physician Medical Practitioner	None	1497406102	0	0	GOMEZ, ELMER	12/5/2024	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
303677	Non-Physician Medical Practitioner	None	1316287022	0	0	GARCIA, EDUARDO B JR NP	10/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12282 DAISY CT	None	RANCHO CUCAMONGA	CA	91739	1922	00	06000	34.13158001	-117.5347994	San Bernardino County
303698	Non-Physician Medical Practitioner	None	1083221568	0	0	GO, CHRISTOPHER NP	4/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
303732	Non-Physician Medical Practitioner	None	1043366644	0	0	GREENE, PARKER W	2/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3581 N EL DORADO DR	None	LONG BEACH	CA	90808	3208	00	06000	33.82204253	-118.0732803	Los Angeles County
303765	Non-Physician Medical Practitioner	None	1588329338	0	0	GOLCHEH, KIMIA PA-C	11/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
303796	Non-Physician Medical Practitioner	None	1902123912	0	0	GUTIERREZ, JOSEPH C PA	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	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	00	06000	33.9171603	-118.1288418	Los Angeles County
303801	Non-Physician Medical Practitioner	None	1871790725	0	0	GOOCH, SUDABEH	5/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	150 N ROBERTSON BLVD	304	BEVERLY HILLS	CA	90211	2142	00	06000	34.06812722	-118.3837146	Los Angeles County
303803	Non-Physician Medical Practitioner	None	1790108959	0	0	GRALIAN, MONICA L	5/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8100 DIERKS ROAD	None	SACRAMENTO	CA	95830	9326	00	06000	38.463597	-121.290786	Sacramento County
303865	Non-Physician Medical Practitioner	None	1710387436	0	0	GARRISON, CHRISTINE L NP	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	26670 LAKEVIEW DRIVE	None	HELENDALE	CA	92342	7805	00	06000	34.7398057	-117.357426	San Bernardino County
303879	Non-Physician Medical Practitioner	None	1932122082	0	0	GROSS, KAREN E NP	11/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2068 LENDEE DRIVE	None	ESCONDIDO	CA	92025	6350	00	06000	33.10865719	-117.0514847	San Diego County
303892	Non-Physician Medical Practitioner	None	1083776512	0	0	GEORGE, REKHA NP	6/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
303922	Non-Physician Medical Practitioner	None	1942201553	0	0	GRADY, HEATHER A PA	9/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.85429563	-117.8166478	Orange County
303924	Non-Physician Medical Practitioner	None	1447918743	0	0	GILTON, KATIE NP	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	00	06000	33.80318951	-118.066068	Orange County
303945	Non-Physician Medical Practitioner	None	1407927601	0	0	GRAHAM, THOMAS M	4/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1903 E FIR AVE	SUITE 101	FRESNO	CA	93720	3862	00	06000	36.83910853	-119.7480285	Fresno County
303949	Non-Physician Medical Practitioner	None	1578942330	0	0	GEORGE, SIMY T NP	3/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1064 REED AVE	APT 2	SUNNYVALE	CA	94086	8468	00	06000	37.36675151	-122.001606	Santa Clara County
303977	Non-Physician Medical Practitioner	None	1003012162	0	0	GAMBLE, DARCESEAN	10/30/2009	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 4	None	SHERMAN OAKS	CA	91403	1824	00	06000	34.160805	-118.4487295	Los Angeles County
303981	Non-Physician Medical Practitioner	None	1982760559	0	0	GUNTHER-MAHER, LAURA	2/25/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8580 WINDING WAY	None	FAIR OAKS	CA	95628	6237	00	06000	38.644344	-121.240332	Sacramento County
304037	Non-Physician Medical Practitioner	None	1851713432	0	0	GERLACH-WANNER, VIOLET A NP	4/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7100 ALVERN ST 202	None	WESTCHESTER	CA	90045	3814	00	06000	33.97467585	-118.3778068	Los Angeles County
304048	Non-Physician Medical Practitioner	None	1417352691	0	0	GALINDO, GUADALUPE NP	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	8905 ROCKAWAY BEACH CT	None	BAKERSFIELD	CA	93311	9665	00	06000	35.30040883	-119.1017757	Kern County
304050	Non-Physician Medical Practitioner	None	1558032946	0	0	GEHER, ROXANNA 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	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	00	06000	34.2202663	-119.1484221	Ventura County
304079	Non-Physician Medical Practitioner	None	1952332405	0	0	GRIFFIN, DONNA	2/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
304116	Non-Physician Medical Practitioner	None	1851558571	0	0	GRIFFINGER-GUIDI, ELISABETH CNM	3/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MILVIA ST.	None	BERKELEY	CA	94704	2636	00	06000	37.86338897	-122.2698455	Alameda County
304119	Non-Physician Medical Practitioner	None	1174811301	0	0	GUTIERREZ, GLORIA E NP	7/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	163 POINTE DRIVE	None	BREA	CA	92821	7636	00	06000	33.92767752	-117.8778871	Orange County
304180	Non-Physician Medical Practitioner	None	1083127922	0	0	GANDHI, ALMIRA J PA	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	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
304222	Non-Physician Medical Practitioner	None	1972522753	0	0	GALAN, VIRGINIA	9/9/2013	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	1501	SANTA MONICA	CA	90404	1135	00	06000	34.02648965	-118.4867439	Los Angeles County
304237	Non-Physician Medical Practitioner	None	1871068445	0	0	GALAVIZ, STEPHANIE 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	1000 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4639	00	06000	34.01070086	-118.1110129	Los Angeles County
304242	Non-Physician Medical Practitioner	None	1548428949	0	0	GALANOS, LINDA A 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	1184 SAN CARLOS DRIVE	None	SAN LUIS OBISPO	CA	93401	5375	00	06000	35.26980219	-120.6486798	San Luis Obispo County
304249	Non-Physician Medical Practitioner	None	1639270036	0	0	GLOVER, BEVERLY RENEE	3/9/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 SERENO DR	WOMEN'S HEALTH	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
304250	Non-Physician Medical Practitioner	None	1740575687	0	0	GARCIA, LUZ P PA-C	3/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18 FOURTH STREET	None	GONZALES	CA	93926	0808	00	06000	36.50698522	-121.4443339	Monterey County
304253	Non-Physician Medical Practitioner	None	1114239902	0	0	GOLDSTEIN-FUCHS, DEBRA J NP	7/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1485 E WILSON AVE	STE G	GLENDALE	CA	91206	3964	00	06000	34.14806647	-118.2318273	Los Angeles County
304289	Non-Physician Medical Practitioner	None	1881308823	0	0	GO, CAROLINE A NP	9/18/2023	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
304336	Non-Physician Medical Practitioner	None	1396036554	0	0	GOLDSTEIN, JILL SUZANNE	3/17/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 WEBSTER ST	#516	SAN FRANCISCO	CA	94115	2373	00	06000	37.7904826	-122.4324477	San Francisco County
304386	Non-Physician Medical Practitioner	None	1841608015	0	0	GOMEZ, EUNICE A NP	3/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
304396	Non-Physician Medical Practitioner	None	1477828150	0	0	GOROSPE, MARY G	4/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8624 ARCPS WAY	None	ELK GROVE	CA	95757	6338	00	06000	38.396286	-121.3844895	Sacramento County
304397	Non-Physician Medical Practitioner	None	1639673858	0	0	GARCIA, REGINA NP	2/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
304403	Non-Physician Medical Practitioner	None	1770774861	0	0	GABEL, CHRISTINA A CNM	2/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8832 ANCHORAGE DR	None	HUNTINGTON BEACH	CA	92646	3206	00	06000	33.67827975	-117.9741223	Orange County
304410	Non-Physician Medical Practitioner	None	1427523893	0	0	GARDNER, SARAH J PA-C	9/17/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH ST	100	OAKLAND	CA	94609	3422	00	06000	37.81892183	-122.2640154	Alameda County
304439	Non-Physician Medical Practitioner	None	1013225671	0	0	GIBSON, YICHING NP	3/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
304503	Non-Physician Medical Practitioner	None	1104371681	0	0	GARCIA, MARIALUISA NP	4/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11692 CENTRAL AVE	None	CHINO	CA	91710	1923	00	06000	34.0409475	-117.6896806	San Bernardino County
304536	Non-Physician Medical Practitioner	None	1710237011	0	0	GARRISON, CAITLIN G PA-C	4/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29833 SANTA MARGARITA PK	SUITE 100	RANCHO SANTA MARG	CA	92688	3619	00	06000	33.63792372	-117.6108629	Orange County
304537	Non-Physician Medical Practitioner	None	1740404557	0	0	GOMEZ, ELAINE M 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	2160 JEFFERSON STREET	260	NAPA	CA	94559	1253	00	06000	38.30647594	-122.2951788	Napa County
304544	Non-Physician Medical Practitioner	None	1225759806	0	0	GOMEZ, KATELYN G PA-C	6/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1662 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1816	00	06000	36.99033079	-121.9816507	Santa Cruz County
304560	Non-Physician Medical Practitioner	None	1528180742	0	0	GREENBERG, SVETLANA	2/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	00	06000	37.72851602	-122.4296638	San Francisco County
304614	Non-Physician Medical Practitioner	None	1275507592	0	0	GLINCOSKY, JEROME NORMAN	5/14/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	340 4TH AVE	SUITE 2	CHULA VISTA	CA	91910	3813	00	06000	32.63831293	-117.0833536	San Diego County
304624	Non-Physician Medical Practitioner	None	1184850612	0	0	GEORGE, JAYA	11/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 CORNERSTONE DR	None	EL DORADO	CA	95762	1310	00	06000	38.63035066	-121.0439262	El Dorado
304632	Non-Physician Medical Practitioner	None	1871232454	0	0	GONZALEZ, TERESA M NP	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	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
304635	Non-Physician Medical Practitioner	None	1225486251	0	0	GRANADOS, KENNETH PA	6/15/2020	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
304677	Non-Physician Medical Practitioner	None	1578960829	0	0	GORE, LEVI B NP	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2330 CABRILLO CIRCLE	None	LODI	CA	95243	3310	00	06000	38.12806146	-121.3040789	San Joaquin County
304678	Non-Physician Medical Practitioner	None	1144846734	0	0	GOTOWSKI, ALEXANDER M PA	7/31/2023	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
304696	Non-Physician Medical Practitioner	None	1750142741	0	0	GOLLOTT, RYAN PA-C	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	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	00	06000	38.463381	-121.416183	Sacramento County
304697	Non-Physician Medical Practitioner	None	1750932844	0	0	GILL, PARMPREET PA	10/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 COFFEE RD	None	MODESTO	CA	95355	2803	00	06000	37.668645	-120.9756715	Stanislaus County
304709	Non-Physician Medical Practitioner	None	1124565130	0	0	GHAZARIAN, TINA NP	7/31/2018	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
304745	Non-Physician Medical Practitioner	None	1992853899	0	0	GALLEGOS, DENISE E	2/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15128 CROSS STONE DRIVE	None	SAN DIEGO	CA	92127	4449	00	06000	33.0059738	-117.1122372	San Diego County
304776	Non-Physician Medical Practitioner	None	1437668043	0	0	GIBSON, CHRISTINA M NP	10/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
304777	Non-Physician Medical Practitioner	None	1972693000	0	0	GARCIA, CASSANDRA	9/13/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	254 N KESSING ST	None	PORTERVILLE	CA	93257	3424	00	06000	36.07048847	-119.025139	Tulare County
304790	Non-Physician Medical Practitioner	None	1124775614	0	0	GIRGIS, SANDRA DEE PA	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	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
304794	Non-Physician Medical Practitioner	None	1417283433	0	0	GHARAPETIAN, SEDA MARTYROSSIAN	5/8/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1030 S GLENDALE AVE	SUITE 407	GLENDALE	CA	91205	5612	00	06000	34.13381535	-118.2519184	Los Angeles County
304798	Non-Physician Medical Practitioner	None	1235879784	0	0	GOCHINGCO, KATHERINE A 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	833 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4735	00	06000	34.01035039	-118.109564	Los Angeles County
304817	Non-Physician Medical Practitioner	None	1487222881	0	0	GONZALEZ GARCIA, SILVIO	11/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	06000	33.786909	-112.129047	Maricopa County
304851	Non-Physician Medical Practitioner	None	1356833578	0	0	GONZALEZ, MICHAEL J PA-C	5/9/2022	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
304853	Non-Physician Medical Practitioner	None	1942843107	0	0	GONZALEZ, GRYSKA PA-C	1/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11190 WARNER AVE	SUITE 300	FOUNTAIN VALLEY	CA	92708	4019	00	06000	33.714	-117.9333585	Orange County
304854	Non-Physician Medical Practitioner	None	1497312045	0	0	GHALCHI, JASMINE	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	1414 S GRAND AVE STE 380	None	LOS ANGELES	CA	90015	3072	00	06000	34.03661142	-118.2657227	Los Angeles County
304864	Non-Physician Medical Practitioner	None	1639651995	0	0	GUIRGUIS, HAIDY S NP	7/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
304904	Non-Physician Medical Practitioner	None	1184210775	0	0	GORE, ASHIMA PA-C	5/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1887 MONTEREY RD	STE 200	SAN JOSE	CA	95112	6136	00	06000	37.308636	-121.8664102	Santa Clara County
304906	Non-Physician Medical Practitioner	None	1881290252	0	0	GUZMAN, EDWIN PA-C	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	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
304939	Non-Physician Medical Practitioner	None	1174703490	0	0	GRICE, DAX	3/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
304995	Non-Physician Medical Practitioner	None	1487388823	0	0	GEORGE, SHANNON M PA-C	11/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5725 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	4007	00	06000	37.688107	-121.8861427	Alameda County
305013	Non-Physician Medical Practitioner	None	1285720516	0	0	GEBHARDT, KATHERINE M	2/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4839 AUTRY AVE	None	LONG BEACH	CA	90808	1118	00	06000	33.84603	-118.127267	Los Angeles County
305021	Non-Physician Medical Practitioner	None	1073011193	0	0	GOMEZ, RACHEL NP	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1975 SHERINGTON PLACE	APT H109	NEWPORT BEACH	CA	92663	6063	00	06000	33.62595339	-117.9071018	Orange County
305024	Non-Physician Medical Practitioner	None	1477368231	0	0	GRAHAM, MADISON PA-C	2/25/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22 CORPORATE PLAZA DR	None	NEWPORT BEACH	CA	92660	7985	00	06000	33.607602	-117.876852	Orange County
305047	Non-Physician Medical Practitioner	None	1760592158	0	0	GROSSI, ANDREA N	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	2827 CATALINA DR	None	ROCKLIN	CA	95765	5165	00	06000	38.81912574	-121.2555912	Placer County
305067	Non-Physician Medical Practitioner	None	1255189908	0	0	GOVARDHAN, SPARSHA NP	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	1100 TRANCAS ST	270	NAPA	CA	94558	2900	00	06000	38.32316569	-122.2981938	Napa County
305079	Non-Physician Medical Practitioner	None	1518525187	0	0	GERBUTAVICIUS, AARON NP	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	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	00	06000	33.73793948	-118.3036095	Los Angeles County
305086	Non-Physician Medical Practitioner	None	1699041566	0	0	GARDNER FAMILY HEALTH NETWORK INC	5/18/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 E. SANTA CLARA STREE	None	SAN JOSE	CA	95112	1900	00	06000	37.34328626	-121.8756374	Santa Clara County
305150	Non-Physician Medical Practitioner	None	1043787930	0	0	GULETZ, HANNAH PA-C	3/26/2020	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
305165	Non-Physician Medical Practitioner	None	1477923076	0	0	GORDON, RITA CNM	3/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	00	06000	34.02726451	-118.4857138	Los Angeles County
305174	Non-Physician Medical Practitioner	None	1023894953	0	0	GENTILE, LAUREN PA-C	1/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	00	06000	34.088004	-117.893475	Los Angeles County
305199	Non-Physician Medical Practitioner	None	1093340424	0	0	GOSHTASBI, NUSHEEN PA	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	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
305211	Non-Physician Medical Practitioner	None	1326815341	0	0	GUAN, ANNIE NP	7/8/2024	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
305213	Non-Physician Medical Practitioner	None	1942740972	0	0	GONZALEZ, JENELLE V NP	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
305221	Non-Physician Medical Practitioner	None	1700260049	0	0	GEE, JOEY PA-C	7/6/2022	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
305237	Non-Physician Medical Practitioner	None	1083056469	0	0	GILPIN, JENNIFER A PA	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	5533 CLARK AVENUE	None	CARMICHAEL	CA	95608	4749	00	06000	38.615805	-121.3352775	Sacramento County
305284	Non-Physician Medical Practitioner	None	1043694201	0	0	GUYETT, KRISTIN A NP	9/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13215 EAST GETTSBURG	None	SANGER	CA	93657	9278	00	06000	36.80088721	-119.5506576	Fresno County
305312	Non-Physician Medical Practitioner	None	1023899069	0	0	GUZMAN-IBARRA, ALEJANDRA	9/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	770 MAGNOLIA BLVD	SUITE 2A	CORONA	CA	92879	3120	00	06000	33.85936872	-117.5534605	Riverside County
305313	Non-Physician Medical Practitioner	None	1801499231	0	0	GONZALEZ, ARTURO PA-C	6/17/2022	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
305329	Non-Physician Medical Practitioner	None	1972188910	0	0	GREISEN, JESSICA PA-C	1/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4001 J STREET	None	SACRAMENTO	CA	95819	3626	00	06000	38.570526	-121.4521695	Sacramento County
305339	Non-Physician Medical Practitioner	None	1770632614	0	0	GUEVARA, SUSAN CNM	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	1665 ESPLANADE	None	CHICO	CA	95926	3312	00	06000	39.74388808	-121.8503372	Butte County
305351	Non-Physician Medical Practitioner	None	1366951253	0	0	GLIDEWELL, KELSEY M PA	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	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
305358	Non-Physician Medical Practitioner	None	1720514466	0	0	GO, KYUNGSOO K	3/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2620 ASSOCIATED RD	APT A78	FULLERTON	CA	92835	3223	00	06000	33.89717487	-117.8840653	Orange County
305359	Non-Physician Medical Practitioner	None	1164857058	0	0	GUNN, VICTOR O	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4268 SERENA LN	None	CLOVIS	CA	93619	5071	00	06000	36.86546902	-119.631033	Fresno County
305391	Non-Physician Medical Practitioner	None	1427585868	0	0	GONZALEZ, SILVIA PA	6/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	00	06000	38.570076	-121.4657145	Sacramento County
305426	Non-Physician Medical Practitioner	None	1306020391	0	0	GOLDSTEIN, TRISTA	10/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH ST	SUITE 208	OAKLAND	CA	94609	3424	00	06000	37.81892183	-122.2640154	Alameda County
305445	Non-Physician Medical Practitioner	None	1831230861	0	0	GOLDEN, SUZANNE ELIZABETH	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	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	00	06000	37.78224789	-122.4412946	San Francisco County
305450	Non-Physician Medical Practitioner	None	1205196524	0	0	GEIGER, ERIN E PA	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	00	06000	38.463381	-121.416183	Sacramento County
305478	Non-Physician Medical Practitioner	None	1497043483	0	0	GONZALEZ, ALEX	8/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1160 SUNSET BLVD	None	ROCKLIN	CA	95765	3710	00	06000	38.8125	-121.2848698	Placer County
305485	Non-Physician Medical Practitioner	None	1760734784	0	0	GASTELUM, OSVELIA NP	4/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	564 CANYON DR	None	BONITA	CA	91902	4206	00	06000	32.65153657	-117.0042779	San Diego County
305519	Non-Physician Medical Practitioner	None	1871058156	0	0	GEORGE, FLORA PA	1/19/2021	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
305609	Non-Physician Medical Practitioner	None	1922254093	0	0	GORSHE, JULIE	7/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1119 PACIFIC AVE	None	SANTA CRUZ	CA	95060	7503	00	06000	36.9722444	-122.0256836	Santa Cruz County
305611	Non-Physician Medical Practitioner	None	1922190776	0	0	GUNTLI, KATHRYN C PA-C	4/20/2018	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
305612	Non-Physician Medical Practitioner	None	1235502162	0	0	GAIDADJIEV, TEODORA A PA	12/11/2019	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
305721	Non-Physician Medical Practitioner	None	1568953487	0	0	GILL, TRENIESE I NP	11/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18564 US HWY 18	104	APPLE VALLEY	CA	92307	2321	00	06000	34.53926652	-117.2592564	San Bernardino County
305723	Non-Physician Medical Practitioner	None	1003411059	0	0	GYABAAH, JOSEPH	3/19/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	00	06000	34.50503628	-117.3265137	San Bernardino County
305725	Non-Physician Medical Practitioner	None	1396240230	0	0	GIZZI, ERIN RN CPNP	9/25/2023	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
305751	Non-Physician Medical Practitioner	None	1053560342	0	0	GALVAN, REBECCA L	3/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	49 OVERPASS ROAD	None	WATSONVILLE	CA	95076	5554	00	06000	36.8727479	-121.7321344	Monterey County
305765	Non-Physician Medical Practitioner	None	1740567627	0	0	GARCIA, MICHAEL A	12/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	261 ALTA ST	None	BRENTWOOD	CA	94513	4270	00	06000	37.92191636	-121.6885166	Contra Costa County
305779	Non-Physician Medical Practitioner	None	1245929249	0	0	GRANT, DEBORAH PA	4/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	00	06000	34.50503628	-117.3265137	San Bernardino County
305796	Non-Physician Medical Practitioner	None	1699232801	0	0	GREGOR, MEGAN E NP	12/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
305798	Non-Physician Medical Practitioner	None	1255965828	0	0	GROSS, HANNAH E PA	4/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
305855	Non-Physician Medical Practitioner	None	1437226263	0	0	GARCIA, MELINDA S	11/14/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	746 CASNER WAY	None	BREA	CA	92821	2365	00	06000	33.93240334	-117.9077929	Orange County
305860	Non-Physician Medical Practitioner	None	1134436777	0	0	GLUSAC, REBECCA LEIGH	10/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	00	06000	34.41386476	-119.6993335	Santa Barbara County
305861	Non-Physician Medical Practitioner	None	1952559031	0	0	GOMEZ, MABEL A	10/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1162 APACHE COURT	None	GILROY	CA	95020	8110	00	06000	37.02931302	-121.6017727	Santa Clara County
305879	Non-Physician Medical Practitioner	None	1588944276	0	0	GALVAN, VIVIAN D NP	6/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24055 EUCALYPTUSE AVE	None	MORENO VALLEY	CA	92553	2832	00	06000	33.93174354	-117.242793	Riverside County
305898	Non-Physician Medical Practitioner	None	1295803963	0	0	GYOR, LORRAINE M 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	1624 ALBEMARLE WAY	None	BURLINGAME	CA	94010	4660	00	06000	37.59119818	-122.3795423	San Mateo County
305908	Non-Physician Medical Practitioner	None	1093473647	0	0	GREEN, TANNER J 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	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	00	06000	34.27904453	-118.459944	Los Angeles County
305911	Non-Physician Medical Practitioner	None	1083247175	0	0	GONZALEZ, BERNADETTE B PA-C	10/19/2020	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
305915	Non-Physician Medical Practitioner	None	1083335111	0	0	GONZALEZ, VICKI N NP	9/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
305929	Non-Physician Medical Practitioner	None	1437542883	0	0	GALVEZ, MELISSA D PA-C	3/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	832 S GREVILLEA AVE	None	INGLEWOOD	CA	90301	3312	00	06000	33.9529004	-118.3548473	Los Angeles County
305934	Non-Physician Medical Practitioner	None	1114342805	0	0	GAMAD, FIEL D NP	5/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2651 E SPICE WAY	None	FRESNO	CA	93720	4933	00	06000	36.85686436	-119.736029	Fresno County
305936	Non-Physician Medical Practitioner	None	1801557947	0	0	GULLY, MICHELLE	1/19/2024	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	SUITE 250	YORBA LINDA	CA	92886	4044	00	06000	33.88842824	-117.8154698	Orange County
305955	Non-Physician Medical Practitioner	None	1144450644	0	0	GALVEZ, KAREN	12/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305985	Non-Physician Medical Practitioner	None	1649496274	0	0	GREGORY, RICHARD J	6/19/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29039 HOLLOW OAK COURT	None	AGOURA HILLS	CA	91301	1623	00	06000	34.1630629	-118.7594385	Los Angeles County
305986	Non-Physician Medical Practitioner	None	1841054103	0	0	GUTIERREZ, JOANE PA-C	12/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 S. ANAHEIM BLVD	SUITE 250	ANAHEIM	CA	92805	9280	00	06000	33.83528856	-117.913627	Orange County
306014	Non-Physician Medical Practitioner	None	1447668918	0	0	GARCIA, DIANA M	10/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	836 LAUREL ST	None	FORT BRAGG	CA	95437	3817	00	06000	39.44544153	-123.7957695	Mendocino County
306015	Non-Physician Medical Practitioner	None	1508532946	0	0	GARCIA, MOLLY R PA	12/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
306018	Non-Physician Medical Practitioner	None	1598395709	0	0	GROSSHEIM, DUSTIN PA	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	44-419 TOWN CENTER WAY	STE E	PALM DESERT	CA	92260	7100	00	06000	33.72583102	-116.398368	Riverside County
306066	Non-Physician Medical Practitioner	None	1548568421	0	0	GOLDEN VALLEY HEALTH CENTER	11/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4150 PATTERSON RD	None	RIVERBANK	CA	95367	9536	00	06000	37.73262081	-120.9200969	Stanislaus County
306082	Non-Physician Medical Practitioner	None	1043464415	0	0	GOLINO, HILLARIE J PA	9/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	262 EVERETT AVE	None	PALO ALTO	CA	94301	1412	00	06000	37.44705401	-122.1645013	Santa Clara County
306106	Non-Physician Medical Practitioner	None	1487380275	0	0	GHEYBI, TATIANA PA-C	10/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 306	ORANGE	CA	92868	3838	00	06000	33.78236048	-117.8664975	Orange County
306109	Non-Physician Medical Practitioner	None	1003863432	0	0	GILMAN, RANDAL K	5/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1288 KENDRA LN	None	UPLAND	CA	91784	9269	00	06000	34.13152928	-117.6326432	San Bernardino County
306174	Non-Physician Medical Practitioner	None	1447619051	0	0	GRECHKO, ALEXANDRIA N	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2610 CATALINA DR	None	DAVIS	CA	95616	0263	00	06000	38.56585266	-121.7535336	Yolo County
306221	Non-Physician Medical Practitioner	None	1609885656	0	0	GREGA, DAVID S	12/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	00	06000	38.602089	-121.3925895	Sacramento County
306234	Non-Physician Medical Practitioner	None	1124098850	0	0	GEE, RENEE C NP	7/13/2004	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 2200	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
306289	Non-Physician Medical Practitioner	None	1942764097	0	0	GIRIUNAS, LEIGHANN M	2/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	365 HAWTHORNE AVENUE	SUITE 201	OAKLAND	CA	94609	3114	00	06000	37.82079728	-122.2633226	Alameda County
306293	Non-Physician Medical Practitioner	None	1568749471	0	0	GOLDSTEIN, ALLISON RACHEL	3/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
306331	Non-Physician Medical Practitioner	None	1023399557	0	0	GUNASEKARAN, MALARKODI NP	1/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 COFFEE RD	None	MODESTO	CA	95355	4201	00	06000	37.653219	-120.975542	Stanislaus County
306338	Non-Physician Medical Practitioner	None	1316007685	0	0	GEORGE, ADEPEJU BOLANLE	6/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8233 E STOCKTON BLVD STE	None	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
306359	Non-Physician Medical Practitioner	None	1538562327	0	0	GORDON, JOY A PA	10/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	00	06000	32.90618683	-117.1814064	San Diego County
306384	Non-Physician Medical Practitioner	None	1770912800	0	0	GEORGE, CHERYL L NP	6/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1925 NORD AVENUE	None	CHICO	CA	95926	3016	00	06000	39.73726769	-121.872133	Butte County
306403	Non-Physician Medical Practitioner	None	1649370446	0	0	GOMEZ, ELNORA C	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	7525 BOYD AVE	None	CORONA	CA	92881	4813	00	06000	33.82560286	-117.5276951	Riverside County
306425	Non-Physician Medical Practitioner	None	1538919279	0	0	GRAJALES, LIZETTE PA-C	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	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
306432	Non-Physician Medical Practitioner	None	1013304716	0	0	GOINGS, PATRICIA B NP	6/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1810 E CATALINA	None	SANTA ANA	CA	92705	7608	00	06000	33.76386441	-117.8416742	Orange County
306443	Non-Physician Medical Practitioner	None	1366189870	0	0	GUTIERREZ, ELENA R CNM	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	1505 SOQUEL DR	STE 1	SANTA CRUZ	CA	95065	1716	00	06000	36.98803429	-121.9848045	Santa Cruz County
306456	Non-Physician Medical Practitioner	None	1144319278	0	0	GAULT, JENNIFER M	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	3263 EVERGLADE AVE	None	CLOVIS	CA	93619	9586	00	06000	36.86489879	-119.6507842	Fresno County
306485	Non-Physician Medical Practitioner	None	1396715538	0	0	GINSBERG, SHARYN IRIS	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	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
306494	Non-Physician Medical Practitioner	None	1710769203	0	0	GOURKAR, RUTUJA 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	13372 NEWPORT AVE	STE B	TUSTIN	CA	92780	3426	00	06000	33.74482862	-117.8152129	Orange County
306498	Non-Physician Medical Practitioner	None	1043209018	0	0	GARZA, DAMIAN X	1/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	631 REENIE WAY	None	SAN ANTONIO	TX	78258	4939	00	06000	29.66492724	-98.48685465	Bexar County
306523	Non-Physician Medical Practitioner	None	1235457466	0	0	GIBBS, JOANNA L PA	12/23/2020	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
306550	Non-Physician Medical Practitioner	None	1114582681	0	0	GOMEZ, JESSICA L PA	12/2/2021	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
306551	Non-Physician Medical Practitioner	None	1346559317	0	0	GONZALES, BERNADETTE P NP	6/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	197 N MOHLER DR	None	ANAHEIM HILLS	CA	92808	1042	00	06000	33.86215736	-117.7687692	Orange County
306553	Non-Physician Medical Practitioner	None	1073903381	0	0	GENSEMER, ALEXANDRA NP	1/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	257 QUINCY AVE	None	LONG BEACH	CA	90803	1636	00	06000	33.766839	-118.139427	Los Angeles County
306557	Non-Physician Medical Practitioner	None	1154878205	0	0	GRIFFITH, CHRISTINA L PA-C	4/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	830 JEFFERSON AVE	STE M	REDWOOD CITY	CA	94063	1804	00	06000	37.48599384	-122.2282125	San Mateo County
306558	Non-Physician Medical Practitioner	None	1740512466	0	0	GALLARDO, GABRIELA R	4/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	968 L PORTER	None	CALEXICO	CA	92231	4120	00	06000	32.67891584	-115.476973	Imperial County
306565	Non-Physician Medical Practitioner	None	1487769212	0	0	GARZA, PATRICK J	10/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3380 LA SIERRA AVE	STE 104-444	RIVERSIDE	CA	92503	5271	00	06000	33.89671994	-117.4708101	Riverside County
306573	Non-Physician Medical Practitioner	None	1578962049	0	0	GRANDQUIST, RICHARD M III	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	7828 DAY CREEK BLVD	APT 826	RANCHO CUCAMONGA	CA	91739	8577	00	06000	34.1112636	-117.5371231	San Bernardino County
306604	Non-Physician Medical Practitioner	None	1508695180	0	0	GEHRKE, SARAH NP	3/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	00	06000	37.95582533	-121.967442	Contra Costa County
306611	Non-Physician Medical Practitioner	None	1073714960	0	0	GALLOWAY, FREDERICK O	4/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5723 CANTERBURY DR	None	CULVER CITY	CA	90230	6546	00	06000	33.98766113	-118.3807876	Los Angeles County
306629	Non-Physician Medical Practitioner	None	1043868052	0	0	GUINN, REBECCA L PA-C	11/1/2021	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
306638	Non-Physician Medical Practitioner	None	1912253576	0	0	GROSVELD, SUSETTE	6/5/2013	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 ST	None	WHITTIER	CA	90606	2549	00	06000	33.96734104	-118.0508773	Los Angeles County
306660	Non-Physician Medical Practitioner	None	1285796029	0	0	GUERRERO, ALMA Y PA-C	8/10/2020	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
306693	Non-Physician Medical Practitioner	None	1750844759	0	0	GHIGLINO-DUETSCH, LESLY NP	5/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1509 WILSON TER	None	GLENDALE	CA	91206	4007	00	06000	34.14950866	-118.2311155	Los Angeles County
306725	Non-Physician Medical Practitioner	None	1033481809	0	0	GONZALES, ROBBIN C	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	11 BEL FLORA COURT	None	ALISO VIEJO	CA	92656	8079	00	06000	33.56846405	-117.7382762	Orange County
306736	Non-Physician Medical Practitioner	None	1245864297	0	0	GEDDA, KRISTIN J 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	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	00	06000	38.12188356	-121.285872	San Joaquin County
306775	Non-Physician Medical Practitioner	None	1164170551	0	0	GABUYA, NICOLE SHARINA S	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	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
306778	Non-Physician Medical Practitioner	None	1679973903	0	0	GOLLES, SANDRA L NP	11/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2394 DREAM STREET	None	REDDING	CA	96001	5938	00	06000	40.56485218	-122.4134314	Shasta County
306841	Non-Physician Medical Practitioner	None	1073561072	0	0	GARNER, JARDENA F	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	3021 LINDEN STREET	None	OAKLAND	CA	94608	4558	00	06000	37.82247612	-122.2791529	Alameda County
306862	Non-Physician Medical Practitioner	None	1861569618	0	0	GLIDEWELL, HAROLD L	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	1220 OLIVE LANE	None	LA CANADA	CA	91011	2211	00	06000	34.21454204	-118.2054122	Los Angeles County
306875	Non-Physician Medical Practitioner	None	1588044333	0	0	GRAYMAN, BRITTA J	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2480 WASHINGTON ST	206	SAN FRANCISCO	CA	94115	1804	00	06000	37.79165139	-122.4341799	San Francisco County
306895	Non-Physician Medical Practitioner	None	1023407897	0	0	GOMORY, STELLA M	2/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 E GLENDORA AVE	None	ORNAGE	CA	92865	2840	00	06000	33.82779612	-117.847256	Orange
306916	Non-Physician Medical Practitioner	None	1588140230	0	0	GRIESINGER, SHARON C PA	1/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
306930	Non-Physician Medical Practitioner	None	1609917160	0	0	GRAEME, JASON SCOTT	6/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	06000	46.1309207	-122.9408931	Cowlitz County
306953	Non-Physician Medical Practitioner	None	1568012144	0	0	GILL, MANDEEP NP	8/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	594 EL CAMINO REAL	None	SANTA CLARA	CA	95050	4345	00	06000	37.35293214	-121.9385135	Santa Clara County
306969	Non-Physician Medical Practitioner	None	1457451569	0	0	GEE, DIANNE C NP	9/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	55 BESSIE STREET	None	SAN FRANCISCO	CA	94110	4611	00	06000	37.74680431	-122.4141597	San Francisco County
306979	Non-Physician Medical Practitioner	None	1144379017	0	0	GILLEY, JAMIE LYNNE	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	3860 CALLE FORTUNADA	STE 210	SAN DIEGO	CA	92123	4800	00	06000	32.81232257	-117.1225381	San Diego County
306987	Non-Physician Medical Practitioner	None	1962946236	0	0	GREELEY, NATHANIEL R	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GATEWAY OAKS DRIVE	SUITE 323	SACRAMENTO	CA	95833	4218	00	06000	38.608164	-121.5172305	Sacramento County
306989	Non-Physician Medical Practitioner	None	1770977340	0	0	GLEICHMAN, VICTORIA PA-C	3/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	00	06000	34.15729818	-118.3277073	Los Angeles County
307000	Non-Physician Medical Practitioner	None	1790133205	0	0	GOULD, MARYLIN R NP	4/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	00	06000	34.13604853	-117.29952	San Bernardino County
307004	Non-Physician Medical Practitioner	None	1386311330	0	0	GRAVESANDE, TAMEKA A NP	9/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1139 CIRBY WAY	None	ROSEVILLE	CA	95661	4421	00	06000	38.72951845	-121.275225	Placer County
307035	Non-Physician Medical Practitioner	None	1528632494	0	0	GALLARDO, ESPERANZA C PA	2/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 BROADWAY	None	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
307047	Non-Physician Medical Practitioner	None	1124043138	0	0	GABBAY, NILOUFAR	2/7/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 POWELL ST	SUITE 920	EMERYVILLE	CA	94608	1826	00	06000	37.83953006	-122.2990736	Alameda County
307049	Non-Physician Medical Practitioner	None	1083896005	0	0	GYSBERS, JOSHUA TRAVIS	7/25/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11175 CAMPUS ST	STE 21121	LOMA LINDA	CA	92354	0000	00	06000	34.05060717	-117.2656018	San Bernardino County
307064	Non-Physician Medical Practitioner	None	1275944654	0	0	GATTI, MIA N PA-C	9/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	00	06000	33.61321911	-117.8722084	Orange County
307067	Non-Physician Medical Practitioner	None	1295003457	0	0	GUEVARA, ERIC V PA	10/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	00	06000	34.50503628	-117.3265137	San Bernardino County
307078	Non-Physician Medical Practitioner	None	1053909770	0	0	GUTHRIE GONZALEZ, DAVID E PA	1/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5725 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	4007	00	06000	37.688107	-121.8861427	Alameda County
307108	Non-Physician Medical Practitioner	None	1306390638	0	0	GUZMAN, CRETIA 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	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
307112	Non-Physician Medical Practitioner	None	1447236914	0	0	GATES, MARY PATRICIA	7/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	00	06000	33.934059	-117.2789475	Riverside County
307129	Non-Physician Medical Practitioner	None	1942728217	0	0	GLOVER, JANELLE PA	1/26/2023	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
307138	Non-Physician Medical Practitioner	None	1255539912	0	0	GALE, CAROLYN D	2/18/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3505 CADILLAC AVE	SUITE N-2	COSTA MESA	CA	92626	1429	00	06000	33.69739868	-117.9304331	Orange County
307143	Non-Physician Medical Practitioner	None	1710390760	0	0	GILBERT-AU, CARA E NP	10/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4598 MISSION STREET	None	SAN FRANCISCO	CA	94112	2622	00	06000	37.72470903	-122.4348557	San Francisco County
307198	Non-Physician Medical Practitioner	None	1598072662	0	0	GREEN VALLEY MEDICAL CORPORATION	4/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41689 ROAD 128	None	OROSI	CA	93647	2060	00	06000	36.54673795	-119.2869613	Tulare County
307206	Non-Physician Medical Practitioner	None	1669520581	0	0	GALLO, CHRISTOPHER P	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	730 PELICAN WY	None	EL CAJON	CA	92020	7347	00	06000	32.78184491	-116.9714326	San Diego County
307216	Non-Physician Medical Practitioner	None	1427469097	0	0	GREENLEE, ZACHARIA D	6/16/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1607 CROW CREEK DR	None	OAKDALE	CA	95361	9656	00	06000	37.7698742	-120.8276994	Stanislaus County
307232	Non-Physician Medical Practitioner	None	1740362920	0	0	GEORGE, VALERIE PA	2/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3298	00	06000	33.78674051	-117.8888713	Orange County
307246	Non-Physician Medical Practitioner	None	1689282618	0	0	GREENE, JOHNNY PA	4/18/2023	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
307275	Non-Physician Medical Practitioner	None	1184409716	0	0	GAUTAM, GAYATRI 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	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
307285	Non-Physician Medical Practitioner	None	1336846161	0	0	GORDILLO, BRIAN J PA	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	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
307300	Non-Physician Medical Practitioner	None	1538354162	0	0	GILLETTE, JAMIE L	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	2171 CALLE PUEBLA	None	KINGMAN	AZ	86409	7746	00	06000	35.444367	-114.0368355	Mohave County
307323	Non-Physician Medical Practitioner	None	1831463751	0	0	GRIMM, HANA R 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	3142 30TH STREET	None	SAN DIEGO	CA	92104	4501	00	06000	32.73815537	-117.1293891	San Diego County
307340	Non-Physician Medical Practitioner	None	1871619023	0	0	GRAVES, DARRYL E	10/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28380 KEATON DR	None	MORENO VALLEY	CA	92555	6022	00	06000	33.92181536	-117.1675147	Riverside County
307342	Non-Physician Medical Practitioner	None	1427292911	0	0	GARCIA, DIANE	12/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	231 W VERNON AVE	None	LOS ANGELES	CA	90037	2700	00	06000	34.0038305	-118.2774195	Los Angeles County
307365	Non-Physician Medical Practitioner	None	1881640456	0	0	GHARIBEH, MAHA	10/18/2005	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
307376	Non-Physician Medical Practitioner	None	1326473067	0	0	GRANT, CRISTIN	12/2/2013	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
307439	Non-Physician Medical Practitioner	None	1265925333	0	0	GUINTO, JONATHAN R PA-C	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	3095 OLD CONEJO RD	None	THOUSAND OAKS	CA	91320	2130	00	06000	34.18969088	-118.9412876	Ventura County
307452	Non-Physician Medical Practitioner	None	1487658225	0	0	GUZMAN, VICKI MAREE	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	350 30TH ST #405	None	OAKLAND	CA	94609	0000	00	06000	37.81892183	-122.2640154	Alameda County
307479	Non-Physician Medical Practitioner	None	1407223563	0	0	GUSTAVES, KAITLYN 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	138 7TH ST	APT 1	SEAL BEACH	CA	90740	6151	00	06000	33.74192676	-118.106801	Orange County
307488	Non-Physician Medical Practitioner	None	1578081055	0	0	GARCIA, CLARINDA G 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	433 WILLOW GLEN WAY	None	SAN JOSE	CA	95125	1241	00	06000	37.30417768	-121.8797166	Santa Clara County
307489	Non-Physician Medical Practitioner	None	1235599572	0	0	GORE, RYAN T	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	1418 BLOSSOM CIRCLE	None	UPLAND	CA	91786	2525	00	06000	34.11457609	-117.6760433	San Bernardino County
307525	Non-Physician Medical Practitioner	None	1306207790	0	0	GABRIELLI, MICHELLE T NP	11/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	902 CIRBY WAY	None	ROSEVILLE	CA	95661	4420	00	06000	38.7294585	-121.2763095	Placer County
307541	Non-Physician Medical Practitioner	None	1346442902	0	0	GOEBEL, BARBARA L NP	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	2277 WILDBERRY LN	None	AUBURN	CA	95603	9530	00	06000	38.93278545	-121.0961983	Placer County
307553	Non-Physician Medical Practitioner	None	1326770926	0	0	GRAYDON, AUSTIN PA	5/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	00	06000	38.546091	-121.447305	Sacramento County
307569	Non-Physician Medical Practitioner	None	1306352349	0	0	GERAMI, PARVANEH NP	6/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
307577	Non-Physician Medical Practitioner	None	1316946874	0	0	GIBBS, ELLEN R NP	10/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1130 COFFEE RD	BUILDING 10	MODESTO	CA	95355	4228	00	06000	37.65884948	-120.9755938	Stanislaus County
307592	Non-Physician Medical Practitioner	None	1992249353	0	0	GODFREY, NICOLE S NP	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	818 1/2 EAST TUJUNGA BLV	None	BURBANK	CA	91501	1434	00	06000	34.18687659	-118.2987382	Los Angeles County
307603	Non-Physician Medical Practitioner	None	1538944384	0	0	GENAO, GISSELLE PA	6/18/2024	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
307604	Non-Physician Medical Practitioner	None	1396885588	0	0	GUTIERREZ, PATRICIA	3/17/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15998 QUANTICO RD STE A	None	APPLE VALLEY	CA	92307	1302	00	06000	34.54175393	-117.270808	San Bernardino County
307634	Non-Physician Medical Practitioner	None	1780148056	0	0	GORDON, DANIELLE A NP	8/12/2020	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
307653	Non-Physician Medical Practitioner	None	1811362981	0	0	GOLDENBERG, DANIELA E	12/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77 N ALMADEN AVENUE	APT 527	SAN JOSE	CA	95110	2782	00	06000	37.33606064	-121.8949984	Santa Clara County
307775	Non-Physician Medical Practitioner	None	1922030576	0	0	GREEN, MICHAEL D	6/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1062 HARBOR VILLAGE DR	None	HARBOR CITY	CA	90710	5241	00	06000	33.79221293	-118.2948657	Los Angeles County
307793	Non-Physician Medical Practitioner	None	1235594425	0	0	GRIFFIN, FLORENCIA L PA	4/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 BON AIR RD	SUITE 120	LARKSPUR	CA	94939	1141	00	06000	37.94364568	-122.5396483	Marin County
307831	Non-Physician Medical Practitioner	None	1982311437	0	0	GUTIERREZ, MICHELLE NP	10/9/2023	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
307842	Non-Physician Medical Practitioner	None	1942976204	0	0	GONZALEZ, MICHELLE N PA-C	1/4/2022	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
307849	Non-Physician Medical Practitioner	None	1932945847	0	0	GALVEZ, ISABEL PA-C	10/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18112 OUTER HWY 18	STE 101	APPLE VALLEY	CA	92307	0840	00	06000	34.54079736	-117.2688963	San Bernardino County
307854	Non-Physician Medical Practitioner	None	1619244480	0	0	GARAY, DONNA C NP	3/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5082 DEREK DRIVE	None	SAN JOSE	CA	95136	3305	00	06000	37.26142087	-121.82574	Santa Clara County
307855	Non-Physician Medical Practitioner	None	1821032707	0	0	GABRESKI, GINA M	3/24/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1328 22ND ST	None	SANTA MONICA	CA	90404	2091	00	06000	34.03122319	-118.4797185	Los Angeles County
307904	Non-Physician Medical Practitioner	None	1730634288	0	0	GOLDBERG, MEGAN A	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	732 STONEY CREEK DRIVE	UNIT 1	DAUPHIN	PA	17018	9610	00	06000	40.37643956	-76.92174149	Dauphin County
307944	Non-Physician Medical Practitioner	None	1588289250	0	0	GAYHART, KATHRYN L 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	4501 X ST	None	SACRAMENTO	CA	95817	2229	00	06000	38.553822	-121.452822	Sacramento County
307946	Non-Physician Medical Practitioner	None	1396025409	0	0	GEORGE, JASON C	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	785 DOLOMITE COURT	None	WEST SACRAMENTO	CA	95691	2821	00	06000	38.579247	-121.520673	Yolo County
307950	Non-Physician Medical Practitioner	None	1285989988	0	0	GREY, JOEL M	11/28/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 ALMOND LANE	None	DAVIS	CA	95618	5035	00	06000	38.54247798	-121.69908	Yolo County
308007	Non-Physician Medical Practitioner	None	1265414130	0	0	GRIJALVA, RAMON A	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	15051 SONNY CIR	None	IRVINE	CA	92604	2913	00	06000	33.68714345	-117.7775336	Orange County
308027	Non-Physician Medical Practitioner	None	1003526724	0	0	GARIBYAN, LILITH NP	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	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	00	06000	34.24862229	-118.2886742	Los Angeles County
308041	Non-Physician Medical Practitioner	None	1043832892	0	0	GRAFF, LACY M PA-C	6/25/2020	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
308074	Non-Physician Medical Practitioner	None	1609987213	0	0	GOTTUS, MICHAEL J	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	24942 AVENIDA VERANEO	None	LAKE FOREST	CA	92630	2226	00	06000	33.65823491	-117.6954882	Orange County
308110	Non-Physician Medical Practitioner	None	1871963942	0	0	GILLIAM, FREDERICK D	5/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3440 NORTH MINDEN STREET	None	VISALIA	CA	93291	6543	00	06000	36.360576	-119.324925	Tulare County
308117	Non-Physician Medical Practitioner	None	1235626458	0	0	GIMUATO, ANN B 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	1524 ASTOR COURT	None	CHULA VISTA	CA	91913	2644	00	06000	32.6170952	-116.995052	San Diego County
308127	Non-Physician Medical Practitioner	None	1821184078	0	0	GORDON, BENJAMIN S PA-C	9/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25170 HANCOCK AVE	SUITE 200	MURRIETA	CA	92562	5969	00	06000	33.565149	-117.1823815	Riverside County
308151	Non-Physician Medical Practitioner	None	1023190014	0	0	GHASEMI, FARIDEH NP	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	11398 POND HURST WAY	None	RIVERSIDE	CA	92505	3471	00	06000	33.90834936	-117.4906335	Riverside County
308153	Non-Physician Medical Practitioner	None	1376911131	0	0	GUIA, BERNADETTE D NP	1/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8215 VAN NUYS BLVD	SUITE 210-204	PANORAMA CITY	CA	91402	4833	00	06000	34.22026244	-118.4488066	Los Angeles County
308155	Non-Physician Medical Practitioner	None	1942603774	0	0	GOSS, SPENCER W NP	5/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2617 HILLEGASS AVE	STE 3D	BERKELEY	CA	94705	3307	00	06000	37.86273873	-122.2562085	Alameda County
308170	Non-Physician Medical Practitioner	None	1922342013	0	0	GUTIERREZ, ANA M NP	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2110 W 24TH ST	STE C	YUMA	AZ	85364	8878	00	06000	32.684094	-114.6452715	Yuma County
308180	Non-Physician Medical Practitioner	None	1154629343	0	0	GIAMMARINO, THOMAS M PA	12/27/2022	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
308213	Non-Physician Medical Practitioner	None	1467680694	0	0	GESSIN, LEAH G	3/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1926 OLIVER AVE	None	SAN DIEGO	CA	92109	5564	00	06000	32.79638621	-117.2332604	San Diego County
308261	Non-Physician Medical Practitioner	None	1942935705	0	0	GONZALES, ANNE B 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	845 LA VETA	STE 108	ORANGE	CA	92868	3930	00	06000	33.78064548	-117.8611107	Orange County
308325	Non-Physician Medical Practitioner	None	1760653885	0	0	GODOY, CAROL G V	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	8738 DORIAN ST	None	DOWNEY	CA	90242	3906	00	06000	33.90602341	-118.1481189	Los Angeles County
308335	Non-Physician Medical Practitioner	None	1528484482	0	0	GREENLEE, NISHA T 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	5567 PALM DRIVE	None	HAWTHORNE	CA	90250	5839	00	06000	33.91328841	-118.3776544	Los Angeles County
308387	Non-Physician Medical Practitioner	None	1790477875	0	0	GONZALEZ, MICHAEL NP	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	1131 W. 6TH ST	STE 150	ONTARIO	CA	91762	1116	00	06000	34.084404	-117.6717015	San Bernardino County
308398	Non-Physician Medical Practitioner	None	1700544822	0	0	GUALY, HANNAH N NP	1/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
308428	Non-Physician Medical Practitioner	None	1215763040	0	0	GLANTZ, COURTNEY 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	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
308432	Non-Physician Medical Practitioner	None	1194503060	0	0	GACUYA, ALDRIN R NP	1/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
308441	Non-Physician Medical Practitioner	None	1508304072	0	0	GREEN-COX, EARTHA M CNP	9/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
308444	Non-Physician Medical Practitioner	None	1881945012	0	0	GONZALEZ, LISA K 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	5133 WILTS PLACE	None	SAN DIEGO	CA	92117	4036	00	06000	32.82790452	-117.1816176	San Diego County
308449	Non-Physician Medical Practitioner	None	1578617650	0	0	GOLL, JOANNA P NP	12/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	707 S JUANITA AVE	None	REDONDO BEACH	CA	90277	4357	00	06000	33.8324221	-118.3797662	Los Angeles County
308470	Non-Physician Medical Practitioner	None	1184264012	0	0	GOLLAZ, YVETTE N NP	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	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
308474	Non-Physician Medical Practitioner	None	1548613177	0	0	GREB, ROBIN M NP	11/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27871 MEDICAL CENTER RD	STE 200	MISSION VIEJO	CA	92691	6406	00	06000	33.558534	-117.6641255	Orange County
308522	Non-Physician Medical Practitioner	None	1275928756	0	0	GOUDEAU, THERON C NP	11/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5161 CLAYTON RD	STE F	CONCORD	CA	94521	3157	00	06000	37.95582533	-121.967442	Contra Costa County
308523	Non-Physician Medical Practitioner	None	1174549729	0	0	GEIER, KATHLEEN A NP	3/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11 EL CAJON	None	LAFAYETTE	CA	94549	2032	00	06000	37.93902649	-122.0972027	Contra Costa County
308577	Non-Physician Medical Practitioner	None	1255914511	0	0	GRABLE, CHRISTOPHER M NP	5/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
308588	Non-Physician Medical Practitioner	None	1659898484	0	0	GUIJO, ANNE RACHEL S NP	6/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	00	06000	37.89702115	-122.0569066	Contra Costa County
308614	Non-Physician Medical Practitioner	None	1104220375	0	0	GARBER, JEFFREY A	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7850 EL PASEO GRANDE	APT 6	LA JOLLA	CA	92037	3300	00	06000	32.85162218	-117.2566964	San Diego County
308629	Non-Physician Medical Practitioner	None	1770742884	0	0	GAMBLE, LYNN NP	2/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	560 COHASSET RD	None	CHICO	CA	95926	2281	00	06000	39.7519137	-121.8477606	Butte County
308665	Non-Physician Medical Practitioner	None	1215359567	0	0	GOHN, COURTNEY E NP	1/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34919 STADLER ST	None	BEAUMONT	CA	92223	7426	00	06000	33.961838	-117.0520316	Riverside County
308689	Non-Physician Medical Practitioner	None	1306244033	0	0	GUERRERO, MICHELLE NP	10/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
308692	Non-Physician Medical Practitioner	None	1548341993	0	0	GRAY, DANA G	6/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	410 TAYLOR STREET	None	WEAVERVILLE	CA	96093	1229	00	06000	40.74021082	-122.9387157	Trinity County
308743	Non-Physician Medical Practitioner	None	1639614100	0	0	GERONIMO, CHRISTINE A P NP	8/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28427 N HERRERA ST	None	VALENCIA	CA	91354	3059	00	06000	34.45511478	-118.565528	Los Angeles County
308747	Non-Physician Medical Practitioner	None	1649496472	0	0	GIVEN, SUSAN E NP	11/26/2024	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
308764	Non-Physician Medical Practitioner	None	1811659311	0	0	GARCIA, GREGORY PA-C	3/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	631 S BROOKHURST ST	SUITE # 101	ANAHEIM	CA	92804	3510	00	06000	33.823647	-117.9589675	Orange County
308806	Non-Physician Medical Practitioner	None	1942413356	0	0	GOUBRAN, JEHAN	8/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1818 N ORANGE GROVE AVE	SUITE 204	POMONA	CA	91767	3028	00	06000	34.07694934	-117.7489598	Los Angeles County
308850	Non-Physician Medical Practitioner	None	1407491574	0	0	GILES, MICHAEL A PA	10/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	00	06000	33.90290859	-117.4941562	Riverside County
308855	Non-Physician Medical Practitioner	None	1447978721	0	0	GEGHAMYAN, ANI NP	9/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	601 S WESTMORELAND AVE	None	LOS ANGELES	CA	90005	3999	00	06000	34.06348495	-118.28845	Los Angeles County
308871	Non-Physician Medical Practitioner	None	1144329731	0	0	GREEN, LAURA LESLIE	12/27/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2030 SUTTER PL	None	DAVIS	CA	95616	6212	00	06000	38.56292466	-121.7715423	Yolo County
308904	Non-Physician Medical Practitioner	None	1962111419	0	0	GERGIS, RANIA PA	12/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4601 DALE ROAD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
308942	Non-Physician Medical Practitioner	None	1245500065	0	0	GREG-MITCHELL, JEVON P NP	1/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28 SEACLIFF DR	None	APTOS	CA	95003	4548	00	06000	36.97453348	-121.9048886	Santa Cruz County
308963	Non-Physician Medical Practitioner	None	1982204533	0	0	GRANTHAM, BRIANDRA 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
308964	Non-Physician Medical Practitioner	None	1265509012	0	0	GULLEY, CINDY C	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	10146 SUN VALLEY DR	None	ALTA LOMA	CA	91737	1775	00	06000	34.16416553	-117.5828175	San Bernardino County
309005	Non-Physician Medical Practitioner	None	1245979756	0	0	GONZALES, SUMMER D PA	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	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
309020	Non-Physician Medical Practitioner	None	1508954132	0	0	GREENFIELD, LAUREL S	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
309049	Non-Physician Medical Practitioner	None	1649429861	0	0	GALLARDO, ERIC M	8/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2032 E BERMUDA ST	APT 203	LONG BEACH	CA	90814	6039	00	06000	33.76985369	-118.1668017	Los Angeles County
309059	Non-Physician Medical Practitioner	None	1174202980	0	0	GAUDREAU, KRISTIN P PA-C	9/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	00	06000	40.78355148	-124.1420294	Humboldt County
309081	Non-Physician Medical Practitioner	None	1164790101	0	0	GARIBAY, CHRISTOPHER P	2/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15377 MATURIN DR	SUITE 195	SAN DIEGO	CA	92127	2313	00	06000	33.00463158	-117.0893456	San Diego County
309089	Non-Physician Medical Practitioner	None	1447352307	0	0	GARCIA, KATHLEEN A	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	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
309095	Non-Physician Medical Practitioner	None	1871936245	0	0	GUTIERREZ, ALLISON E 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	1000 NORTH HUDSON	None	PASADENA	CA	91104	4508	00	06000	34.16303879	-118.1340004	Los Angeles County
309163	Non-Physician Medical Practitioner	None	1407613920	0	0	GONZALEZ, FLAVIO NP	11/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	820 S AKERS ST	STE 120	VISALIA	CA	93277	8306	00	06000	36.323757	-119.3491755	Tulare County
309184	Non-Physician Medical Practitioner	None	1295119246	0	0	GIMENEZ, CHANDRA NP	3/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
309210	Non-Physician Medical Practitioner	None	1447814397	0	0	GOODEN-CLARKE, RENEE P NP	5/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	00	06000	37.39572142	-122.1051204	Santa Clara County
309234	Non-Physician Medical Practitioner	None	1396211645	0	0	GARDNER, LAKEYLA H NP	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	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
309280	Non-Physician Medical Practitioner	None	1841218724	0	0	GOW, IAN MACARTHUR	5/27/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	00	06000	38.76553806	-121.2497067	Placer County
309284	Non-Physician Medical Practitioner	None	1306075981	0	0	GIARDINI, MICHELLE	9/1/2009	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	EMERGENCY DEPARTMENT	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
309323	Non-Physician Medical Practitioner	None	1710452404	0	0	GASKINS, JANELLE R PA	11/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14114 BUSINESS CENTER DR	STE A	MORENO VALLEY	CA	92553	9113	00	06000	33.9148002	-117.2714647	Riverside County
309339	Non-Physician Medical Practitioner	None	1871014621	0	0	GIMELBERG, YELENA PA	1/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	00	06000	34.44257521	-119.7584538	Santa Barbara County
309373	Non-Physician Medical Practitioner	None	1174670012	0	0	GOMEZ, JOSEPHINA T NP	11/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	619 MANGELS AVE	None	SAN FRANCISCO	CA	94127	2213	00	06000	37.733022	-122.4516619	San Francisco County
309412	Non-Physician Medical Practitioner	None	1609104835	0	0	GILLESPIE, MARK PA-C	1/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
309416	Non-Physician Medical Practitioner	None	1669945838	0	0	GHADIMI, LEAH A 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	1655 S WESTERN AVE	None	LOS ANGELES	CA	90006	5801	00	06000	34.042653	-118.3090565	Los Angeles County
309507	Non-Physician Medical Practitioner	None	1548597388	0	0	GALERA, EDGARDO D NP	8/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	203 SORRENTO LN	None	AMERICAN CANYON	CA	94503	3174	00	06000	38.17512367	-122.2454938	Napa County
309532	Non-Physician Medical Practitioner	None	1083296016	0	0	GIRON-DOMINGUEZ, BEATRIZ 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	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
309633	Non-Physician Medical Practitioner	None	1184292286	0	0	GENSLER, DANIEL M NP	10/5/2022	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
309641	Non-Physician Medical Practitioner	None	1174973986	0	0	GIL, ANNA C 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	1708 COUNTRY VISTAS LN	None	BONITA	CA	91902	3073	00	06000	32.65984521	-116.9973569	San Diego County
309679	Non-Physician Medical Practitioner	None	1396877494	0	0	GONZALES, JENNIFER BARBA	11/30/2007	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 402	LOS ANGELES	CA	90033	2464	00	06000	34.05112725	-118.2173921	Los Angeles County
309710	Non-Physician Medical Practitioner	None	1063587525	0	0	GOODYEAR, NANCY LOU	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	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	00	06000	38.57535	-121.407633	Sacramento County
309725	Non-Physician Medical Practitioner	None	1093877276	0	0	GHIZZONI, MAURA CLAIRE	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	350 30TH ST	SUITE 205	OAKLAND	CA	94609	3424	00	06000	37.81892183	-122.2640154	Alameda County
309736	Non-Physician Medical Practitioner	None	1053374397	0	0	GREEN, STACEY D	3/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21781 VENTURA BLVD # 308	None	WOODLAND HILLS	CA	91364	1835	00	06000	34.16845734	-118.6020052	Los Angeles County
309747	Non-Physician Medical Practitioner	None	1699792309	0	0	GASCON, MONICA M	9/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5408 CHEYENNE CT	None	ANTIOCH	CA	94531	9091	00	06000	37.95556662	-121.770467	Contra Costa County
309748	Non-Physician Medical Practitioner	None	1497791222	0	0	GEDION, NAOMI	5/11/2004	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
309753	Non-Physician Medical Practitioner	None	1447232665	0	0	GUY, JAN PA	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	940 N WESTERN AVE	A	SAN PEDRO	CA	90732	2403	00	06000	33.75111361	-118.3090432	Los Angeles County
309761	Non-Physician Medical Practitioner	None	1013546878	0	0	GIBBONS, ERA MAE C NP	6/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1655 S WESTERN AVE	None	LOS ANGELES	CA	90006	5801	00	06000	34.042653	-118.3090565	Los Angeles County
309779	Non-Physician Medical Practitioner	None	1235817651	0	0	GURZHI, EKATERINA A PA-C	3/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4140 JADE STREET	SUITE 100	CAPITOLA	CA	95010	3956	00	06000	36.97026148	-121.9638195	Santa Cruz County
309823	Non-Physician Medical Practitioner	None	1801241385	0	0	GILL, SHAMINDER	9/19/2022	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
309826	Non-Physician Medical Practitioner	None	1013444959	0	0	GLENNON, NICOLE C PA-C	4/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1435 S VERMONT AVE	SUITE 100	LOS ANGELES	CA	90006	4554	00	06000	34.045335	-118.2916355	Los Angeles County
309844	Non-Physician Medical Practitioner	None	1528457025	0	0	GOODWIN, PATRICK R NP	4/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	STE 280	SAN DIEGO	CA	92123	2776	00	06000	32.80027449	-117.153846	San Diego County
309886	Non-Physician Medical Practitioner	None	1417634452	0	0	GUERRERO, JORDAN V PA-C	10/17/2023	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
309889	Non-Physician Medical Practitioner	None	1568656262	0	0	GARCIA, MIGUEL A PA	3/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	195 FOOTHILL BLVD	None	RIALTO	CA	92376	5165	00	06000	34.1067027	-117.3680972	San Bernardino County
309946	Non-Physician Medical Practitioner	None	1417274283	0	0	GUTIERREZ, HANI K	7/27/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	226 SYCAMORE AVENUE	None	MILL VALLEY	CA	94941	2812	00	06000	37.8985263	-122.5353537	Marin County
310003	Non-Physician Medical Practitioner	None	1205207594	0	0	GLAVIANO, VINCENT A NP	1/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12746 W JEFFERSON BLVD	FL 2-4	LOS ANGELES	CA	90094	2885	00	06000	33.97751255	-118.417598	Los Angeles County
310008	Non-Physician Medical Practitioner	None	1881796464	0	0	GARDNER, TERRY YVONNE	12/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
310034	Non-Physician Medical Practitioner	None	1285964809	0	0	GOLEMBESKI, JAYME	7/25/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	06000	39.742164	-104.8350375	Adams County
310063	Non-Physician Medical Practitioner	None	1245913706	0	0	GIRAUDO, JENNIFER PA-C	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	45 E SAN JOAQUIN ST	None	SALINAS	CA	93901	2903	00	06000	36.65855611	-121.6575982	Monterey County
310072	Non-Physician Medical Practitioner	None	1629650635	0	0	GRILLO, MARISSA M PA	6/4/2022	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
310116	Non-Physician Medical Practitioner	None	1396083192	0	0	GRAY, ANDREW T	5/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	755 14TH AVE	APT 115	SANTA CRUZ	CA	95062	4071	00	06000	36.96588559	-121.9904731	Santa Cruz County
310120	Non-Physician Medical Practitioner	None	1285665620	0	0	GEBHARDT, JULIE M PA	4/24/2019	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
310127	Non-Physician Medical Practitioner	None	1538321500	0	0	GUERRA, CYNTHIA J NP	3/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
310139	Non-Physician Medical Practitioner	None	1396111530	0	0	GARY AND MARY WEST SENIOR DE	5/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1525 4TH AVE	None	SAN DIEGO	CA	92101	1307	00	06000	32.72168758	-117.1611197	San Diego County
310143	Non-Physician Medical Practitioner	None	1073115002	0	0	GILL, GURPREET K NP	3/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	00	06000	38.67049812	-121.7238394	Yolo County
310165	Non-Physician Medical Practitioner	None	1720591589	0	0	GERAGHTY, NORA	12/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3610 ARDEN CREEK RD	None	SACRAMENTO	CA	95864	1515	00	06000	38.599704	-121.3798275	Sacramento County
310173	Non-Physician Medical Practitioner	None	1063758704	0	0	GORDON, ALICIA	10/10/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 O STREET	APT 119	SACRAMENTO	CA	95811	6167	00	06000	38.572407	-121.48569	Sacramento County
310187	Non-Physician Medical Practitioner	None	1447648357	0	0	GUIRGUIS, MARY	9/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5955 E CALLE PRINCIPIA	None	ANAHEIM	CA	92807	4711	00	06000	33.84457012	-117.7841148	Orange County
310202	Non-Physician Medical Practitioner	None	1538672068	0	0	GARCIA, MICHELLE J	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	33013 KORBEL ST	None	UNION CITY	CA	94587	5447	00	06000	37.5735519	-122.0648984	Alameda County
310220	Non-Physician Medical Practitioner	None	1497131320	0	0	GLAUBKE, KRISTIN NP	4/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
310223	Non-Physician Medical Practitioner	None	1053092270	0	0	GARCIA, JULIA PA	10/1/2023	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
310266	Non-Physician Medical Practitioner	None	1437585718	0	0	GUTIERREZ, LISA A	8/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	936 S OLIVE ST	STE 440	LOS ANGELES	CA	90015	3495	00	06000	34.0427554	-118.259075	Los Angeles County
310347	Non-Physician Medical Practitioner	None	1669729869	0	0	GOLDBERG, SONJA N PA	8/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
310351	Non-Physician Medical Practitioner	None	1548410616	0	0	GHYSELS, SUSAN M	8/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4120 E 11TH AVE	None	SPOKANE	WA	99202	5325	00	06000	47.645307	-117.349389	Spokane County
310361	Non-Physician Medical Practitioner	None	1770781312	0	0	GANDHI, SIMMI NP	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1357 1/2 LAVETA TERR	None	LOS ANGELES	CA	90026	7458	00	06000	34.07712446	-118.2552196	Los Angeles County
310373	Non-Physician Medical Practitioner	None	1851431290	0	0	GRIPSHOVER, JANET NP	11/23/2022	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
310400	Non-Physician Medical Practitioner	None	1225708241	0	0	GAINEY, NICOLE M PA-C	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	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
310403	Non-Physician Medical Practitioner	None	1285780296	0	0	GEVERTS, LINDA J NP	3/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 29TH ST	STE 301	OAKLAND	CA	94609	3522	00	06000	37.81784861	-122.2652263	Alameda County
310406	Non-Physician Medical Practitioner	None	1720744469	0	0	GUERRERO, MARKUS J PA	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	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
310415	Non-Physician Medical Practitioner	None	1932302973	0	0	GAUSE, LISA M NP	1/14/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20291 RAVENWOOD LN	None	HUNTINGTON BEACH	CA	92646	5457	00	06000	33.66806961	-117.9486227	Orange County
310436	Non-Physician Medical Practitioner	None	1609481530	0	0	GABRIEL, HUNTER C PA-C	3/10/2022	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
310457	Non-Physician Medical Practitioner	None	1508433400	0	0	GRANESE, JULIA E 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	44725 10TH ST WEST	170	LANCASTER	CA	93534	4936	00	06000	34.695693	-118.1480965	Los Angeles County
310458	Non-Physician Medical Practitioner	None	1629372149	0	0	GONZALES, JACQUELYN NP	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	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
310469	Non-Physician Medical Practitioner	None	1255660973	0	0	GOLDSTEIN, JILLIAN LOVE	3/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	887 POTRERO AVE	None	SAN FRANCISCO	CA	94110	2869	00	06000	37.75846598	-122.4068266	San Francisco County
310514	Non-Physician Medical Practitioner	None	1922366186	0	0	GARDNER PACKARD CHILDREN'S HEALTH CENTER	11/20/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3351 EL CAMINO REAL	SUITE 100	ATHERTON	CA	94027	3811	00	06000	37.4659667	-122.2071835	San Mateo County
310541	Non-Physician Medical Practitioner	None	1114029535	0	0	GALLAGHER, JENNIFER M	4/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12832 ADAH LANE	None	POWAY	CA	92084	5850	00	06000	32.95266344	-117.0300256	San Diego County
310562	Non-Physician Medical Practitioner	None	1114513132	0	0	GU, FELICIA PA	1/8/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	00	06000	34.03833368	-118.3726622	Los Angeles County
310577	Non-Physician Medical Practitioner	None	1649663824	0	0	GRISSINGER, AMY 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	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
310585	Non-Physician Medical Practitioner	None	1740327899	0	0	GARCIA, ISABEL A	10/19/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	217 E 3RD ST	None	CORONA	CA	92879	1438	00	06000	33.87832551	-117.5643419	Riverside County
310632	Non-Physician Medical Practitioner	None	1487060463	0	0	GARFIELD, RAHMIEL H NP	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	5956 ALLEPPO LANE	None	PALMDALE	CA	93551	2825	00	06000	34.63438022	-118.2357109	Los Angeles County
310651	Non-Physician Medical Practitioner	None	1265784698	0	0	GRANADOS, ANGELA M CNM	6/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11420 DICKY ST	None	WHITTIER	CA	90606	2327	00	06000	33.97645141	-118.0648554	Los Angeles County
310666	Non-Physician Medical Practitioner	None	1790086916	0	0	GALE, CHRISTOPHER-MICHAEL	9/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1350 N CRESCENT HEIGHTS	APT 2	WEST HOLLYWOOD	CA	90046	4537	00	06000	34.095906	-118.365894	Los Angeles County
310674	Non-Physician Medical Practitioner	None	1649348921	0	0	GONZAGA, JESSE	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	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	00	06000	37.819368	-122.263902	Alameda County
310692	Non-Physician Medical Practitioner	None	1316635667	0	0	GUARDADO, KAREN L NP	9/4/2023	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
310732	Non-Physician Medical Practitioner	None	1932535986	0	0	GORAYA, MANBIR NP	10/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1794 KODIAK CIRCLE	None	RENO	NV	89511	3011	00	06000	39.39066861	-119.7758388	Washoe County
310736	Non-Physician Medical Practitioner	None	1366174112	0	0	GREWAL, PRABHJOT	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
310766	Non-Physician Medical Practitioner	None	1992130132	0	0	GARNER, ANTONIA M NP	6/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
310803	Non-Physician Medical Practitioner	None	1700338118	0	0	GOLLA, KYM Y	2/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3205 LOS FELIZ BLVD	APT 7	LOS ANGELES	CA	90039	1523	00	06000	34.12344735	-118.2686869	Los Angeles County
310805	Non-Physician Medical Practitioner	None	1699720755	0	0	GLADMAN, KATE M	1/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	0000	00	06000	37.36893518	-122.0779448	Santa Clara County
310816	Non-Physician Medical Practitioner	None	1609535558	0	0	GEORGE, CERENE C NP	5/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
310817	Non-Physician Medical Practitioner	None	1952396392	0	0	GARCIA, MICHELLE N PA-C	4/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 SHERMAN DR	STE 203	RIVERSIDE	CA	92503	4001	00	06000	33.92678822	-117.4368632	Riverside County
310851	Non-Physician Medical Practitioner	None	1346801388	0	0	GARCIA, BREANN PA-C	4/19/2024	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	STE K	SALINAS	CA	93901	4072	00	06000	36.65998191	-121.6461895	Monterey County
310858	Non-Physician Medical Practitioner	None	1215216916	0	0	G, DOMINGO K	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	9481 COMPASS POINT DR S	None	SAN DIEGO	CA	92126	5536	00	06000	32.92667763	-117.1199743	San Diego County
310873	Non-Physician Medical Practitioner	None	1750710919	0	0	GREEN, TRAVIS D	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	27001 MOULTON PKWY	SUITE A-102	LAGUNA HILLS	CA	92656	3626	00	06000	33.57086878	-117.7000485	Orange County
310898	Non-Physician Medical Practitioner	None	1811470925	0	0	GALLE, COURTNEY NP	10/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	00	06000	33.61676129	-117.869325	Orange County
310925	Non-Physician Medical Practitioner	None	1710072251	0	0	GREEN, HOLLY L	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	1633 HILL DRIVE	None	LOS ANGELES	CA	90041	1442	00	06000	34.14442509	-118.2016973	Los Angeles County
310942	Non-Physician Medical Practitioner	None	1013315563	0	0	GWALTNEY, KELLIE N CNM	4/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 AVENUE OF THE ARTS	None	COSTA MESA	CA	92626	1927	00	06000	33.69346296	-117.8778103	Orange County
310960	Non-Physician Medical Practitioner	None	1124283189	0	0	GREGORY, JOSEPH E	1/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4173 SERENA AVE	None	CLOVIS	CA	93619	0514	00	06000	36.86580757	-119.6339093	Fresno County
310973	Non-Physician Medical Practitioner	None	1205603958	0	0	GERGES, MARIAM M PA-C	2/28/2025	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
311070	Non-Physician Medical Practitioner	None	1417910852	0	0	GOLDFADER, REBECCA	7/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 CRANE STREET	None	MENLO PARK	CA	94025	4429	00	06000	37.45264069	-122.1878743	San Mateo County
311102	Non-Physician Medical Practitioner	None	1972996593	0	0	GUEVARA-GALAN, JESSICA L NP	10/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12712 FOXLEY DR	None	WHITTIER	CA	90602	3419	00	06000	33.96116144	-118.0461234	Los Angeles County
311126	Non-Physician Medical Practitioner	None	1639682057	0	0	GRAVES, JENNIFER N NP	1/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	311 LEEWARD AVENUE	None	PISMO BEACH	CA	93449	2121	00	06000	35.15381386	-120.6699265	San Luis Obispo County
311138	Non-Physician Medical Practitioner	None	1699959445	0	0	GOMEZ, ERICA O PA	6/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
311142	Non-Physician Medical Practitioner	None	1740063247	0	0	GRANT, COURTNEY PA-C	12/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	136 N 3RD ST	None	LOMPOC	CA	93436	7002	00	06000	34.64013944	-120.4451768	Santa Barbara County
311146	Non-Physician Medical Practitioner	None	1497099360	0	0	GONZALES, LEANNA N PA	10/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
311173	Non-Physician Medical Practitioner	None	1821746603	0	0	GARCIA, CLARA LIZETTE NP	4/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	81715 DR CARREON BLVD	None	INDIO	CA	92201	5564	00	06000	33.7073825	-116.2385415	Riverside County
311186	Non-Physician Medical Practitioner	None	1104101401	0	0	GARCIA, LUIS E PA-C	6/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	208 CONCOURSE BLVD	STE 1	SANTA ROSA	CA	95403	8120	00	06000	38.51255309	-122.7884839	Sonoma County
311195	Non-Physician Medical Practitioner	None	1588190664	0	0	GUZMAN, VANESSA PA-C	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	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	00	06000	34.20289797	-118.6294006	Los Angeles County
311225	Non-Physician Medical Practitioner	None	1639843840	0	0	GALLARDO, ANDREA PA	3/14/2022	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
311230	Non-Physician Medical Practitioner	None	1245552553	0	0	GIANNETTI, CHRISTINA	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	6350 STONERIDGE MALL RD	APT G-116	PLEASANTON	CA	94588	8065	00	06000	37.692999	-121.921281	Alameda County
311254	Non-Physician Medical Practitioner	None	1760720221	0	0	GROSS, STACEY B NP	9/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3635 TERRACE VIEW DR	None	ENCINO	CA	91436	4019	00	06000	34.13714747	-118.4999656	Los Angeles County
311279	Non-Physician Medical Practitioner	None	1821812322	0	0	GOSVENER, MITCHELL 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	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	00	06000	33.67831005	-117.852138	Orange County
311286	Non-Physician Medical Practitioner	None	1730489972	0	0	GARRISON, PATRICIA M	12/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1321 COLBY AVE	None	EVERETT	WA	98201	1665	00	06000	47.99969831	-122.207987	Snohomish County
311295	Non-Physician Medical Practitioner	None	1760538250	0	0	GOARD, PATRICIA ANN KELLY	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	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	00	06000	37.69960369	-121.7628917	Alameda County
311321	Non-Physician Medical Practitioner	None	1366956708	0	0	GOODNIGHT, MAKEDA L NP	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
311328	Non-Physician Medical Practitioner	None	1992049910	0	0	GRANFLOR, ELIZA A 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	18423 DELIA AVE	None	TORRANCE	CA	90504	5008	00	06000	33.86314168	-118.3283643	Los Angeles County
311339	Non-Physician Medical Practitioner	None	1902506892	0	0	GIESE, AMY	6/7/2024	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
311368	Non-Physician Medical Practitioner	None	1073866406	0	0	GANN, THOMAS JUDAH	10/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	500 N US HIGHWAY 89	None	PRESCOTT	AZ	86313	5001	00	06000	34.5454256	-112.4632044	Yavapai County
311407	Non-Physician Medical Practitioner	None	1104102805	0	0	GAMBLE, MELANIE ANNE	7/6/2012	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
311414	Non-Physician Medical Practitioner	None	1154789154	0	0	GILL, YARDANA M NP	4/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	124 DRAEGER DR	None	MORAGA	CA	94556	2137	00	06000	37.84914346	-122.1244375	Contra Costa County
311415	Non-Physician Medical Practitioner	None	1245603174	0	0	GENATO, GRETCHEN D NP	11/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13163 FOUNTAIN PARK DR	UNIT B421	PLAYA VISTA	CA	90094	2430	00	06000	33.97455562	-118.4293053	Los Angeles County
311421	Non-Physician Medical Practitioner	None	1316121817	0	0	GANTIOQUE, RAYMUND G NP	6/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	675 EAST BOXWOOD LANE	None	AZUSA	CA	91702	4216	00	06000	34.1428531	-117.8970495	Los Angeles County
311439	Non-Physician Medical Practitioner	None	1861126633	0	0	GREER, JENNA L NP	1/27/2023	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
311440	Non-Physician Medical Practitioner	None	1063115137	0	0	GOUMENIDIS, PENNY A PA-C	5/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
311453	Non-Physician Medical Practitioner	None	1477302305	0	0	GRIGORYAN, TATEVIK NP	9/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	00	06000	37.5531875	-121.9805141	Alameda County
311485	Non-Physician Medical Practitioner	None	1578597746	0	0	GABRILLO, ESTRELLA T NP	1/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	631 N 13TH AVE	STE A	UPLAND	CA	91786	4946	00	06000	34.10139899	-117.6337368	San Bernardino County
311547	Non-Physician Medical Practitioner	None	1003157041	0	0	G, LOPEZ L PA-C	6/27/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	00	06000	33.91571158	-117.4549231	Riverside County
311604	Non-Physician Medical Practitioner	None	1598867657	0	0	GONZALEZ, AUDREY A NP	6/6/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1736 N OAKWOOD	None	ANAHEIM	CA	92807	1037	00	06000	33.86810038	-117.8149724	Orange County
311607	Non-Physician Medical Practitioner	None	1316161664	0	0	GONZALEZ, LETICIA K	6/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6552 OXFORD DR	None	HUNTINGTON BEACH	CA	92647	2642	00	06000	33.74222215	-118.0145492	Orange County
311615	Non-Physician Medical Practitioner	None	1982194247	0	0	GARNER, RYAN J PA-C	10/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
311637	Non-Physician Medical Practitioner	None	1477164689	0	0	GERARD-BUONOMO, RACHEL NP	1/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3828 DELMAS	None	CULVER CITY	CA	90232	2713	00	06000	34.02308948	-118.3972101	Los Angeles County
311658	Non-Physician Medical Practitioner	None	1134280464	0	0	GRUTKOWSKI, LORA L NP	3/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	00	06000	37.79071145	-122.4308506	San Francisco County
311679	Non-Physician Medical Practitioner	None	1699122390	0	0	GRAVELINE, NOREEN C PA-C	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20924 BEN CT	None	SANTA CLARITA	CA	91350	1418	00	06000	34.4595169	-118.5014266	Los Angeles County
311734	Non-Physician Medical Practitioner	None	1255371746	0	0	GREGORY, ASHLEY L	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	1342 CORDOVA AVENUE	None	GLENDALE	CA	91207	1530	00	06000	34.1662634	-118.2418239	Los Angeles County
311783	Non-Physician Medical Practitioner	None	1003101494	0	0	GOODENOUGH, AARON	7/15/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 N BRENT ST STE 201	None	VENTURA	CA	93003	2835	00	06000	34.27345057	-119.2569821	Ventura County
311790	Non-Physician Medical Practitioner	None	1205642584	0	0	GUZMAN, CINDY	1/8/2025	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
311806	Non-Physician Medical Practitioner	None	1639258395	0	0	GIBBINS, HILARY	5/14/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
311831	Non-Physician Medical Practitioner	None	1902428600	0	0	GIANG, CONNIE PA	9/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
311882	Non-Physician Medical Practitioner	None	1619267358	0	0	GRANDE, MEGAN C	12/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	537 TUSCANY VIEW ST	None	LAS VEGAS	NV	89145	4877	00	06000	36.16465256	-115.284581	Clark County
311911	Non-Physician Medical Practitioner	None	1730724824	0	0	GOMEZ, JOSEPH CHRIS G PA	11/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
311963	Non-Physician Medical Practitioner	None	1609659879	0	0	GAO, MICHAEL PA	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	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
312022	Non-Physician Medical Practitioner	None	1851910012	0	0	GOLDSTEIN, ALEEZA R PA	4/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3851 KATELLA AVENUE	SUITE 150	LOS ALAMITOS	CA	90720	3363	00	06000	33.80319053	-118.0657305	Orange County
312042	Non-Physician Medical Practitioner	None	1932715059	0	0	GUREGHIAN, ALEXANDER S PA-C	2/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3166	00	06000	34.09027878	-118.1450083	Los Angeles County
312050	Non-Physician Medical Practitioner	None	1740363571	0	0	GEELHOED, MICHELLE	12/9/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3113 N SEPULVEDA BLVD	SUITE A	MANHATTAN BEACH	CA	90266	2481	00	06000	33.898167	-118.3961265	Los Angeles County
312075	Non-Physician Medical Practitioner	None	1427753870	0	0	GUARTE, JESSICA NP	4/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 19TH ST	None	RANCHO CUCAMONGA	CA	91737	3538	00	06000	34.13274747	-117.593073	San Bernardino County
312089	Non-Physician Medical Practitioner	None	1760480610	0	0	GARFIELD HEALTH CENTER	4/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N GARFIELD AVE	SUITE 203	MONTEREY PARK	CA	91754	1746	00	06000	34.064181	-118.122834	Los Angeles County
312093	Non-Physician Medical Practitioner	None	1053551853	0	0	GAUL, JANEEN C NP	10/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5930 SITTING BULL PLACE	None	SIMI VALLEY	CA	93063	5722	00	06000	34.28886459	-118.6756155	Ventura County
312117	Non-Physician Medical Practitioner	None	1659493674	0	0	GOSLA, NAZEMA PA-C	5/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1981 N BROADWAY	STE 190	WALNUT CREEK	CA	94596	3671	00	06000	37.90582392	-122.0613697	Contra Costa County
312124	Non-Physician Medical Practitioner	None	1346961380	0	0	GABALY, CHELSEA PA-C	10/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 NORTH INDIAN CANYON	SUITE W300	PALM SPRINGS	CA	92262	4809	00	06000	33.839505	-116.5455735	Riverside County
312125	Non-Physician Medical Practitioner	None	1245458124	0	0	GUTIERREZ, NOEMI A	9/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	311 S ORANGE DR	None	LOS ANGELES	CA	90036	3008	00	06000	34.068429	-118.3418865	Los Angeles County
312161	Non-Physician Medical Practitioner	None	1679349864	0	0	GARCIA, JESSICA	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	100 HOSPITAL DR	STE 200	VALLEJO	CA	94589	2580	00	06000	38.13100118	-122.2403008	Solano County
312163	Non-Physician Medical Practitioner	None	1104096569	0	0	GILLOCK, KIMBERLY	7/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	06000	39.742164	-104.8350375	Adams County
312167	Non-Physician Medical Practitioner	None	1851896948	0	0	GOODING, SAMANTHA O NP	6/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3203 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5831	00	06000	33.97264641	-118.2101997	Los Angeles County
312216	Non-Physician Medical Practitioner	None	1427658376	0	0	GUERRA, RAEANNE C PA-C	1/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14114 BUSINESS CENTER DR	STE A	MORENO VALLEY	CA	92553	9113	00	06000	33.9148002	-117.2714647	Riverside County
312229	Non-Physician Medical Practitioner	None	1477072775	0	0	GARCIA TORRES, STEPHANIE L PA	9/29/2020	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
312307	Non-Physician Medical Practitioner	None	1235453754	0	0	GADSON, BULEAH M	3/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6861 VIA IRANA	None	STANTON	CA	90680	1922	00	06000	33.80593828	-118.0135377	Orange County
312328	Non-Physician Medical Practitioner	None	1316044282	0	0	GOMEZ, ERICA A PA	3/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2251 N HARBOR BLVD	None	FULLERTON	CA	92835	2601	00	06000	33.89691672	-117.9291749	Orange County
312333	Non-Physician Medical Practitioner	None	1841710969	0	0	GILLILAN, REBECCA O PA-C	11/21/2019	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
312375	Non-Physician Medical Practitioner	None	1760590897	0	0	GALUSTIANS, NANCY JILL	10/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	181 SOUTH BUENA VISTA ST	3RD FLOOR	BURBANK	CA	91505	1204	00	06000	34.15958049	-118.328816	Los Angeles County
312399	Non-Physician Medical Practitioner	None	1164033965	0	0	GARCIA, RAQUEL A NP	12/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3389 G ST	STE B	MERCED	CA	95340	0964	00	06000	37.32623805	-120.4692747	Merced County
312410	Non-Physician Medical Practitioner	None	1457078560	0	0	GUILAS, HANNA N CNP	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	8112 MILLIKEN AVE	SUITE 201	RANCHO CUCAMONGA	CA	91730	7473	00	06000	34.10480366	-117.5570863	San Bernardino County
312432	Non-Physician Medical Practitioner	None	1598207110	0	0	GILLAMAC, MARIA A NP	1/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5191 FOXGLOVE DRIVE	None	HUNTINGTON BEACH	CA	92649	4091	00	06000	33.71841953	-118.0381095	Orange County
312524	Non-Physician Medical Practitioner	None	1154431203	0	0	GROTHE, THOMAS MICHAEL	12/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	3208	00	06000	37.65894608	-122.440161	San Mateo County
312528	Non-Physician Medical Practitioner	None	1316353923	0	0	GODFREY, TIMIAN M NP	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5682 ESCAMILLA RD	None	LAS VEGAS	NV	89135	1442	00	06000	36.08574343	-115.3160879	Clark County
312610	Non-Physician Medical Practitioner	None	1730654609	0	0	GLENN, HANNAH PA-C	10/31/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
312615	Non-Physician Medical Practitioner	None	1235523150	0	0	GARCIA, MATEO NP	2/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	00	06000	34.13990611	-118.2182985	Los Angeles County
312643	Non-Physician Medical Practitioner	None	1912307505	0	0	GREWAL, RITU K NP	5/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 E HERNDON AVE	None	FRESNO	CA	93720	3235	00	06000	36.83626267	-119.7674845	Fresno County
312671	Non-Physician Medical Practitioner	None	1134647308	0	0	GARCIA, BRENDON J PA-C	1/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2656 EDITH AVE	STE B	REDDING	CA	96001	3030	00	06000	40.57073094	-122.3974088	Shasta County
312682	Non-Physician Medical Practitioner	None	1861025884	0	0	GERMANN, QUENTIN D PA	9/22/2020	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
312773	Non-Physician Medical Practitioner	None	1881705804	0	0	GOMOLAK, DENISE ANN	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	1569 SLOAT BLVD	SUITE #333	SAN FRANCISCO	CA	94132	1256	00	06000	37.73393082	-122.4907724	San Francisco County
312817	Non-Physician Medical Practitioner	None	1881145852	0	0	GRIFFIN, KIMBERLY M NP	11/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10757 LEMON AVE	APT 522	ALTA LOMA	CA	91737	6945	00	06000	34.137351	-117.570447	San Bernardino County
312862	Non-Physician Medical Practitioner	None	1699916643	0	0	GORDON, COURTNEY KELLEHER	11/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3333 CALIFORNIA ST	SUITE 380	SAN FRANCISCO	CA	94118	1981	00	06000	37.78706282	-122.4482385	San Francisco County
312870	Non-Physician Medical Practitioner	None	1851614887	0	0	GRIFFIN, JUDITH	12/2/2013	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	MOB 3, 3 FLOOR	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
312881	Non-Physician Medical Practitioner	None	1114216793	0	0	GILLIAM, JAMIE	4/28/2011	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
312891	Non-Physician Medical Practitioner	None	1174988174	0	0	GONZALEZ, SARA C NP	11/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1444 S MAIN ST	None	SANTA ANA	CA	92707	1717	00	06000	33.727401	-117.8678195	Orange County
312895	Non-Physician Medical Practitioner	None	1609349646	0	0	GEIGER, SARAH R 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	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
312932	Non-Physician Medical Practitioner	None	1619044468	0	0	GRAVITT, CARIANN M	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	4027 CEDARWOOD COURT	None	BREA	CA	92823	1076	00	06000	33.92395151	-117.8382317	Orange County
312943	Non-Physician Medical Practitioner	None	1497866792	0	0	GROUSIS, FRANCESCA ANN	11/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7055 N MAPLE AVE STE 106	None	FRESNO	CA	93720	8012	00	06000	36.83914089	-119.7453593	Fresno County
312971	Non-Physician Medical Practitioner	None	1760516298	0	0	GUILES, MICHAEL D PA-C	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	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
312980	Non-Physician Medical Practitioner	None	1417200684	0	0	GOTT, DIONE M	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	840 PENSIVE COURT	None	NAPA	CA	94559	2043	00	06000	38.277576	-122.298034	Napa County
313056	Non-Physician Medical Practitioner	None	1326275587	0	0	GUZMAN, OLIVIA	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	5 MONTEREY VISTA CT	None	WATSONVILLE	CA	95076	6605	00	06000	36.91360317	-121.7764702	Santa Cruz County
313082	Non-Physician Medical Practitioner	None	1376109033	0	0	GLADNEY, ELIZABETH M 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	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	00	06000	38.26109552	-122.0470245	Solano County
313092	Non-Physician Medical Practitioner	None	1265183024	0	0	GOMEZ-RAMIREZ, ILIANA NP	1/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1590 SOUTH IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	00	06000	32.77950118	-115.5697279	Imperial County
313131	Non-Physician Medical Practitioner	None	1336371954	0	0	GREIF, SHERRI BETH	12/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2103 PICKWICK DR	None	CAMARILLO	CA	93010	6427	00	06000	34.22230046	-119.041623	Ventura County
313140	Non-Physician Medical Practitioner	None	1720528318	0	0	GRETAH, WESLEY PA	5/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
313146	Non-Physician Medical Practitioner	None	1942552195	0	0	GYSLER, RAYMOND EDWARD	4/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	00	06000	33.20904502	-117.2286439	San Diego County
313177	Non-Physician Medical Practitioner	None	1770671828	0	0	GREGORY, JACQUELINE 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	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	00	06000	35.12986992	-120.6006027	San Luis Obispo County
313183	Non-Physician Medical Practitioner	None	1205914546	0	0	GREEN, FELECIA PA-C	3/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16630 BROADWAY	None	GARDENA	CA	90248	2716	00	06000	33.87988966	-118.278108	Los Angeles County
313204	Non-Physician Medical Practitioner	None	1447287206	0	0	GLASSMAN, ERIC V 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	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.85429563	-117.8166478	Orange County
313243	Non-Physician Medical Practitioner	None	1437988946	0	0	GONWA RAMONDA, ADDIE NP	12/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	00	06000	33.78785047	-117.8631495	Orange County
313247	Non-Physician Medical Practitioner	None	1912358474	0	0	GYAWALI, SMITA PA-C	8/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	127 HOSPITAL DR	204	VALLEJO	CA	94589	2562	00	06000	38.13103371	-122.2387342	Solano County
313256	Non-Physician Medical Practitioner	None	1174657514	0	0	GORDON, EURAL E	2/9/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7400 DISTRICT BLVD STE C	None	BAKERSFIELD	CA	93313	4818	00	06000	35.31317675	-119.0831837	Kern County
313266	Non-Physician Medical Practitioner	None	1588423651	0	0	GUERRERO, VIRGINIA NP	6/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2438 PONDEROSA DRIVE N	C-101	CAMARILLO	CA	93010	2369	00	06000	34.24219545	-119.0227012	Ventura County
313273	Non-Physician Medical Practitioner	None	1427238138	0	0	GONZALES, ANTHONY	11/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4464 OWENS ST	106	CORONA	CA	92883	0837	00	06000	33.81332792	-117.5049757	Riverside County
313277	Non-Physician Medical Practitioner	None	1467075689	0	0	GUTHRIE, CATHERINE A	6/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27212 CALAROGA AVENUE	None	HAYWARD	CA	94545	4339	00	06000	37.63229023	-122.0896425	Alameda County
313336	Non-Physician Medical Practitioner	None	1548036478	0	0	GREWAL, RUPINDER NP	4/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 WEST I ST	None	LOS BANOS	CA	95616	6201	00	06000	37.06346603	-120.8593647	Merced County
313345	Non-Physician Medical Practitioner	None	1295928513	0	0	GARDNER, JONI CHERYL	7/8/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7200 REDWOOD BLVD	None	NOVATO	CA	94945	3250	00	06000	38.10306471	-122.5700837	Marin County
313355	Non-Physician Medical Practitioner	None	1285230490	0	0	GONZALEZ, MICHAEL PA-C	8/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	00	06000	32.8384953	-116.9677746	San Diego County
313374	Non-Physician Medical Practitioner	None	1972018745	0	0	GRGICH, KYLE M	4/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1143 S POSITANO AVENUE	None	ANAHIEM	CA	92808	1534	00	06000	33.85129264	-117.739977	Orange County
313376	Non-Physician Medical Practitioner	None	1558684878	0	0	GILLETTE, SHEILA G NP	6/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W PUEBLO STREET	None	SANTA BARBARA	CA	93102	0689	00	06000	34.42887662	-119.7237878	Santa Barbara County
313406	Non-Physician Medical Practitioner	None	1043753957	0	0	GUEST, STEPHANIE NP	9/11/2017	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
313425	Non-Physician Medical Practitioner	None	1639232440	0	0	GALILEO, MARGARET J PA	11/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13617 RUNNING SPRINGS DR	None	CHINO HILLS	CA	91709	1443	00	06000	34.00575801	-117.7405909	San Bernardino County
313426	Non-Physician Medical Practitioner	None	1821155763	0	0	GOMEZ, JOSE LEONEL	8/17/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2955 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	0000	00	06000	33.97333678	-118.2163277	Los Angeles County
313436	Non-Physician Medical Practitioner	None	1710521844	0	0	GEIGER, KIM G NP	11/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
313448	Non-Physician Medical Practitioner	None	1295192441	0	0	GIERSCH, KATHERINE B	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4424 B STREET	None	SACRAMENTO	CA	95819	2127	00	06000	38.576322	-121.444497	Sacramento County
313479	Non-Physician Medical Practitioner	None	1528551843	0	0	GAZA, MARY GRACE A NP	10/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
313482	Non-Physician Medical Practitioner	None	1265921126	0	0	GARCIA, ASHLEY L PA	12/14/2023	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
313483	Non-Physician Medical Practitioner	None	1295988095	0	0	GIHBSSON, PETA-GAY M	10/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5105 E WOODWIND LANE	None	ANAHEIM	CA	92807	1207	00	06000	33.86727221	-117.8038124	Orange County
313499	Non-Physician Medical Practitioner	None	1811530025	0	0	GUZMAN, JESLIN	9/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13768 ROSWELL AVENUE	SUITE 118	CHINO	CA	91710	1402	00	06000	34.0038	-117.7218555	San Bernardino County
313511	Non-Physician Medical Practitioner	None	1003442120	0	0	GEE, CHRISTINA PA-C	3/17/2024	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
313547	Non-Physician Medical Practitioner	None	1760176812	0	0	GONG, ZHUORAN NP	6/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2707 E VALLEY BLVD	SUITE 208	WEST COVINA	CA	91792	3195	00	06000	34.00296323	-117.8868537	Los Angeles County
313608	Non-Physician Medical Practitioner	None	1346669074	0	0	GRESHAM, LANETTE S NP	12/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4918 RIDGEFIELD CIRCLE	None	FAIRFIELD	CA	94534	6432	00	06000	38.16691574	-122.1403719	Solano County
313611	Non-Physician Medical Practitioner	None	1700935103	0	0	GROSSI, TERESA A	12/28/2007	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
313614	Non-Physician Medical Practitioner	None	1649548686	0	0	GREENHAW, KAREN A	2/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16154 DARTOLO RD	None	RAMONA	CA	92065	4603	00	06000	33.00896026	-116.793935	San Diego County
313640	Non-Physician Medical Practitioner	None	1770921587	0	0	GARCIA, DAFNE NP	12/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	#357	LA MESA	CA	91942	3027	00	06000	32.77978322	-117.0094766	San Diego County
313658	Non-Physician Medical Practitioner	None	1144333642	0	0	GOLDFARB, DAVID S PA-C	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	1111 EXPOSITION BLVD	BLDG 700	SACRAMENTO	CA	95815	4314	00	06000	38.598876	-121.4502885	Sacramento County
313713	Non-Physician Medical Practitioner	None	1578554150	0	0	GUZMAN, RAMONA L	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	48677 VICTORIA LN	None	OAKHURST	CA	93644	9216	00	06000	37.32772782	-119.6601883	Madera County
313726	Non-Physician Medical Practitioner	None	1174332100	0	0	GARCIA, RUBEN NP	2/24/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	00	06000	33.994269	-117.3485375	Riverside County
313746	Non-Physician Medical Practitioner	None	1154509305	0	0	GILARDONE, PAUL J	10/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4535 SOUTH BLOSSER ROAD	None	SANTA MARIA	CA	93455	4148	00	06000	34.87365	-120.4540555	Santa Barbara County
313759	Non-Physician Medical Practitioner	None	1750015715	0	0	GIRON, ADRIANA	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	5725 S SOTO ST	None	HUNTINGTON PARK	CA	90255	9993	00	06000	33.990444	-118.2193965	Los Angeles County
313781	Non-Physician Medical Practitioner	None	1235843962	0	0	GLASGOW, LEIGH E 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	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	00	06000	38.567007	-121.468068	Sacramento County
313784	Non-Physician Medical Practitioner	None	1811961923	0	0	GERHART, ANN ELIZABETH	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34800 BOB WILSON DR	NMCSD, ATTN: MEDICAL STA	SAN DIEGO	CA	92134	1098	00	06000	32.724567	-117.145467	San Diego County
313790	Non-Physician Medical Practitioner	None	1144949660	0	0	GENDRON, DANIEL J NP	1/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47111 MONROE ST	None	INDIO	CA	92201	6739	00	06000	33.70620698	-116.2339008	Riverside County
313826	Non-Physician Medical Practitioner	None	1174105589	0	0	GALLEGOS, CYNTHIA NP	9/29/2023	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
313838	Non-Physician Medical Practitioner	None	1790866937	0	0	GRIFFIN, KATHERINE P	5/3/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	770 MASON ST	None	VACAVILLE	CA	95688	4646	00	06000	38.35504697	-121.983852	Solano County
313851	Non-Physician Medical Practitioner	None	1013361435	0	0	GREEN, TAMMY	11/18/2024	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
313859	Non-Physician Medical Practitioner	None	1982855698	0	0	GASQUE, DOE D 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	18564 US HWY 18	104	APPLE VALLEY	CA	92307	2321	00	06000	34.53926652	-117.2592564	San Bernardino County
313861	Non-Physician Medical Practitioner	None	1619343654	0	0	GHANNADI, SARA PA	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	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	00	06000	33.82476552	-117.994914	Orange County
313876	Non-Physician Medical Practitioner	None	1770164295	0	0	GURON, REBECCA L 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	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
313899	Non-Physician Medical Practitioner	None	1578318283	0	0	GONZALES, KRISTI MARES	10/9/2024	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
313918	Non-Physician Medical Practitioner	None	1821552308	0	0	GAMBRELL, PAMELA NP	6/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	00	06000	34.52471945	-117.3042336	San Bernardino County
313929	Non-Physician Medical Practitioner	None	1023059318	0	0	GATES, LAWRENCE DAVID	11/16/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N. PEPPER AVENUE	None	COLTON	CA	92324	0000	00	06000	34.073505	-117.3505995	San Bernardino County
313951	Non-Physician Medical Practitioner	None	1467940106	0	0	GONZALEZ, DIANA N NP	6/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	680 EPIC WAY	UNIT 407	SAN JOSE	CA	95134	2870	00	06000	37.40073045	-121.9190583	Santa Clara County
313966	Non-Physician Medical Practitioner	None	1144728361	0	0	GILL, HARMAN K PA	2/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	777 CAMPUS COMMONS RD	SUITE 120	SACRAMENTO	CA	95825	8343	00	06000	38.571021	-121.416786	Sacramento County
314024	Non-Physician Medical Practitioner	None	1659459030	0	0	GRAY, PATRICK L	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	230 CARDINAL LANE	None	RIVERSIDE	CA	92507	1212	00	06000	34.01851052	-117.3193335	Riverside County
314040	Non-Physician Medical Practitioner	None	1487908463	0	0	GREEN, SARAH B NP	10/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1027 S BEDFORD ST	APT 2	LOS ANGELES	CA	90035	2118	00	06000	34.05849881	-118.3804332	Los Angeles County
314041	Non-Physician Medical Practitioner	None	1083963532	0	0	GRAHAM, STACEY D NP	4/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
314049	Non-Physician Medical Practitioner	None	1578214128	0	0	GIN, MCKENNA N PA	6/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
314075	Non-Physician Medical Practitioner	None	1912195744	0	0	GEHLKEN, DAVID A	2/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1025 VIA SINUOSO	None	CHULA VISTA	CA	91910	7038	00	06000	32.63134101	-117.0131869	San Diego County
314089	Non-Physician Medical Practitioner	None	1891081311	0	0	GROSSMAN, LEAH N NP	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	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
314092	Non-Physician Medical Practitioner	None	1548857162	0	0	GIROUARD, MARLENA NP	2/1/2021	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
314112	Non-Physician Medical Practitioner	None	1891188454	0	0	GONZALEZ, MARINA N V	10/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2159 MENTONE BLVD	None	MENTONE	CA	92359	9594	00	06000	34.06976349	-117.115605	San Bernardino County
314114	Non-Physician Medical Practitioner	None	1831425875	0	0	GUERRA, JENNIFER K	10/29/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4687 RAWHIDE ST	None	MONTCLAIR	CA	91763	6142	00	06000	34.05525952	-117.7027875	San Bernardino County
314169	Non-Physician Medical Practitioner	None	1922503085	0	0	GOODE, JOANNE P 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	161 S UPAS STREET	None	ESCONDIDO	CA	92025	3945	00	06000	33.11419171	-117.093459	San Diego County
314170	Non-Physician Medical Practitioner	None	1750681714	0	0	GUERRERO, JOANNA	12/14/2010	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	SUITE 230	CASTRO VALLEY	CA	94546	5331	00	06000	37.69836512	-122.0873587	Alameda County
314172	Non-Physician Medical Practitioner	None	1295971158	0	0	GAMBLES FARR, SAMANTHA A	6/25/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5477 WOLVERINE TER	None	CARLSBAD	CA	92010	7159	00	06000	33.14410143	-117.2780951	San Diego County
314181	Non-Physician Medical Practitioner	None	1326596073	0	0	GARTON, ANNA M NP	5/7/2019	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
314221	Non-Physician Medical Practitioner	None	1477978344	0	0	GILL, ASHLEY G 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	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
314237	Non-Physician Medical Practitioner	None	1518274919	0	0	GOODWIN, RACHEL K CNM	6/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
314251	Non-Physician Medical Practitioner	None	1720396633	0	0	GENTY, ALEXANDER R NP	7/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	101 CIVIC CTR LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	06000	34.480224	-114.3390555	Mohave County
314299	Non-Physician Medical Practitioner	None	1326673542	0	0	GONZALEZ, KIMBERLY PA-C	10/14/2020	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
314304	Non-Physician Medical Practitioner	None	1760255863	0	0	GRANGER, KELSEY	12/11/2024	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
314310	Non-Physician Medical Practitioner	None	1942637434	0	0	GREENWELL, BARBARA NP	7/1/2022	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
314313	Non-Physician Medical Practitioner	None	1194109264	0	0	GATES, TAESIA C NP	12/1/2022	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
314351	Non-Physician Medical Practitioner	None	1417372186	0	0	GORA, KELLI C NP	10/9/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	771 EDGEMOOR RD	None	BIG BEAR LAKE	CA	92315	1619	00	06000	34.23872594	-116.9303726	San Bernardino County
314382	Non-Physician Medical Practitioner	None	1891960712	0	0	GOLEC, ERIN	8/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	00	06000	36.65911769	-121.6448024	Monterey County
314400	Non-Physician Medical Practitioner	None	1841530169	0	0	GILDEN, JENNIFER L	11/20/2023	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	SUITE 203-2	RIVERSIDE	CA	92506	0173	00	06000	33.9760171	-117.3860626	Riverside County
314416	Non-Physician Medical Practitioner	None	1124268479	0	0	GRAY, JULIE K	1/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	448 N POINSETTIA PL	None	LOS ANGELES	CA	90036	2505	00	06000	34.07965999	-118.3486491	Los Angeles County
314422	Non-Physician Medical Practitioner	None	1376027235	0	0	GROSSMAN, MEGAN D PA	8/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1818 VERDUGO BLVD	STE 200	GLENDALE	CA	91208	1408	00	06000	34.20560177	-118.216054	Los Angeles County
314430	Non-Physician Medical Practitioner	None	1710794615	0	0	GERBRACHT, WYATT NP	1/22/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	880 OAK PARK BLVD	STE 201	ARROYO GRANDE	CA	93420	1821	00	06000	35.13368306	-120.6053585	San Luis Obispo County
314455	Non-Physician Medical Practitioner	None	1174566707	0	0	GRIFFITH, KRISTINE Z PA-C	8/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6631 AUTUMN GLEN CT	None	RANCHO CUCAMONGA	CA	91701	9218	00	06000	34.13381823	-117.5536142	San Bernardino County
314468	Non-Physician Medical Practitioner	None	1346735925	0	0	GRIPE, LINDSEY N NP	9/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1001 BELMONT AVE	APT 306	LONG BEACH	CA	90804	5965	00	06000	33.77937499	-118.1448234	Los Angeles County
314481	Non-Physician Medical Practitioner	None	1982980397	0	0	GEAR, FRIEDA EDITH	4/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2422 N GRANDVIEW BLVD	None	WAUKESHA	WI	53188	6105	00	06000	43.03741587	-88.25589969	Waukesha County
314489	Non-Physician Medical Practitioner	None	1982948295	0	0	GATICALES, JOSE R K	8/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	8337 FOX BROOK ST	None	LAS VEGAS	NV	89139	6755	00	06000	36.037035	-115.241968	Clark County
314597	Non-Physician Medical Practitioner	None	1871268730	0	0	GACII, MARY CNM	10/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	00	06000	33.12123297	-117.1199417	San Diego County
314601	Non-Physician Medical Practitioner	None	1053036897	0	0	GEILER, SCOTT D PA	4/13/2023	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
314618	Non-Physician Medical Practitioner	None	1780121582	0	0	GIKUHI, JOTHAM K NP	8/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 SOUTH E STREET	None	SANTA ROSA	CA	95404	5132	00	06000	38.435895	-122.706396	Sonoma County
314661	Non-Physician Medical Practitioner	None	1427068972	0	0	GOTTESFELD, STEVEN M PA-C	8/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVENUE	SUITE 650	LA JOLLA	CA	92037	1224	00	06000	32.882913	-117.226341	San Diego County
314680	Non-Physician Medical Practitioner	None	1780885673	0	0	GOOSSEN, MICHELLE H	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	132 AVENIDA BARCELONA	None	SAN CLEMENTE	CA	92672	4244	00	06000	33.42142388	-117.6111233	Orange County
314691	Non-Physician Medical Practitioner	None	1013785765	0	0	GILBERT, HALI PA	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	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
314696	Non-Physician Medical Practitioner	None	1326072950	0	0	GONZALES, LIONEL MADRID	8/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	SUITE 503	ORANGE	CA	92868	3854	00	06000	33.78236048	-117.8664975	Orange County
314757	Non-Physician Medical Practitioner	None	1104229178	0	0	GATMAITAN, DYANE L NP	5/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13119 MIRA MAR DRIVE	None	SYLMAR	CA	91342	3470	00	06000	34.31103667	-118.4056749	Los Angeles County
314766	Non-Physician Medical Practitioner	None	1689240780	0	0	GRAYSON, COURTNEY N PA	8/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 CHESTER AVENUE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
314789	Non-Physician Medical Practitioner	None	1952836025	0	0	GOMEZ, ELSA NP	3/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1424 HOLLOWELL ST	None	ONTARIO	CA	91762	2810	00	06000	34.066422	-117.6777495	San Bernardino County
314800	Non-Physician Medical Practitioner	None	1982363412	0	0	GIBSON, SHAELYN	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	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
314813	Non-Physician Medical Practitioner	None	1134641319	0	0	GONZALES, KAYLAH B	10/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 WEST HENDERSON AVE	None	PORTERVILLE	CA	93257	1731	00	06000	36.0804034	-119.0217006	Tulare County
314840	Non-Physician Medical Practitioner	None	1477754315	0	0	GARZA, JOSHUA	9/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5530 GEORGIA DR	None	BAKERSFIELD	CA	93308	9304	00	06000	35.40854314	-119.0022762	Kern County
314851	Non-Physician Medical Practitioner	None	1306305396	0	0	GOLDIN, JULIA RN CNM	2/9/2021	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
314870	Non-Physician Medical Practitioner	None	1013256833	0	0	GALLO, LARISA A	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	733 N KINGS ROAD	APT 219	LOS ANGELES	CA	90069	5913	00	06000	34.08454269	-118.3717873	Los Angeles County
314871	Non-Physician Medical Practitioner	None	1376908830	0	0	GARDNER, ARIEL C PA-C	9/27/2019	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
314886	Non-Physician Medical Practitioner	None	1083014559	0	0	GOREHAM, DEBORAH L NP	12/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13011 SYLVA LANE	None	SONORA	CA	95370	6913	00	06000	37.98615415	-120.3605832	Tuolumne County
314911	Non-Physician Medical Practitioner	None	1053811570	0	0	GARCIA, YVETTE P NP	3/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18397 JACKSON AVE	None	LEMOORE	CA	93245	9541	00	06000	36.25462202	-119.7881936	Kings County
314920	Non-Physician Medical Practitioner	None	1396181475	0	0	GALARZA, RICHARD A PA-C	5/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
314922	Non-Physician Medical Practitioner	None	1164730131	0	0	GARCIA, MICHELLE M NP	9/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5276 COLODNY DRIVE	UNIT D	AGOURA HILLS	CA	91301	4931	00	06000	34.14498169	-118.7417607	Los Angeles County
314969	Non-Physician Medical Practitioner	None	1518010628	0	0	GUIEB, TESSIE M	10/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 SERENO DRIVE	None	VALLEJO	CA	94589	0000	00	06000	38.12828446	-122.24821	Solano County
314974	Non-Physician Medical Practitioner	None	1679350896	0	0	GONZALEZ, ELIDA PA	6/6/2024	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
315012	Non-Physician Medical Practitioner	None	1265640734	0	0	GREENFIELD, TENNILLE	9/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 E VALENCIA MESA DR	SUITE 105	FULLERTON	CA	92835	3813	00	06000	33.89343304	-117.9279349	Orange County
315035	Non-Physician Medical Practitioner	None	1558433516	0	0	GRIFFIN, JAN JOHNSON	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	391 TAYLOR BLVD	SUITE 250	PLEASANT HILL	CA	94523	2294	00	06000	37.96119614	-122.070409	Contra Costa County
315115	Non-Physician Medical Practitioner	None	1598132128	0	0	GWILLIAM, LISA D NP	11/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3419 SOYLA DR	None	OCEANSIDE	CA	92058	7488	00	06000	33.22475743	-117.3471056	San Diego County
315133	Non-Physician Medical Practitioner	None	1275860470	0	0	GIBBONEY, KATHE B NP	7/7/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	617 VETERANS BLVD	STE 101	REDWOOD CITY	CA	94063	1496	00	06000	37.4924484	-122.2318516	San Mateo County
315155	Non-Physician Medical Practitioner	None	1659602720	0	0	GRIGORIAN, ALEX S	7/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10691 BATON ROUGE AVE	None	PORTER RANCH	CA	91326	2905	00	06000	34.26421359	-118.5527925	Los Angeles County
315167	Non-Physician Medical Practitioner	None	1003353723	0	0	GEVSHANYAN, LUIZA K NP	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	7033 MATILIJA AVE	None	VAN NUYS	CA	91405	3332	00	06000	34.198542	-118.433488	Los Angeles County
315172	Non-Physician Medical Practitioner	None	1700294576	0	0	GREWAL, GURPREET S NP	9/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4018 THATCH AVE	None	BAKERSFIELD	CA	93313	2949	00	06000	35.3090103	-119.0460311	Kern County
315180	Non-Physician Medical Practitioner	None	1649243437	0	0	GEARE, JOSEPH P	9/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2616 WITHINGTON WAY	None	LAKEPORT	CA	95453	6943	00	06000	39.06633681	-122.9277009	Lake County
315190	Non-Physician Medical Practitioner	None	1750056255	0	0	GRIFFIN, VALERIE NP	7/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MISSION BLVD	None	JACKSON	CA	95642	2564	00	06000	38.35007723	-120.7659932	Amador County
315236	Non-Physician Medical Practitioner	None	1669803441	0	0	GOMES, AMBER N	6/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2321 S HAMPTON CIR	None	SANTA ROSA	CA	95401	8804	00	06000	38.44971	-122.7587625	Sonoma County
315265	Non-Physician Medical Practitioner	None	1932646734	0	0	GALVAN, SAMANTHA R NP	4/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2127 MANZANA WAY	None	SAN DIEGO	CA	92139	4017	00	06000	32.69095766	-117.0236284	San Diego County
315272	Non-Physician Medical Practitioner	None	1073160958	0	0	GETZ, LEAH R PA-C	10/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27800 MEDICAL CENTER RD	#310	MISSION VIEJO	CA	92691	6461	00	06000	33.55952733	-117.6645199	Orange County
315290	Non-Physician Medical Practitioner	None	1487486395	0	0	GILL, AMRUTA NP	8/23/2024	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
315335	Non-Physician Medical Practitioner	None	1710652375	0	0	GOMEZ, JESSICA A	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	350 S OAK AVE	None	OAKDALE	CA	95361	3519	00	06000	37.75764557	-120.8600743	Stanislaus County
315359	Non-Physician Medical Practitioner	None	1295050920	0	0	GARABEDIAN, TALINE GRACE	5/13/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5970 S CENTRAL AVE	None	LOS ANGELES	CA	90001	1150	00	06000	33.985584	-118.256433	Los Angeles County
315382	Non-Physician Medical Practitioner	None	1568991081	0	0	GAUVAIN, ALLISON E NP	9/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1214 WEST 1ST ST	None	RENO	NV	89503	5540	00	06000	39.52248066	-119.8292442	Washoe County
315392	Non-Physician Medical Practitioner	None	1811310287	0	0	GARROVILLAS, SABRINA Y NP	3/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25031 KATIE AVENUE	None	LAGUNA HILLS	CA	92653	4322	00	06000	33.60437154	-117.693351	Orange County
315396	Non-Physician Medical Practitioner	None	1649411489	0	0	GOULD, MICHELLE M NP	4/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	111 COLUMBIA AVE	None	REDWOOD CITY	CA	94063	3612	00	06000	37.46942476	-122.2082054	San Mateo County
315407	Non-Physician Medical Practitioner	None	1013391358	0	0	GULTOM, MARIA NP	1/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1826 GARVEY AVE	APT 2	ALHAMBRA	CA	91803	4232	00	06000	34.06330496	-118.1537315	Los Angeles County
315409	Non-Physician Medical Practitioner	None	1609361252	0	0	GANDASETIAWAN, PATRICIA 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	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	00	06000	33.91745451	-117.9133065	Orange County
315444	Non-Physician Medical Practitioner	None	1114295458	0	0	GOODMAN, MOLLIE	5/23/2012	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	5TH FLOOR	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
315446	Non-Physician Medical Practitioner	None	1962832089	0	0	GITAU, AGNES W NP	6/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7600 HOSPITAL DR	STE G	SACRAMENTO	CA	95823	5406	00	06000	38.463876	-121.414698	Sacramento County
315478	Non-Physician Medical Practitioner	None	1154801280	0	0	GUERRERO, JOHN F NP	7/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
315500	Non-Physician Medical Practitioner	None	1740908995	0	0	GROB, GILDA PA-C	3/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
315508	Non-Physician Medical Practitioner	None	1982991576	0	0	GLEASON, GRACE NP	3/21/2023	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
315600	Non-Physician Medical Practitioner	None	1932241619	0	0	GEORGE, TONYA C PA-C	7/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	00	06000	34.069509	-118.383743	Los Angeles County
315621	Non-Physician Medical Practitioner	None	1043941651	0	0	GONZALEZ, BENJAMIN PA-C	4/19/2024	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
315629	Non-Physician Medical Practitioner	None	1538317110	0	0	GEORGENS, SILVIE A PA	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	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	00	06000	32.83133206	-117.1252363	San Diego County
315633	Non-Physician Medical Practitioner	None	1053423608	0	0	GEHRINGER, SHARON K	12/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	507 ALTIVO AVE	None	LA SELVA BEACH	CA	95076	1609	00	06000	36.94186816	-121.8586001	Santa Cruz County
315654	Non-Physician Medical Practitioner	None	1699238899	0	0	GARRISON, LINDSAY E PA	1/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1405 MAGNOLIA AVE	STE A	CHICO	CA	95926	3226	00	06000	39.74046859	-121.8497839	Butte County
315671	Non-Physician Medical Practitioner	None	1598205056	0	0	GALAVIZ, MARICELA A	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	294 CINNAMON OAK AVE	None	VENTURA	CA	93004	1390	00	06000	34.2956387	-119.1528973	Ventura County
315673	Non-Physician Medical Practitioner	None	1376101105	0	0	GONZALEZ, LYDONA F NP	1/10/2023	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
315726	Non-Physician Medical Practitioner	None	1437136348	0	0	GUTIERREZ, LINDA TELLO	10/7/2002	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 201	FRESNO	CA	93701	2125	00	06000	36.74500687	-119.7846885	Fresno County
315730	Non-Physician Medical Practitioner	None	1043445349	0	0	GORDON, DAVID MICHAEL	12/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 PARNASSUS AVE	SUITE 404	SAN FRANCISCO	CA	94117	3608	00	06000	37.76403932	-122.4561371	San Francisco County
315745	Non-Physician Medical Practitioner	None	1013581941	0	0	GARIA, CHRISTIAN J 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	47111 MONROE ST	None	INDIO	CA	92201	6739	00	06000	33.70620698	-116.2339008	Riverside County
315746	Non-Physician Medical Practitioner	None	1184464075	0	0	GALIZA, LAWRENCE	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	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	00	06000	35.39052148	-119.0070765	Kern County
315774	Non-Physician Medical Practitioner	None	1083940514	0	0	GARCIA, JAVIER C PA-C	8/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4770 W HERNDON AVE	STE 111	FRESNO	CA	93722	8401	00	06000	36.83717984	-119.8778388	Fresno County
315780	Non-Physician Medical Practitioner	None	1558891218	0	0	GOLDING, LAUREN PA	2/24/2024	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
315781	Non-Physician Medical Practitioner	None	1154623601	0	0	GRAY, RACHEL M	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	2046 HOOPA RD	None	W SACRAMENTO	CA	95691	5242	00	06000	38.53839967	-121.5364382	Yolo County
315807	Non-Physician Medical Practitioner	None	1285062489	0	0	GOOSE LAKE MEDICAL SERVICES	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	535 S MAIN ST	None	ALTURAS	CA	96101	4114	00	06000	41.4803401	-120.5425134	Modoc County
315811	Non-Physician Medical Practitioner	None	1902455215	0	0	GEVORKIAN, LIANA M NP	6/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1509 WILSON TER	None	GLENDALE	CA	91206	4007	00	06000	34.14950866	-118.2311155	Los Angeles County
315817	Non-Physician Medical Practitioner	None	1538130638	0	0	GRAHAM, NICOLE	8/19/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 LOCUST SREET	None	SANTA CRUZ	CA	95060	0000	00	06000	36.97519309	-122.027024	Santa Cruz County
315838	Non-Physician Medical Practitioner	None	1861948952	0	0	GOVE, SAMANTHA A NP	5/13/2018	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
315858	Non-Physician Medical Practitioner	None	1164966842	0	0	GOLDBERG, MARIE PA-C	4/26/2018	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
315869	Non-Physician Medical Practitioner	None	1659842615	0	0	GOMEZ, ALEXIS J M NP	1/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5333 BALTIMORE DR	STE 6	LA MESA	CA	91942	2085	00	06000	32.77607122	-117.0275784	San Diego County
315870	Non-Physician Medical Practitioner	None	1457488033	0	0	GRANATO, GREG	8/18/2008	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	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315871	Non-Physician Medical Practitioner	None	1013690395	0	0	GUNTER, KENA NP	9/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24422 AVENIDA DE LA CARL	130	LAGUNA HILLS	CA	92653	3636	00	06000	33.56726005	-117.705397	Orange County
315873	Non-Physician Medical Practitioner	None	1447795661	0	0	GOSHEN, KIRSTEN NP	1/22/2021	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 570	LA JOLLA	CA	92037	1224	00	06000	32.882913	-117.226341	San Diego County
315883	Non-Physician Medical Practitioner	None	1982785739	0	0	GUZMAN, HORTENCIA	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	744 CAMINITO OBISPO	APT 5	CHULA VISTA	CA	91913	1790	00	06000	32.62995	-116.982504	San Diego County
315884	Non-Physician Medical Practitioner	None	1649624040	0	0	GREEN, RICHARD A JR	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	427 RICHMOND AVE	None	CLOVIS	CA	93619	7670	00	06000	36.85800106	-119.7063342	Fresno County
315920	Non-Physician Medical Practitioner	None	1316311517	0	0	GOMEZ, JENNIFER M	6/16/2023	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
315968	Non-Physician Medical Practitioner	None	1992960843	0	0	GADDAM, ISAAC P NP	6/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2516 E WHITMORE AVE	None	CERES	CA	95307	2645	00	06000	37.59473849	-120.9489745	Stanislaus County
315982	Non-Physician Medical Practitioner	None	1437811528	0	0	GUZMAN, MARICELA L 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	1671 W MAIN STREET	SUITE A	EL CENTRO	CA	92243	5420	00	06000	32.79277051	-115.5732165	Imperial County
316017	Non-Physician Medical Practitioner	None	1437314960	0	0	GUPTA, SHWETA 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	19312 EMPTY SADDLE RD	None	WALNUT	CA	91789	4285	00	06000	34.02136559	-117.8810995	Los Angeles County
316027	Non-Physician Medical Practitioner	None	1568816916	0	0	GROH, JULIA W	8/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1006 WEST DOROTHY DRIVE	None	BREA	CA	92821	2015	00	06000	33.942204	-117.911551	Orange County
316037	Non-Physician Medical Practitioner	None	1407556624	0	0	GONG, KARAH PA-C	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	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
316038	Non-Physician Medical Practitioner	None	1407490501	0	0	GALVEZ, CYNTHIA A PA-C	5/10/2021	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
316039	Non-Physician Medical Practitioner	None	1528184751	0	0	GUILLEMIN-WILLIAMS, MONICA R	2/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3384 CLIPPER DR	None	CHINO HILLS	CA	91709	2809	00	06000	33.96996147	-117.7304538	San Bernardino County
316044	Non-Physician Medical Practitioner	None	1851599427	0	0	GALICIA, CHRISTIAN R	11/30/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	171 W VALENCIA AVE	APT D	BURBANK	CA	91502	2045	00	06000	34.17000584	-118.3059788	Los Angeles County
316054	Ordering, Referring, Prescribing	N/A	1003002288	0	0	GICHURU, STEPHEN N PA-C	12/27/2017	Taxonomy not applicable	NA	n/a	000	Unknown	PA15965	N/A	N/A	N/A	N/A	N/A	409 E MERCED	A	WEST COVINA	CA	91790	0000	00	06000	34.05501985	-117.9380648	Los Angeles County
316064	Ordering, Referring, Prescribing	N/A	1003023946	0	0	GOLD, KAREN	6/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14779	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
316068	Ordering, Referring, Prescribing	N/A	1003036559	0	0	GIBSON, CHRISTINE E CNM	6/5/2015	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	497691	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
316094	Ordering, Referring, Prescribing	N/A	1003104514	0	0	GARCIA, KARIN W LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40924	N/A	N/A	N/A	N/A	N/A	8337 TELEGRAPH RD	115	PICO RIVERA	CA	90660	4940	00	06000	33.96454327	-118.1134473	Los Angeles County
316119	Ordering, Referring, Prescribing	N/A	1003140476	0	0	GUERRERO, LINDA G LCSW	12/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89025	N/A	N/A	N/A	N/A	N/A	695 S. VERMONT AVENUE	None	LOS ANGELES	CA	90005	1101	00	06000	34.06078495	-118.2916863	Los Angeles County
316146	Ordering, Referring, Prescribing	N/A	1003177742	0	0	GOH, JANELLE J LCSW	3/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27255	N/A	N/A	N/A	N/A	N/A	2400 WIBLE ROAD	14	BAKERSFIELD	CA	93304	4734	00	06000	35.3328934	-119.0389535	Kern County
316167	Ordering, Referring, Prescribing	N/A	1003209933	0	0	GONZALEZ, LETICIA M NP	12/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95002251	N/A	N/A	N/A	N/A	N/A	1357 OAKLAND BOULEVARD	None	WALNUT CREEK	CA	94596	4303	00	06000	37.89795717	-122.0701674	Contra Costa County
316174	Ordering, Referring, Prescribing	N/A	1003214792	0	0	GREEN, KAITLYN M LCSW	6/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88897	N/A	N/A	N/A	N/A	N/A	12000 ENTERPRISE DR	None	AUBURN	CA	95603	3730	00	06000	38.90876842	-121.0843219	Placer County
316205	Ordering, Referring, Prescribing	N/A	1003261892	0	0	GUENTHER, TIMOTHY MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151538	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
316213	Ordering, Referring, Prescribing	N/A	1003269937	0	0	GARLAPATI, PRANAV MD	3/24/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162905	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
316225	Ordering, Referring, Prescribing	N/A	1003281510	0	0	GATEWOOD, GABRIELLE LMFT	11/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142856	N/A	N/A	N/A	N/A	N/A	4411 E KINGS CANYON ROAD	319	FRESNO	CA	93702	3604	00	06000	36.73594649	-119.7521955	Fresno County
316230	Ordering, Referring, Prescribing	N/A	1003288770	0	0	GARCIA, EVA A NP	9/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022665	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	6002	00	06000	34.25974984	-119.2179337	Ventura County
316245	Ordering, Referring, Prescribing	N/A	1003304031	0	0	GOLDEN, JENNIFER M DO	3/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	17692	N/A	N/A	N/A	N/A	N/A	1130 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
316274	Ordering, Referring, Prescribing	N/A	1003356056	0	0	GHAITH, NADA	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74253	N/A	N/A	N/A	N/A	N/A	215 N 2ND STREET	None	EL CAJON	CA	92021	7243	00	06000	32.796792	-116.935631	San Diego County
316295	Ordering, Referring, Prescribing	N/A	1003385113	0	0	GARCIA, ADRIAN	11/19/2020	Taxonomy not applicable	NA	n/a	000	Unknown	3663	N/A	N/A	N/A	N/A	N/A	9401 PAINTER AVE.	None	WHITTIER	CA	90605	9060	00	06000	33.953337	-118.046439	Los Angeles County
316299	Ordering, Referring, Prescribing	N/A	1003384520	0	0	GUPTA, ASHNA PA	2/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55992	N/A	N/A	N/A	N/A	N/A	1130 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
316300	Ordering, Referring, Prescribing	N/A	1003394123	0	0	GOTTSCHALK, ANDREA LPCC	6/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC10223	N/A	N/A	N/A	N/A	N/A	6386 ALVARADO CT	SUITE 310	SAN DIEGO	CA	92120	4905	00	06000	32.77666838	-117.0614255	San Diego County
316303	Ordering, Referring, Prescribing	N/A	1003394511	0	0	GOLANI, RAHUL D	3/22/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103000	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
316313	Ordering, Referring, Prescribing	N/A	1003408113	0	0	GALDO, CHELSEA PA-C	2/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA59169	N/A	N/A	N/A	N/A	N/A	4631 TELLER AVE	100	NEWPORT BEACH	CA	92660	8105	00	06000	33.66641504	-117.857408	Orange County
316359	Ordering, Referring, Prescribing	N/A	1003475286	0	0	GULWANI, KARIMA NP	4/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012454	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
316362	Ordering, Referring, Prescribing	N/A	1003478587	0	0	GROVER, ELIZABETH V	10/27/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105306	N/A	N/A	N/A	N/A	N/A	172 E GRANT AVE	None	WINTERS	CA	95694	1780	00	06000	38.5264496	-121.9668052	Yolo County
316384	Ordering, Referring, Prescribing	N/A	1003518457	0	0	GALINDO-GUERRERO, ANABELL LCSW	3/23/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88273	N/A	N/A	N/A	N/A	N/A	1855 N FAIR OAKS	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
316434	Ordering, Referring, Prescribing	N/A	1003917097	0	0	GUERRERO, KHANH-LINH PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55655	N/A	N/A	N/A	N/A	N/A	700 LAWRENCE EXPY	DEPT 162 CLINICAL PHARMA	SANTA CLARA	CA	95051	5173	00	06000	37.33578	-121.999329	Santa Clara County
316461	Ordering, Referring, Prescribing	N/A	1003953936	0	0	GOPALAN, SHANTI DDS	5/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	55853	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	ALPINE	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego County
316540	Ordering, Referring, Prescribing	N/A	1013102797	0	0	GARCIA, JUAN M LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85999	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
316544	Ordering, Referring, Prescribing	N/A	1013101161	0	0	GORDON, KENYETTA M MD	5/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C186176	N/A	N/A	N/A	N/A	N/A	1675 NORTHCREST DR	None	CRESCENT CITY	CA	95531	8928	00	06000	41.77547021	-124.1998045	Del Norte County
316574	Ordering, Referring, Prescribing	N/A	1013172477	0	0	GREEN, HARRY OD	3/18/2024	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	13578	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
316575	Ordering, Referring, Prescribing	N/A	1013172535	0	0	GILMER, BRIAN B MD	11/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131091	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
316599	Ordering, Referring, Prescribing	N/A	1013215433	0	0	GLYNN, MAUREEN LMFT	9/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127950	N/A	N/A	N/A	N/A	N/A	4190 DOUGLAS BLVD.	SUITE 300	ROSEVILLE	CA	95746	5918	00	06000	38.740617	-121.2229935	Placer County
316606	Ordering, Referring, Prescribing	N/A	1013221233	0	0	GIRARDEY, BRIGETTE LMFT	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105242	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN.	None	CONCORD	CA	94519	2651	00	06000	37.98393807	-122.0466953	Contra Costa County
316651	Ordering, Referring, Prescribing	N/A	1013301290	0	0	GOITIA, JESSE J JR MD	12/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145083	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
316657	Ordering, Referring, Prescribing	N/A	1013311620	0	0	GIN, LUCY D NP	10/1/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001548	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
316665	Ordering, Referring, Prescribing	N/A	1013315563	0	0	GWALTNEY, KELLIE CNM	9/8/2019	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	235651	N/A	N/A	N/A	N/A	N/A	731 S HIGHLAND AVE	None	FULLERTON	CA	92832	2753	00	06000	33.863598	-117.928718	Orange County
316670	Ordering, Referring, Prescribing	N/A	1013332923	0	0	GALVEZ, CRISTINA PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68674	N/A	N/A	N/A	N/A	N/A	995 SPERRY AVE	None	PATTERSON	CA	95363	9262	00	06000	37.46446646	-121.1402745	Stanislaus County
316677	Ordering, Referring, Prescribing	N/A	1013342625	0	0	GACILAN, GILBERT S LCSW	12/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85152	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
316683	Ordering, Referring, Prescribing	N/A	1013349711	0	0	GUTIERREZ, WENDY M LMFT	12/31/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105657	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
316752	Ordering, Referring, Prescribing	N/A	1013453109	0	0	GAMAL, ELSAYED H	10/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75903	N/A	N/A	N/A	N/A	N/A	540 E VIRGINIA WAY.	103	BARSTOW	CA	92311	2891	00	06000	34.88811047	-117.01989	San Bernardino County
316807	Ordering, Referring, Prescribing	N/A	1013546878	0	0	GIBBONS, ERA MAE NP	9/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014355	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
316809	Ordering, Referring, Prescribing	N/A	1013569912	0	0	GILCHRIST, CAROLINE E LMFT	6/2/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133074	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
316815	Ordering, Referring, Prescribing	N/A	1013571231	0	0	GEKAS, ANDREA CNM	5/19/2021	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	CNM05379	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
316832	Ordering, Referring, Prescribing	N/A	1013634013	0	0	GARCIA, SANDRA NP	8/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022278	N/A	N/A	N/A	N/A	N/A	520 N MAIN ST	120	SANTA ANA	CA	92701	4623	00	06000	33.749316	-117.868123	Orange County
316855	Ordering, Referring, Prescribing	N/A	1013795921	0	0	GRANGER, OLIVIA G PA-C	10/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63576	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	None	VENTURA	CA	93004	1378	00	06000	34.29321532	-119.1597424	Ventura County
316875	Ordering, Referring, Prescribing	N/A	1023026523	0	0	GUERRERO, CARLOS	10/13/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	14967	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
316891	Ordering, Referring, Prescribing	N/A	1023105335	0	0	GIST, LAUREN MD	1/31/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81381	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
316905	Ordering, Referring, Prescribing	N/A	1023133014	0	0	GRANADO, DANA M OT	11/19/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	5746	N/A	N/A	N/A	N/A	N/A	19401 S. VERMONT AVE. SU	None	TORRANCE	CA	90502	9999	00	06000	33.85486409	-118.2905603	Los Angeles County
316938	Ordering, Referring, Prescribing	N/A	1023203122	0	0	GENUINO, ELMERIEL I PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59962	N/A	N/A	N/A	N/A	N/A	5571 DRIFTWOOD AVE	None	LA PALMA	CA	90623	1820	00	06000	33.84691514	-118.0359524	Orange County
317013	Ordering, Referring, Prescribing	N/A	1023369956	0	0	GALLY, AMBER A	9/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	22593	N/A	N/A	N/A	N/A	N/A	918 W. FOOTHILL BLVD	#A	UPLAND	CA	91786	3772	00	06000	34.10676594	-117.6636152	San Bernardino County
317035	Ordering, Referring, Prescribing	N/A	1023406543	0	0	GONZALEZ, KOURTNEY A LMFT	5/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101398	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
317038	Ordering, Referring, Prescribing	N/A	1023408044	0	0	GONG, KAY L	7/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26621	N/A	N/A	N/A	N/A	N/A	409 JACKSON ST	None	HAYWARD	CA	94544	1530	00	06000	37.66243575	-122.0841894	Alameda County
317049	Ordering, Referring, Prescribing	N/A	1023428232	0	0	GASCA, ANETTE LCSW	9/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110286	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
317103	Ordering, Referring, Prescribing	N/A	1023506367	0	0	GOGGIN, SAMANTHA MD	1/3/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163693	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
317113	Ordering, Referring, Prescribing	N/A	1023513413	0	0	GONZALEZ, GERALDO LMFT	3/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125933	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
317132	Ordering, Referring, Prescribing	N/A	1023556826	0	0	GARAFOLO, SUZANNE LCSW	12/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73519	N/A	N/A	N/A	N/A	N/A	406 SUNRISE AVE	STE 300	ROSEVILLE	CA	95661	4106	00	06000	38.73944898	-121.2720559	Placer County
317160	Ordering, Referring, Prescribing	N/A	1023595691	0	0	GARCIA ROSAS, RUTH A	6/19/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102478	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
317172	Ordering, Referring, Prescribing	N/A	1023635562	0	0	GRISTAN, YANA D MD	6/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186841	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
317173	Ordering, Referring, Prescribing	N/A	1023639788	0	0	GIRALDO, JANIEL V LMFT	7/1/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147791	N/A	N/A	N/A	N/A	N/A	2313 I STREET	None	EUREKA	CA	95501	4244	00	06000	40.78679534	-124.1601037	Humboldt County
317202	Ordering, Referring, Prescribing	N/A	1023697323	0	0	GILLIE, MONICA MD	11/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	8029	N/A	N/A	N/A	N/A	N/A	455 OCONNOR DR	SUITE 200	SAN JOSE	CA	95128	1632	00	06000	37.326654	-121.939897	Santa Clara County
317221	Ordering, Referring, Prescribing	N/A	1023766789	0	0	GELETYUK, OKSANA PA-C	3/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA60899	N/A	N/A	N/A	N/A	N/A	12586 AVENUE 408	None	OROSI	CA	93647	9454	00	06000	36.53030229	-119.2915122	Tulare County
317243	Ordering, Referring, Prescribing	N/A	1023899069	0	0	GUZMAN-IBARRA, ALEJANDRA PA-C	10/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63437	N/A	N/A	N/A	N/A	N/A	770 MAGNOLIA AVE	#2A	CORONA	CA	92879	3120	00	06000	33.85936872	-117.5534605	Riverside County
317276	Ordering, Referring, Prescribing	N/A	1033220405	0	0	GARCIA, LAURA NP	5/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP7825	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
317279	Ordering, Referring, Prescribing	N/A	1033233408	0	0	GARCIA, SYLVIA LMFT	6/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC46789	N/A	N/A	N/A	N/A	N/A	695 S. VERMONT AVE.	None	LOS ANGELES	CA	90005	1101	00	06000	34.06078495	-118.2916863	Los Angeles County
317292	Ordering, Referring, Prescribing	N/A	1033248216	0	0	GOOD, ISABEL D NP	2/10/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	236363	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
317294	Ordering, Referring, Prescribing	N/A	1033245766	0	0	GORDON-MARTINEZ, MARTA L LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106730	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
317299	Ordering, Referring, Prescribing	N/A	1033250477	0	0	GARBER, SILVIA	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49862	N/A	N/A	N/A	N/A	N/A	2080 S E ST	100	SAN BERNARDINO	CA	92408	2773	00	06000	34.06448311	-117.2895975	San Bernardino County
317300	Ordering, Referring, Prescribing	N/A	1033263538	0	0	GOLDBERG, RAE ANN	4/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41814	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
317346	Ordering, Referring, Prescribing	N/A	1033350996	0	0	GRAMS, VERONICA L LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98690	N/A	N/A	N/A	N/A	N/A	15339 SATICOY STREET	None	VAN NUYS	CA	91406	3345	00	06000	34.2084865	-118.4678505	Los Angeles County
317349	Ordering, Referring, Prescribing	N/A	1033353982	0	0	GREEN, ELLEN H MD	11/20/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	113954	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
317392	Ordering, Referring, Prescribing	N/A	1033398193	0	0	GONZALEZ, MARIA E LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80424	N/A	N/A	N/A	N/A	N/A	149 S. MEDNIK AVE., SUIT	None	LOS ANGELES	CA	90022	1606	00	06000	34.0354999	-118.1618625	Los Angeles County
317401	Ordering, Referring, Prescribing	N/A	1033442389	0	0	GROCHOWSKI, JANET L	5/1/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	59538	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVE	BUILDING 80 6TH FLOOR	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
317425	Ordering, Referring, Prescribing	N/A	1033475108	0	0	GUSTAFSON, LOLETA M LMFT	12/9/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49983	N/A	N/A	N/A	N/A	N/A	33445 YUCAIPA BLVD STE 2	None	YUCAIPA	CA	92399	0000	00	06000	34.03377987	-117.0744869	San Bernardino County
317432	Ordering, Referring, Prescribing	N/A	1033478748	0	0	GRAY, JEFFREY T MD	2/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G56251	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT STE 170	STE 170	SACRAMENTO	CA	95834	1658	00	06000	38.637702	-121.474773	Sacramento County
317439	Ordering, Referring, Prescribing	N/A	1033487707	0	0	GUSTAFSSON, CARINA B LMFT	4/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79609	N/A	N/A	N/A	N/A	N/A	31946 MISSION TRL	SUITE B	LAKE ELSINORE	CA	92530	4539	00	06000	33.65640803	-117.2979656	Riverside County
317491	Ordering, Referring, Prescribing	N/A	1033559331	0	0	GOLCHOOBIAN, TABASSOM P	8/20/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D42318	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
317537	Ordering, Referring, Prescribing	N/A	1033631742	0	0	GUZMAN LOPEZ, STEPHANIE A LCSW	5/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99443	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
317571	Ordering, Referring, Prescribing	N/A	1033676549	0	0	GO, KAITE NP	11/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008372	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
317582	Ordering, Referring, Prescribing	N/A	1033691241	0	0	GREENLEE, JEFFREY R JR DC	12/3/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33938	N/A	N/A	N/A	N/A	N/A	1121 E WASHINGTON AVE	None	ESCONDIDO	CA	92025	2254	00	06000	33.13236227	-117.0691443	San Diego County
317588	Ordering, Referring, Prescribing	N/A	1033698931	0	0	GUTIERREZ-ROMERO, JESSICA	4/16/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122040	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
317618	Ordering, Referring, Prescribing	N/A	1033770367	0	0	GONZALEZ, JUAN ANTONIO L LPCC	6/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	16813	N/A	N/A	N/A	N/A	N/A	1055 W HENDERSON AVE	SUITE 2	PORTERVILLE	CA	93257	1490	00	06000	36.08036906	-119.0410926	Tulare County
317630	Ordering, Referring, Prescribing	N/A	1033775812	0	0	GREWAL, KULRAJ MD	4/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	A185698	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
317631	Ordering, Referring, Prescribing	N/A	1033806260	0	0	GRAJALES, STEPHANIE LCSW	4/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114866	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
317648	Ordering, Referring, Prescribing	N/A	1033886007	0	0	GARCIA, ELIZABETH LMFT	5/21/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146989	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
317671	Ordering, Referring, Prescribing	N/A	1043219967	0	0	GREENBERG, MARK MD	6/4/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C196671	N/A	N/A	N/A	N/A	N/A	475 BRUCE STREET	None	YREKA	CA	96097	3483	00	06000	41.71860037	-122.6467317	Siskiyou County
317672	Ordering, Referring, Prescribing	N/A	1043213705	0	0	GONZALEZ, TAMMY L	9/18/2017	Taxonomy not applicable	NA	n/a	000	Unknown	16497	N/A	N/A	N/A	N/A	N/A	925 G ST	None	REEDLEY	CA	93654	2626	00	06000	36.59806483	-119.4526979	Fresno County
317693	Ordering, Referring, Prescribing	N/A	1043334204	0	0	GIANNINI, KAREN A LMFT	4/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40315	N/A	N/A	N/A	N/A	N/A	1029 N BROADWAY	None	ESCONDIDO	CA	92026	3043	00	06000	33.13421302	-117.0870941	San Diego County
317755	Ordering, Referring, Prescribing	N/A	1043437080	0	0	GALLEGATI, MARIO LMFT	7/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48237	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
317835	Ordering, Referring, Prescribing	N/A	1043604754	0	0	GRZENDA, ADRIENNE MD	11/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146893	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	0000	00	06000	34.32450186	-118.4456317	Los Angeles County
317868	Ordering, Referring, Prescribing	N/A	1043651599	0	0	GOLDMAN, MELANIE L LCSW	3/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100755	N/A	N/A	N/A	N/A	N/A	22978 EL TORO RD	None	LAKE FOREST	CA	92630	4961	00	06000	33.62895849	-117.6898866	Orange County
317875	Ordering, Referring, Prescribing	N/A	1043670128	0	0	GALLAHAN, QUENBY	10/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52980	N/A	N/A	N/A	N/A	N/A	5656 RATERS DR	None	SANTA ROSA	CA	95409	4314	00	06000	38.46492	-122.6487285	Sonoma County
317879	Ordering, Referring, Prescribing	N/A	1043677339	0	0	GOODMAN, MARY B NP	9/10/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003472	N/A	N/A	N/A	N/A	N/A	1316 THIRD ST PROMENADE	SUITE 201	SANTA MONICA	CA	90401	0401	00	06000	34.01670895	-118.497462	Los Angeles County
317899	Ordering, Referring, Prescribing	N/A	1043699929	0	0	GHOBADIMANESH, ALEXANDER DO	9/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17207	N/A	N/A	N/A	N/A	N/A	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	00	06000	34.01581788	-118.3348506	Los Angeles County
317917	Ordering, Referring, Prescribing	N/A	1043721707	0	0	GUO, SHUAISHUAI PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77648	N/A	N/A	N/A	N/A	N/A	2145 MARKET ST	None	SAN FRANCISCO	CA	94114	1321	00	06000	37.76677904	-122.4297101	San Francisco County
317936	Ordering, Referring, Prescribing	N/A	1043742588	0	0	GERWER, JOHANNA E MD	7/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169752	N/A	N/A	N/A	N/A	N/A	8788 JAMACHA RD	None	SPRING VALLEY	CA	91977	4035	00	06000	32.71482507	-117.0098243	San Diego County
317950	Ordering, Referring, Prescribing	N/A	1043758139	0	0	GIBSON, MARIN NP	8/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026958	N/A	N/A	N/A	N/A	N/A	3100 COHASSET RD	None	CHICO	CA	95973	0962	00	06000	39.77184653	-121.8436243	Butte County
317959	Ordering, Referring, Prescribing	N/A	1043768583	0	0	GUTIERREZ, GABRYEL T LMFT	6/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT128103	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
317967	Ordering, Referring, Prescribing	N/A	1043787930	0	0	GULETZ, HANNAH PA-C	11/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56245	N/A	N/A	N/A	N/A	N/A	7275 EAST SOUTHGATE DR.	204	SACRAMENTO	CA	95823	2629	00	06000	38.493576	-121.436559	Sacramento County
317976	Ordering, Referring, Prescribing	N/A	1043802465	0	0	GARCIA, MICHELLE A PT	11/4/2020	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	299395	N/A	N/A	N/A	N/A	N/A	4445 EASTGATE MALL	STE 103	SAN DIEGO	CA	92121	1979	00	06000	32.87856225	-117.2103399	San Diego County
317979	Ordering, Referring, Prescribing	N/A	1043823305	0	0	GALVEZ, GUILLERMO NP	8/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015216	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
317980	Ordering, Referring, Prescribing	N/A	1043810997	0	0	GARLEJO, SHURREN T LMFT	3/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131988	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
318012	Ordering, Referring, Prescribing	N/A	1043873623	0	0	GUERRERO, LEONOR LMFT	1/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130619	N/A	N/A	N/A	N/A	N/A	222 W SIXTH ST.	230	SAN PEDRO	CA	90731	9998	00	06000	33.73876969	-118.2824628	Los Angeles County
318024	Ordering, Referring, Prescribing	N/A	1043912678	0	0	GERLACH, JOHN MD	9/17/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A199099	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
318038	Ordering, Referring, Prescribing	N/A	1043946866	0	0	GRAHAM, SARAH CNM	4/28/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236369	N/A	N/A	N/A	N/A	N/A	500 COHASSET RD	15	CHICO	CA	95926	2260	00	06000	39.75142109	-121.8506286	Butte County
318040	Ordering, Referring, Prescribing	N/A	1043981574	0	0	GOVEA, AIME LMFT	12/8/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136296	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
318051	Ordering, Referring, Prescribing	N/A	1053035592	0	0	GILL, HARJEET K NP	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022622	N/A	N/A	N/A	N/A	N/A	760 E ALMOND AVE	None	MADERA	CA	93637	5617	00	06000	36.94546284	-120.04872	Madera County
318067	Ordering, Referring, Prescribing	N/A	1053094094	0	0	GREEN, KATHLEEN LCSW	11/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93383	N/A	N/A	N/A	N/A	N/A	6147 SUTTER AVE	None	CARMICHAEL	CA	95608	2738	00	06000	38.63325214	-121.3236304	Sacramento County
318069	Ordering, Referring, Prescribing	N/A	1053110049	0	0	GUTIERREZ RIVERA, JIMENA MD	2/28/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	P210001	N/A	N/A	N/A	N/A	N/A	1134 E CARTMILL AVE	None	TULARE	CA	93274	9610	00	06000	36.24056145	-119.3308446	Tulare County
318092	Ordering, Referring, Prescribing	N/A	1053329144	0	0	GABRIEL, ALYSE DO	12/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8893	N/A	N/A	N/A	N/A	N/A	2415 UNIVERSITY AVE	3RD FLOOR	EAST PALO ALTO	CA	94303	1164	00	06000	37.47232529	-122.139568	San Mateo County
318098	Ordering, Referring, Prescribing	N/A	1053351510	0	0	GRIFFITH, JOHN MD	7/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G38044	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
318101	Ordering, Referring, Prescribing	N/A	1053407940	0	0	GALLARDO, ROSA M	1/22/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA50940	N/A	N/A	N/A	N/A	N/A	7100 VAN NUYS BLVD	STE 108	VAN NUYS	CA	91405	3063	00	06000	34.19957761	-118.4487663	Los Angeles County
318112	Ordering, Referring, Prescribing	N/A	1053435586	0	0	GLANTZ, JULIE M LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20286	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR.	SUITE 200	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
318138	Ordering, Referring, Prescribing	N/A	1053465872	0	0	GARCIA, RACHELLE M LMFT	4/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53721	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
318147	Ordering, Referring, Prescribing	N/A	1053480046	0	0	GLAZE-JUNGWIRTH, VANESSA E N	12/28/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	365460	N/A	N/A	N/A	N/A	N/A	1014 SAN JUAN AVE	None	EXETER	CA	93221	1312	00	06000	36.29887348	-119.1316702	Tulare County
318167	Ordering, Referring, Prescribing	N/A	1053508648	0	0	GRAY, ASHLEY E	9/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48834	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	SUITE 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
318169	Ordering, Referring, Prescribing	N/A	1053506832	0	0	GOLDBACH, SHANE LMFT	2/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT131450	N/A	N/A	N/A	N/A	N/A	695 S VERMONT AVE	None	LOS ANGELES	CA	90005	1349	00	06000	34.06078495	-118.2916863	Los Angeles County
318176	Ordering, Referring, Prescribing	N/A	1053517961	0	0	GRAVATT, MICHAEL H	5/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	MD60147456	N/A	N/A	N/A	N/A	N/A	1607 E PLANTATION RD	None	MOHAVE VALLEY	AZ	86440	8420	00	06000	34.851987	-114.5952675	Mohave County
318180	Ordering, Referring, Prescribing	N/A	1053526236	0	0	GUDINO, MELINDA C LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82429	N/A	N/A	N/A	N/A	N/A	123 WEST GUTIERREZ STREE	None	SANTA BARBARA	CA	93003	3424	00	06000	34.41387023	-119.6962788	Santa Barbara County
318189	Ordering, Referring, Prescribing	N/A	1053543751	0	0	GAINES, EMILY K LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79569	N/A	N/A	N/A	N/A	N/A	299 TWELFTH ST.	SUITE A	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
318230	Ordering, Referring, Prescribing	N/A	1053623132	0	0	GONZALEZ, LUCIA	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97661	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST	None	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
318242	Ordering, Referring, Prescribing	N/A	1053644591	0	0	GREEN, RYAN C MSW LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61473	N/A	N/A	N/A	N/A	N/A	1211 5TH ST	None	EUREKA	CA	95501	0636	00	06000	40.80305422	-124.1581436	Humboldt County
318248	Ordering, Referring, Prescribing	N/A	1053663930	0	0	GOTTFRIED, DESIREE M LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114843	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
318261	Ordering, Referring, Prescribing	N/A	1053677526	0	0	GUERRERO, MARIA A PHARMD	4/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	43538	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
318317	Ordering, Referring, Prescribing	N/A	1053741124	0	0	GONZALES, MIRNA L LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT	N/A	N/A	N/A	N/A	N/A	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	00	06000	35.20895551	-118.839294	Kern County
318347	Ordering, Referring, Prescribing	N/A	1053781112	0	0	GALE, KIMBERLY A PHARMD	3/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65998	N/A	N/A	N/A	N/A	N/A	3420 ARDEN WAY	None	SACRAMENTO	CA	95825	2019	00	06000	38.59533	-121.384062	Sacramento County
318364	Ordering, Referring, Prescribing	N/A	1053798462	0	0	GILBERT, PAUL K LPCC	5/22/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7871	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
318365	Ordering, Referring, Prescribing	N/A	1053789446	0	0	GARAY ZECENA, SUSI R NP	8/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031588	N/A	N/A	N/A	N/A	N/A	9995 CARMEL MOUNTAIN RD	None	SAN DIEGO	CA	92129	2889	00	06000	32.96073738	-117.1119913	San Diego County
318370	Ordering, Referring, Prescribing	N/A	1053804773	0	0	GILL, PRUBDEEP S PHARMD	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75900	N/A	N/A	N/A	N/A	N/A	1591 GEER RD	None	TURLOCK	CA	95380	3200	00	06000	37.506834	-120.848997	Stanislaus County
318404	Ordering, Referring, Prescribing	N/A	1053866533	0	0	GONZALEZ, JAVIER LCSW	6/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101922	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
318419	Ordering, Referring, Prescribing	N/A	1053893537	0	0	GAYSON, CARYN M	9/21/2017	Taxonomy not applicable	NA	n/a	000	Unknown	540173	N/A	N/A	N/A	N/A	N/A	984 BOSTWICK LANE	STE 1	SANTA CRUZ	CA	95062	1756	00	06000	36.98413062	-121.9854332	Santa Cruz County
318420	Ordering, Referring, Prescribing	N/A	1053891978	0	0	GREY, SHARISSA LCSW	3/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121708	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
318454	Ordering, Referring, Prescribing	N/A	1053974071	0	0	GOPALAKRISHNAN, SIDDESH MD	9/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182572	N/A	N/A	N/A	N/A	N/A	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92806	3210	00	06000	33.78674051	-117.8888713	Orange County
318456	Ordering, Referring, Prescribing	N/A	1053989921	0	0	GUERRERO, JESSIE MD	2/14/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193927	N/A	N/A	N/A	N/A	N/A	6801 COLDWATER CANYON AV	None	NORTH HOLLYWOOD	CA	91605	5162	00	06000	34.194447	-118.4138285	Los Angeles County
318457	Ordering, Referring, Prescribing	N/A	1053996389	0	0	GRISWOLD, LINDSEY E PA-C	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59741	N/A	N/A	N/A	N/A	N/A	1742 OREGON ST	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
318477	Ordering, Referring, Prescribing	N/A	1063039055	0	0	GUTIERREZ GARCIA, CAROLINA MD	9/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182259	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
318485	Ordering, Referring, Prescribing	N/A	1063061737	0	0	GOLDENSHTEYN, FAY PHARMD	1/15/2019	Taxonomy not applicable	NA	n/a	000	Unknown	78839	N/A	N/A	N/A	N/A	N/A	1224 VINE ST	None	LOS ANGELES	CA	90038	1612	00	06000	34.093332	-118.326603	Los Angeles County
318513	Ordering, Referring, Prescribing	N/A	1063161990	0	0	GAO, YAJUAN CNP	12/7/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019355	N/A	N/A	N/A	N/A	N/A	701 S ATLANTIC BLVD	100	MONTEREY PARK	CA	91754	0000	00	06000	34.05382447	-118.1363489	Los Angeles County
318570	Ordering, Referring, Prescribing	N/A	1063536019	0	0	GOLTSMAN, VICTORIA MD	6/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63647	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	STE.#210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
318571	Ordering, Referring, Prescribing	N/A	1063530616	0	0	GIL, ABBY B LMFT	12/8/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107403	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
318613	Ordering, Referring, Prescribing	N/A	1063584522	0	0	GOEBEL, MONIKA LMFT	2/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48170	N/A	N/A	N/A	N/A	N/A	1029 N BROADWAY	None	ESCONDIDO	CA	92026	3043	00	06000	33.13421302	-117.0870941	San Diego County
318621	Ordering, Referring, Prescribing	N/A	1063601383	0	0	GIVENS, LYNN M LCSW	3/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79441	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
318644	Ordering, Referring, Prescribing	N/A	1063656908	0	0	GELSDORF, CHRISTOPH MD	2/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113751	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
318669	Ordering, Referring, Prescribing	N/A	1063700466	0	0	GASHA TAMASHIRO, CARLOS G MD	6/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137062	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
318680	Ordering, Referring, Prescribing	N/A	1063716884	0	0	GANESH, GEETA C PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	44523	N/A	N/A	N/A	N/A	N/A	350 N. LEMON AVE	None	WALNUT	CA	91789	2345	00	06000	34.01922399	-117.8652848	Los Angeles County
318687	Ordering, Referring, Prescribing	N/A	1063725042	0	0	GEIER, MICHELLE L	6/20/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	65671	N/A	N/A	N/A	N/A	N/A	760 HARRISON STEET	None	SAN FRANCISCO	CA	94103	1235	00	06000	37.78155484	-122.3987081	San Francisco County
318700	Ordering, Referring, Prescribing	N/A	1063760296	0	0	GARCIA, SANDRA V LCSW	5/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75037	N/A	N/A	N/A	N/A	N/A	7555 VAN NUYS BLVD	None	VAN NUYS	CA	91405	1949	00	06000	34.207911	-118.4487955	Los Angeles County
318702	Ordering, Referring, Prescribing	N/A	1063760981	0	0	GU, PAN LCSW	5/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27400	N/A	N/A	N/A	N/A	N/A	729 FILBERT ST	None	SAN FRANCISCO	CA	94133	2760	00	06000	37.80103613	-122.4119083	San Francisco County
318738	Ordering, Referring, Prescribing	N/A	1063796316	0	0	GHARAKHANIAN, MEGHEDI PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64393	N/A	N/A	N/A	N/A	N/A	3001 FOOTHILL BLVD	None	LA CRESCENTA	CA	91214	2714	00	06000	34.22747229	-118.2452305	Los Angeles County
318756	Ordering, Referring, Prescribing	N/A	1063813673	0	0	GARCIA, JENNIFER E LCSW	12/8/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86902	N/A	N/A	N/A	N/A	N/A	619 E 5TH ST.	None	LOS ANGELES	CA	90013	2109	00	06000	34.0432666	-118.2422934	Los Angeles County
318784	Ordering, Referring, Prescribing	N/A	1063850378	0	0	GILL, CHRYSTAL	7/29/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP22961	N/A	N/A	N/A	N/A	N/A	1120 WEST AVENUE M4	None	PALMDALE	CA	93551	0001	00	06000	34.64264888	-118.1509125	Los Angeles County
318787	Ordering, Referring, Prescribing	N/A	1063859486	0	0	GOMEZ-MAKHINSON, JULIANA MD	11/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138823	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
318799	Ordering, Referring, Prescribing	N/A	1063880797	0	0	GAVIDIA, ERICA LCSW	8/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89594	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
318828	Ordering, Referring, Prescribing	N/A	1063910560	0	0	GONZALEZ, MARIELLA LMFT	6/1/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147168	N/A	N/A	N/A	N/A	N/A	233 W. BASELINE RD	None	LA VERNE	CA	91750	2353	00	06000	34.12068064	-117.7523547	Los Angeles County
318844	Ordering, Referring, Prescribing	N/A	1063938512	0	0	GEIGER, JENNIFER A MD MPH	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158226	N/A	N/A	N/A	N/A	N/A	2170 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7026	00	06000	38.91229842	-119.9978133	El Dorado County
318868	Ordering, Referring, Prescribing	N/A	1063969145	0	0	GARCIA, GIOVANNI LMFT	3/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145491	N/A	N/A	N/A	N/A	N/A	4160 GRAND VIEW BLVD	200	LOS ANGELES	CA	90066	5214	00	06000	33.99763808	-118.4256183	Los Angeles County
318886	Ordering, Referring, Prescribing	N/A	1073020376	0	0	GARCIA, GREGORY A PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75627	N/A	N/A	N/A	N/A	N/A	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	00	06000	37.66312028	-122.4631592	San Mateo County
318896	Ordering, Referring, Prescribing	N/A	1073028502	0	0	GONZALES, SHAINA LCSW	2/13/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68022	N/A	N/A	N/A	N/A	N/A	130 N BRAND BLVD	202	GLENDALE	CA	91203	2644	00	06000	34.147521	-118.2549325	Los Angeles County
318905	Ordering, Referring, Prescribing	N/A	1073039301	0	0	GIBBS, ELIZABETH F DO	9/7/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17208	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
318917	Ordering, Referring, Prescribing	N/A	1073062360	0	0	GOMA, GENESIS LMFT	4/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	130633	N/A	N/A	N/A	N/A	N/A	500 AIRPORT WAY	None	CAMARILLO	CA	93010	8500	00	06000	34.2075752	-119.0762641	Ventura County
318926	Ordering, Referring, Prescribing	N/A	1073074761	0	0	GOYNE, CHRISTOPHER MD	6/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179696	N/A	N/A	N/A	N/A	N/A	200 WEST ARBOR DRIVE	#8465	SAN DIEGO	CA	92103	8465	00	06000	32.7537975	-117.1658298	San Diego County
318940	Ordering, Referring, Prescribing	N/A	1073090221	0	0	GUTIERREZ, JENNIFER D LCSW	3/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100722	N/A	N/A	N/A	N/A	N/A	2130 E 4TH ST	#200	SANTA ANA	CA	92705	3818	00	06000	33.74808392	-117.836143	Orange County
318964	Ordering, Referring, Prescribing	N/A	1073154068	0	0	GARCIA, SARAH LCSW	7/26/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW124568	N/A	N/A	N/A	N/A	N/A	852 E DANENBERG DR	None	EL CENTRO	CA	92243	8517	00	06000	32.773176	-115.5270465	Imperial County
318978	Ordering, Referring, Prescribing	N/A	1073175584	0	0	GARNETT, TONIA R LCSW	2/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111263	N/A	N/A	N/A	N/A	N/A	320 N MADISON AVE	None	LOS ANGELES	CA	90004	3779	00	06000	34.07696749	-118.2891433	Los Angeles County
319013	Ordering, Referring, Prescribing	N/A	1073357703	0	0	GUARDADO, DAMARIS D NP	6/13/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030558	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
319015	Ordering, Referring, Prescribing	N/A	1073379251	0	0	GOULARTE, SHERYL NP	5/16/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030148	N/A	N/A	N/A	N/A	N/A	18144 SECO ST	None	JAMESTOWN	CA	95327	9498	00	06000	37.95208073	-120.4216785	Tuolumne County
319048	Ordering, Referring, Prescribing	N/A	1073641486	0	0	GUERRA, CYNTHIA LCSW	4/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76364	N/A	N/A	N/A	N/A	N/A	711 N COURT ST	STE B	VISALIA	CA	93291	3638	00	06000	36.336384	-119.292543	Tulare County
319079	Ordering, Referring, Prescribing	N/A	1073707733	0	0	GIBSON, CHRISTINE M	9/8/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D56174	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
319080	Ordering, Referring, Prescribing	N/A	1073709358	0	0	GUIDO, ANDREA S LCSW	1/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28718	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	2ND FLOOR	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
319106	Ordering, Referring, Prescribing	N/A	1073794152	0	0	GUARDADO, ESTHER	4/22/2014	Taxonomy not applicable	NA	n/a	000	Unknown	PA17635	N/A	N/A	N/A	N/A	N/A	1206 E 17TH STREET	SUITE 101	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
319114	Ordering, Referring, Prescribing	N/A	1073809067	0	0	GASANOVA, DONARA NP	9/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018451	N/A	N/A	N/A	N/A	N/A	8527 SEPULVEDA BLVD	None	NORTH HILLS	CA	91343	5824	00	06000	34.225524	-118.4677265	Los Angeles County
319115	Ordering, Referring, Prescribing	N/A	1073809109	0	0	GARFIAS, GUADALUPE V LCSW	1/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79589	N/A	N/A	N/A	N/A	N/A	9864 BALDWIN PL	None	EL MONTE	CA	91731	2202	00	06000	34.07063297	-118.054303	Los Angeles County
319116	Ordering, Referring, Prescribing	N/A	1073809455	0	0	GUIN, BRANDON K LMFT	11/13/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49987	N/A	N/A	N/A	N/A	N/A	1025 ATLANTIC AVE	STE 101	ALAMEDA	CA	94501	1189	00	06000	37.78071789	-122.2658953	Alameda County
319183	Ordering, Referring, Prescribing	N/A	1073929824	0	0	GUTIERREZ, ANTONIO LCSW	5/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW71535	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
319186	Ordering, Referring, Prescribing	N/A	1073944930	0	0	GARVIN, SHEA LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99770	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
319204	Ordering, Referring, Prescribing	N/A	1073974952	0	0	GARRETT, GIORGIA L MD	9/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158361	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
319205	Ordering, Referring, Prescribing	N/A	1073968327	0	0	GEIGER, LISA M	3/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	39032	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
319208	Ordering, Referring, Prescribing	N/A	1073977435	0	0	GIACOMAZZI, CHRISTINA DO	8/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15797	N/A	N/A	N/A	N/A	N/A	4405 VANDEVER AVE	None	SAN DIEGO	CA	92120	3315	00	06000	32.78765609	-117.09908	San Diego County
319213	Ordering, Referring, Prescribing	N/A	1073980264	0	0	GARFIELD, ELLEN LMFT	10/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103425	N/A	N/A	N/A	N/A	N/A	6233 SOQUEL DR	C	APTOS	CA	95003	3117	00	06000	36.99054564	-121.931252	Santa Cruz County
319292	Ordering, Referring, Prescribing	N/A	1083086797	0	0	GORMLEY, JESSE	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70716	N/A	N/A	N/A	N/A	N/A	3559 ROUND BARN BLVD	None	SANTA ROSA	CA	95403	0001	00	06000	38.47813376	-122.7279674	Sonoma County
319293	Ordering, Referring, Prescribing	N/A	1083083083	0	0	GEVORKIAN, GARY J PHARMD	9/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72639	N/A	N/A	N/A	N/A	N/A	800 S CENTRAL AVE	STE 101A	GLENDALE	CA	91204	4375	00	06000	34.13654729	-118.2578243	Los Angeles County
319306	Ordering, Referring, Prescribing	N/A	1083106637	0	0	GOWER, ARJAN MD	5/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164983	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
319336	Ordering, Referring, Prescribing	N/A	1083158224	0	0	GALLEGOS, SONIA LCSW	3/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76067	N/A	N/A	N/A	N/A	N/A	1600 BAILEY AVE	None	NEEDLES	CA	92363	9998	00	06000	34.830963	-114.6183555	San Bernardino County
319367	Ordering, Referring, Prescribing	N/A	1083195465	0	0	GALAYAN, GAYANE PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65335	N/A	N/A	N/A	N/A	N/A	1101 W TEHACHAPI BLVD	None	TEHACHAPI	CA	93561	2559	00	06000	35.1318273	-118.4672295	Kern County
319387	Ordering, Referring, Prescribing	N/A	1083243455	0	0	GONZALEZ, URIEL A LMFT	8/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140746	N/A	N/A	N/A	N/A	N/A	1461 E COOLEY DR	100	COLTON	CA	92324	3921	00	06000	34.05562007	-117.3036377	San Bernardino County
319402	Ordering, Referring, Prescribing	N/A	1083275986	0	0	GOTTLIEB, JILLIAN G MD MPH	4/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL1957	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
319405	Ordering, Referring, Prescribing	N/A	1083281687	0	0	GARCIA DE SANTIAGO, JACQUELIN LCSW	4/18/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LCSW122071	N/A	N/A	N/A	N/A	N/A	355 DOVER PKWY	None	DELANO	CA	93215	3440	00	06000	35.7610493	-119.2523273	Kern County
319410	Ordering, Referring, Prescribing	N/A	1083289722	0	0	GRANT, JACOB LMFT	12/24/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152255	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST	None	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
319437	Ordering, Referring, Prescribing	N/A	1083388599	0	0	GIVENS, MARIYAH T LMFT	2/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137274	N/A	N/A	N/A	N/A	N/A	20101 HAMILTON AVENUE	160	TORRANCE	CA	90502	1306	00	06000	33.84828383	-118.2860386	Los Angeles County
319441	Ordering, Referring, Prescribing	N/A	1083389019	0	0	GOBEA, JOANNA NP	8/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018061	N/A	N/A	N/A	N/A	N/A	3110 KERNER BLVD	None	SAN RAFAEL	CA	94901	5411	00	06000	37.9579262	-122.5004492	Marin County
319503	Ordering, Referring, Prescribing	N/A	1083761456	0	0	GRIMES, ERIN M	8/15/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	23637	N/A	N/A	N/A	N/A	N/A	12835 POINTE DEL MAR WAY	1	DEL MAR	CA	92014	3846	00	06000	32.93216216	-117.2433492	San Diego County
319505	Ordering, Referring, Prescribing	N/A	1083778286	0	0	GLEZER, NATANYA S PSYD	8/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24505	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
319511	Ordering, Referring, Prescribing	N/A	1083785513	0	0	GILLILAND, THERESA L	2/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	11076	N/A	N/A	N/A	N/A	N/A	2547 W SHAW AVE	None	FRESNO	CA	93711	3321	00	06000	36.80804173	-119.8385565	Fresno County
319528	Ordering, Referring, Prescribing	N/A	1083807606	0	0	GALLIVAN, SHELLEY M NP	3/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	713054	N/A	N/A	N/A	N/A	N/A	1503 GRANT RD	None	MOUNTAIN VIEW	CA	94040	3292	00	06000	37.37672165	-122.0757295	Santa Clara County
319541	Ordering, Referring, Prescribing	N/A	1083859912	0	0	GROOT, JANTJE M MD	5/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102213	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
319564	Ordering, Referring, Prescribing	N/A	1083910368	0	0	GARG, AMANDEEP	1/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	63946	N/A	N/A	N/A	N/A	N/A	303 W NAPA ST	None	SONOMA	CA	95476	6516	00	06000	38.29248664	-122.4638317	Sonoma County
319567	Ordering, Referring, Prescribing	N/A	1083907000	0	0	GWYNN, JOHANNA C LCSW	5/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81616	N/A	N/A	N/A	N/A	N/A	2513 24TH ST	None	SAN FRANCISCO	CA	94110	1002	00	06000	37.75308592	-122.4047531	San Francisco County
319570	Ordering, Referring, Prescribing	N/A	1083918353	0	0	GARCIA, YVETTE LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83501	N/A	N/A	N/A	N/A	N/A	1111 VAN NESS AVE	SUITE 200	FRESNO	CA	93721	2002	00	06000	36.73622928	-119.7909185	Fresno County
319645	Ordering, Referring, Prescribing	N/A	1093025546	0	0	GUZMAN, MARIANA	6/13/2016	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88015	N/A	N/A	N/A	N/A	N/A	1328 SOUTH MISSION ROAD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
319649	Ordering, Referring, Prescribing	N/A	1093034696	0	0	GILLETT, TARA CNP	4/15/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	674279	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	GE07	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
319656	Ordering, Referring, Prescribing	N/A	1093056202	0	0	GUTTIKONDA, BHARAT RAM CHOWDRY DDS	6/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62137	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
319665	Ordering, Referring, Prescribing	N/A	1093064420	0	0	GOLSHANI, AZADEH PSYD	6/21/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28464	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
319670	Ordering, Referring, Prescribing	N/A	1093067647	0	0	GORENCE, JESSICA PHARMD	5/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	60445	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
319680	Ordering, Referring, Prescribing	N/A	1093097974	0	0	GONG, ZHENG PHARMD	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50972	N/A	N/A	N/A	N/A	N/A	1130 BIRD AVE	None	SAN JOSE	CA	95125	1700	00	06000	37.3105694	-121.8949819	Santa Clara County
319711	Ordering, Referring, Prescribing	N/A	1093147381	0	0	GALLEGO, MAKENZIE L LCSW	1/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91987	N/A	N/A	N/A	N/A	N/A	10301 VISTA DR	None	CUPERTINO	CA	95014	2040	00	06000	37.32655045	-122.0276	Santa Clara County
319721	Ordering, Referring, Prescribing	N/A	1093165391	0	0	GRIM, CAROLINE C LMFT	11/13/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107146	N/A	N/A	N/A	N/A	N/A	45111 FERN AVE	None	LANCASTER	CA	93534	2301	00	06000	34.70150394	-118.1452081	Los Angeles County
319722	Ordering, Referring, Prescribing	N/A	1093164808	0	0	GERMAIN, NATASHA PA-C	8/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53508	N/A	N/A	N/A	N/A	N/A	12157 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3204	00	06000	34.18669745	-118.3985415	Los Angeles County
319737	Ordering, Referring, Prescribing	N/A	1093182461	0	0	GUIEB, FELICIA W PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73133	N/A	N/A	N/A	N/A	N/A	2262 MARKET STREET	None	SAN FRANCISCO	CA	94114	1114	00	06000	37.76498914	-122.4322587	San Francisco County
319746	Ordering, Referring, Prescribing	N/A	1093191231	0	0	GODOY-ORANTES, ANDREA LMFT	4/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125823	N/A	N/A	N/A	N/A	N/A	525 N CABRILLO PARK DRIV	SUITE 300	SANTA ANA	CA	92701	5046	00	06000	33.75047365	-117.8404984	Orange County
319759	Ordering, Referring, Prescribing	N/A	1093212557	0	0	GOMEZ, JENNIFER I LMFT	3/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131754	N/A	N/A	N/A	N/A	N/A	14535 SHERMAN CIR	None	VAN NUYS	CA	91405	3087	00	06000	34.20064259	-118.450312	Los Angeles County
319765	Ordering, Referring, Prescribing	N/A	1093216145	0	0	GRAHAM, AMAUNI P LMFT	3/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124772	N/A	N/A	N/A	N/A	N/A	16255 VENTURA BLVD STE 5	None	ENCINO	CA	91436	2310	00	06000	34.15693902	-118.4876816	Los Angeles County
319768	Ordering, Referring, Prescribing	N/A	1093225120	0	0	GALLAU, KELSEY E LMFT	9/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121561	N/A	N/A	N/A	N/A	N/A	2218 N 1ST STREET	None	SAN JOSE	CA	95131	2007	00	06000	37.37769052	-121.9213491	Santa Clara County
319771	Ordering, Referring, Prescribing	N/A	1093231920	0	0	GREENFIELD, AIMEE L PA	2/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54858	N/A	N/A	N/A	N/A	N/A	3802 MAIN ST	None	OCCIDENTAL	CA	95465	0000	00	06000	38.40900707	-122.9476089	Sonoma County
319784	Ordering, Referring, Prescribing	N/A	1093247025	0	0	GUTIERREZ, JACQUELINE R LMFT	12/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122964	N/A	N/A	N/A	N/A	N/A	11731 E TELEGRAPH RD	K	SANTA FE SPRINGS	CA	90670	6815	00	06000	33.94630253	-118.0832082	Los Angeles County
319825	Ordering, Referring, Prescribing	N/A	1093324972	0	0	GRIMM, KALINA P OD	7/22/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34588	N/A	N/A	N/A	N/A	N/A	1345 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6904	00	06000	38.26310949	-122.05269	Solano County
319829	Ordering, Referring, Prescribing	N/A	1093332090	0	0	GRANT, BRIANNA N PA-C	6/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61260	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
319832	Ordering, Referring, Prescribing	N/A	1093345381	0	0	GIBSON, VERONICA H NP	4/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020781	N/A	N/A	N/A	N/A	N/A	725 W. LA VETA AVE.	#260	ORANGE	CA	92868	4439	00	06000	33.78063949	-117.8603285	Orange County
319869	Ordering, Referring, Prescribing	N/A	1093455784	0	0	GOLDBERG-BOLTZ, NICOLE MD	1/6/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A190277	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
319896	Ordering, Referring, Prescribing	N/A	1093746836	0	0	GHOBRIAL-SEDKY, KARIM W MD	7/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119201	N/A	N/A	N/A	N/A	N/A	7290 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1829	00	06000	32.76884635	-117.0406752	San Diego County
319904	Ordering, Referring, Prescribing	N/A	1093759987	0	0	GHODDUSI-TABARS, FARIDEH R	6/3/2005	Taxonomy not applicable	NA	n/a	099	DENTIST	D39640	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
319931	Ordering, Referring, Prescribing	N/A	1093842379	0	0	GUINN, KATJA-LARISSA LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39581	N/A	N/A	N/A	N/A	N/A	17053 E. FOOTHILL BLVD.	None	FONTANA	CA	92335	3574	00	06000	34.10655148	-117.432828	San Bernardino County
319935	Ordering, Referring, Prescribing	N/A	1093851867	0	0	GONZALEZ, ANA L LMFT	5/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105818	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
319962	Ordering, Referring, Prescribing	N/A	1093898694	0	0	GRANJA, TIFFANY LCSW	8/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26769	N/A	N/A	N/A	N/A	N/A	1359 N. GRAND AVENUE, CO	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
319963	Ordering, Referring, Prescribing	N/A	1093899353	0	0	GUTMAN, NICOLE L LCSW	11/19/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27217	N/A	N/A	N/A	N/A	N/A	1224 VINE ST	None	LOS ANGELES	CA	90038	1612	00	06000	34.093332	-118.326603	Los Angeles County
319975	Ordering, Referring, Prescribing	N/A	1093911224	0	0	GARIBALDI, MICHELLE A LMFT	12/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40177	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
319999	Ordering, Referring, Prescribing	N/A	1093963258	0	0	GHASSEMI, BANAFSHEH E PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60302	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST 13TH FL	None	OAKLAND	CA	94612	3429	00	06000	37.80593773	-122.2656714	Alameda County
320008	Ordering, Referring, Prescribing	N/A	1093969560	0	0	GALLEGOS, LINDA D LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100380	N/A	N/A	N/A	N/A	N/A	210 E. ENOS DRIVE, SUITE	SUITE A	SANTA MARIA	CA	93454	7769	00	06000	34.9340215	-120.4343968	Santa Barbara County
320013	Ordering, Referring, Prescribing	N/A	1093992729	0	0	GOCHEZ, GLORIA M LCSW	1/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72143	N/A	N/A	N/A	N/A	N/A	296 E MONTEREY AVE	None	POMONA	CA	91767	5400	00	06000	34.06058194	-117.7459832	Los Angeles County
320016	Ordering, Referring, Prescribing	N/A	1093993685	0	0	GOLEZ, CANDICE D MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110303	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
320030	Ordering, Referring, Prescribing	N/A	1104034420	0	0	GUZMAN, MINERVA LMFT	10/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111901	N/A	N/A	N/A	N/A	N/A	12631 IMPERIAL HWY	SUITE #C-103	SANTA FE SPRINGS	CA	90670	4710	00	06000	33.91718487	-118.0627524	Los Angeles County
320035	Ordering, Referring, Prescribing	N/A	1104042712	0	0	GOLDEN, BETHANY N CNM	9/10/2017	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	628554	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
320054	Ordering, Referring, Prescribing	N/A	1104081215	0	0	GONZALEZ, ADRIANA G LCSW	12/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110127	N/A	N/A	N/A	N/A	N/A	149 PASADENA AVENUE	SUITE A	PASADENA	CA	91030	2947	00	06000	34.11188281	-118.1734374	Los Angeles County
320068	Ordering, Referring, Prescribing	N/A	1104111418	0	0	GONZALES, PETRA M LCSW	3/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114557	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	FIRST FLOOR	SAN PABLO	CA	94806	5910	00	06000	37.95651393	-122.3371491	Contra Costa County
320077	Ordering, Referring, Prescribing	N/A	1104118637	0	0	GABLE, MARY S MD	2/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A105881	N/A	N/A	N/A	N/A	N/A	1103 N B STREET, SUITE E	None	SACRAMENTO	CA	95811	0326	00	06000	38.59119	-121.48659	Sacramento County
320087	Ordering, Referring, Prescribing	N/A	1104139666	0	0	GALVEZ, ADRIANA R LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69737	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD STE	None	WEST SACRAMENTO	CA	95616	9701	00	06000	38.58811316	-121.5270471	Yolo County
320101	Ordering, Referring, Prescribing	N/A	1104179217	0	0	GUDINO, DAVID	12/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80521	N/A	N/A	N/A	N/A	N/A	631C MAPLE AVE	STE C	LOS ANGELES	CA	90014	2211	00	06000	34.04327665	-118.2485423	Los Angeles County
320170	Ordering, Referring, Prescribing	N/A	1104279280	0	0	GUARDADO, CAROL LCSW	1/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87311	N/A	N/A	N/A	N/A	N/A	6851 LENNOX AVE.,	100	VAN NUYS	CA	91405	4073	00	06000	34.19553967	-118.4454933	Los Angeles County
320186	Ordering, Referring, Prescribing	N/A	1104311695	0	0	GONZALES, MELISSA C NP	6/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	95009271	N/A	N/A	N/A	N/A	N/A	216 E FRESNO ST	None	AVENAL	CA	93204	1525	00	06000	36.00349612	-120.1355935	Kings County
320187	Ordering, Referring, Prescribing	N/A	1104309020	0	0	GOLD, DANIELLE L LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66627	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
320201	Ordering, Referring, Prescribing	N/A	1104336353	0	0	GREWAL, SHAUNDEEP S LMFT	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114947	N/A	N/A	N/A	N/A	N/A	7800 NILES STREET	None	BAKERSFIELD	CA	93306	4922	00	06000	35.37628052	-118.9179	Kern County
320209	Ordering, Referring, Prescribing	N/A	1104345834	0	0	GUTIERREZ, DIANA LCSW	4/14/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101114	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
320214	Ordering, Referring, Prescribing	N/A	1104349497	0	0	GAMBOA, VANESSA LCSW	12/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106359	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
320230	Ordering, Referring, Prescribing	N/A	1104371681	0	0	GARCIA, MARIALUISA NP	4/23/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95004668	N/A	N/A	N/A	N/A	N/A	16127 FOOTHILL BLVD	None	FONTANA	CA	92335	3374	00	06000	34.10650281	-117.4531156	San Bernardino County
320251	Ordering, Referring, Prescribing	N/A	1104398155	0	0	GENDRON, LINDA M LCSW	12/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99052	N/A	N/A	N/A	N/A	N/A	1989 VICENTE DR	None	SAN LUIS OBISPO	CA	93405	6863	00	06000	35.25396985	-120.6858341	San Luis Obispo County
320282	Ordering, Referring, Prescribing	N/A	1104475128	0	0	GANA, EDDY M LCSW	10/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW103797	N/A	N/A	N/A	N/A	N/A	3200 W. TEMPLE ST.	100	LOS ANGELES	CA	90026	0000	00	06000	34.07540543	-118.2815509	Los Angeles County
320283	Ordering, Referring, Prescribing	N/A	1104479385	0	0	GRAMKOWSKI, BRIDGET E CNP	10/21/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15893	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
320312	Ordering, Referring, Prescribing	N/A	1104595446	0	0	GILMORE, KYLA MSW LCSW	7/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123852	N/A	N/A	N/A	N/A	N/A	7001A EAST PKWY	None	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
320347	Ordering, Referring, Prescribing	N/A	1104928662	0	0	GONZALEZ, MARTHA MD	2/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C149849	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
320359	Ordering, Referring, Prescribing	N/A	1104955921	0	0	GLANVILLE, NICOLA K LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42794	N/A	N/A	N/A	N/A	N/A	1086 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2505	00	06000	35.11933967	-120.5958538	San Luis Obispo County
320378	Ordering, Referring, Prescribing	N/A	1104974039	0	0	GLUPCZYNSKI, DEBORAH MD	3/24/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85071	N/A	N/A	N/A	N/A	N/A	918 W FOOTHILL BLVD	A	UPLAND	CA	91786	3772	00	06000	34.10676594	-117.6636152	San Bernardino County
320380	Ordering, Referring, Prescribing	N/A	1104982321	0	0	GIBSON-PAUL, BARBARA F LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	28643	N/A	N/A	N/A	N/A	N/A	1202 W CIVIC CENTER DR	None	SANTA ANA	CA	92703	2252	00	06000	33.75148649	-117.883188	Orange County
320385	Ordering, Referring, Prescribing	N/A	1104989649	0	0	GOLDMAN, ROBERT D MD	5/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G44889	N/A	N/A	N/A	N/A	N/A	1127 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90017	3907	00	06000	34.05270508	-118.2641005	Los Angeles County
320405	Ordering, Referring, Prescribing	N/A	1114041712	0	0	GREWAL, HARINDER MD	10/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A32070	N/A	N/A	N/A	N/A	N/A	24275 JEFFERSON AVE	None	MURRIETA	CA	92562	0124	00	06000	33.5676365	-117.2174559	Riverside County
320427	Ordering, Referring, Prescribing	N/A	1114064730	0	0	GUERRERO ROSAS, CARLOS A LCSW	6/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66163	N/A	N/A	N/A	N/A	N/A	312 CLAY ST	150	OAKLAND	CA	94607	3510	00	06000	37.79802567	-122.2780981	Alameda County
320452	Ordering, Referring, Prescribing	N/A	1114117603	0	0	GORDON, MONICA TERESA P MD	6/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A86089	N/A	N/A	N/A	N/A	N/A	1370 S. STATE STREET	SUITE B	SAN JACINTO	CA	92583	4922	00	06000	33.773796	-116.9719185	Riverside County
320455	Ordering, Referring, Prescribing	N/A	1114127412	0	0	GRUBB, DAVID G MD	12/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G25785	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN ST	None	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
320513	Ordering, Referring, Prescribing	N/A	1114236098	0	0	GARRETT, SHIMEAKA	6/20/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA21174	N/A	N/A	N/A	N/A	N/A	161 MILL ST	None	TEHACHAPI	CA	93561	2523	00	06000	35.13410412	-118.4520157	Kern County
320522	Ordering, Referring, Prescribing	N/A	1114266004	0	0	GALLEGOS, DONNA LMFT	12/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52753	N/A	N/A	N/A	N/A	N/A	12759 VAN NUYS BLVD	None	PACOIMA	CA	91331	1627	00	06000	34.27413859	-118.4111289	Los Angeles County
320541	Ordering, Referring, Prescribing	N/A	1114301595	0	0	GASTON, KRISTA L LMFT	7/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120058	N/A	N/A	N/A	N/A	N/A	2775 ARLINGTON DR.	None	SAN LEANDRO	CA	94578	1234	00	06000	37.70848727	-122.1116851	Alameda County
320611	Ordering, Referring, Prescribing	N/A	1114400561	0	0	GONZALEZ, ALAN PHARMD	2/26/2024	Taxonomy not applicable	NA	n/a	000	Unknown	RPH78853	N/A	N/A	N/A	N/A	N/A	1330 GATEWAY BLVD	STE B2	FAIRFIELD	CA	94533	6915	00	06000	38.26309879	-122.0520604	Solano County
320633	Ordering, Referring, Prescribing	N/A	1114438538	0	0	GAY, JENNIFER A LMFT	8/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109700	N/A	N/A	N/A	N/A	N/A	137 N. COTTONWOOD	None	WOODLAND	CA	95695	6664	00	06000	38.68538399	-121.7933582	Yolo County
320657	Ordering, Referring, Prescribing	N/A	1114475662	0	0	GONZALEZ, EMILY LMFT	4/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132300	N/A	N/A	N/A	N/A	N/A	5284 ADOLFO RD	SUITE 100	CAMARILLO	CA	93012	6790	00	06000	34.21515637	-118.9970881	Ventura County
320665	Ordering, Referring, Prescribing	N/A	1114491545	0	0	GERAGHTY, MICHAEL E PHD	12/26/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30600	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
320701	Ordering, Referring, Prescribing	N/A	1114571593	0	0	GAO, SARAH X	6/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51898	N/A	N/A	N/A	N/A	N/A	6843 MISSION ST	None	DALY CITY	CA	94014	2006	00	06000	37.69800563	-122.4641796	San Mateo County
320703	Ordering, Referring, Prescribing	N/A	1114574084	0	0	GALLO, SAMANTHA J PA-C	11/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60382	N/A	N/A	N/A	N/A	N/A	49165 RD 426	None	OAKHURST	CA	93644	8621	00	06000	37.33008829	-119.6505029	Madera County
320724	Ordering, Referring, Prescribing	N/A	1114658267	0	0	GAUTAM, PRATIMA OD	5/21/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35439	N/A	N/A	N/A	N/A	N/A	4448 YORK BLVD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
320726	Ordering, Referring, Prescribing	N/A	1114632221	0	0	GUPTA, PALAK DDS	12/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108448	N/A	N/A	N/A	N/A	N/A	843 S STATE COLLEGE BLVD	None	ANAHEIM	CA	92806	4613	00	06000	33.830181	-117.889378	Orange County
320736	Ordering, Referring, Prescribing	N/A	1114683422	0	0	GENDEL, JAMAICA A PA-C	12/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60554	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
320737	Ordering, Referring, Prescribing	N/A	1114693520	0	0	GREKOV, GALINA NP	5/17/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017333	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4569	00	06000	34.67013731	-118.1222748	Los Angeles County
320768	Ordering, Referring, Prescribing	N/A	1114947447	0	0	GONZALEZ, PEDRO	6/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	16154	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE STREET	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
320770	Ordering, Referring, Prescribing	N/A	1124003835	0	0	GILL, HARPREET M MD	8/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A62887	N/A	N/A	N/A	N/A	N/A	7273 14TH AVENUE	None	SACRAMENTO	CA	95820	3566	00	06000	38.540097	-121.419063	Sacramento County
320773	Ordering, Referring, Prescribing	N/A	1124007430	0	0	GREENE, GILBERT E DO	12/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A4367	N/A	N/A	N/A	N/A	N/A	1307 N COMMERCE ST	None	STOCKTON	CA	95202	1012	00	06000	37.96535383	-121.2959608	San Joaquin County
320776	Ordering, Referring, Prescribing	N/A	1124013206	0	0	GORDON, PAMELA K MD	6/14/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C196924	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
320813	Ordering, Referring, Prescribing	N/A	1124137765	0	0	GOFFMAN, JERRY M PHD	6/30/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY7081	N/A	N/A	N/A	N/A	N/A	5741 MISSION BLVD	7	JURUPA VALLELY	CA	92509	4304	00	06000	33.99894093	-117.4106829	Riverside County
320845	Ordering, Referring, Prescribing	N/A	1124177761	0	0	GOMEZ, MIRTHA M DDS	1/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS50407	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
320852	Ordering, Referring, Prescribing	N/A	1124192844	0	0	GARCIA, NATALIE LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48026	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
320858	Ordering, Referring, Prescribing	N/A	1124212477	0	0	GALLEGOS, AGUSTINA P LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44550	N/A	N/A	N/A	N/A	N/A	359 GABILAN DR	None	SOLEDAD	CA	93960	3550	00	06000	36.43614633	-121.3277604	Monterey County
320863	Ordering, Referring, Prescribing	N/A	1124219878	0	0	GOEBEL, APRIL D	2/22/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	29904	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
320892	Ordering, Referring, Prescribing	N/A	1124276449	0	0	GANGEL, NATHALIE D LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84695	N/A	N/A	N/A	N/A	N/A	825 SOUTHWOOD DR	None	SOUTH SAN FRANCIS	CA	94080	0099	00	06000	37.64946358	-122.435325	San Mateo County
320898	Ordering, Referring, Prescribing	N/A	1124300272	0	0	GILBERT, JACQUELYN	8/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62869	N/A	N/A	N/A	N/A	N/A	16 RANCHO DEL MAR	None	APTOS	CA	95003	3902	00	06000	36.97840741	-121.908134	Santa Cruz County
320904	Ordering, Referring, Prescribing	N/A	1124309430	0	0	GORMAN, AMANDA B RN CPNP	2/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21001	N/A	N/A	N/A	N/A	N/A	1131 OXFORD RD	None	BURLINGAME	CA	94010	3360	00	06000	37.59040166	-122.3738756	San Mateo County
320914	Ordering, Referring, Prescribing	N/A	1124286836	0	0	GARCIA, MARIA A LCSW	8/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70030	N/A	N/A	N/A	N/A	N/A	3303 N. BROADWAY BLVD	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
320920	Ordering, Referring, Prescribing	N/A	1124332648	0	0	GONZALEZ, CLAUDIA PSYD	1/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28286	N/A	N/A	N/A	N/A	N/A	31180 ROAD 72	None	VISALIA	CA	93291	9672	00	06000	36.35594779	-119.4124242	Tulare County
320935	Ordering, Referring, Prescribing	N/A	1124363445	0	0	GOVIND, MELANIE T LCSW	5/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27236	N/A	N/A	N/A	N/A	N/A	828 S BASCOM AVE	100	SAN JOSE	CA	95128	2651	00	06000	37.31225204	-121.9317854	Santa Clara County
320994	Ordering, Referring, Prescribing	N/A	1124458559	0	0	GONZALEZ, DAVID LCSW	11/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87496	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
321001	Ordering, Referring, Prescribing	N/A	1124469663	0	0	GINWALA, CAITLIN N LMFT	11/13/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96759	N/A	N/A	N/A	N/A	N/A	921 W. AVE J	C	LANCASTER	CA	93534	3443	00	06000	34.6895043	-118.1463998	Los Angeles County
321008	Ordering, Referring, Prescribing	N/A	1124476809	0	0	GARNER, SARAH J LCSW	1/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106507	N/A	N/A	N/A	N/A	N/A	1675 MORENA BLVD	SUITE 100	SAN DIEGO	CA	92110	3703	00	06000	32.77645845	-117.2072648	San Diego County
321035	Ordering, Referring, Prescribing	N/A	1124470547	0	0	GOMEZ, LINA M MD FAAP	1/13/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167503	N/A	N/A	N/A	N/A	N/A	7237 E SOUTHGATE DR	A	SACRAMENTO	CA	95823	2637	00	06000	38.494629	-121.435686	Sacramento County
321058	Ordering, Referring, Prescribing	N/A	1124538939	0	0	GARCIA, NANCY V LMFT	9/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121974	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
321082	Ordering, Referring, Prescribing	N/A	1124581590	0	0	GHNEIM, SHADDIA A LMFT	3/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124978	N/A	N/A	N/A	N/A	N/A	200 E KATELLA AVE	None	ORANGE	CA	92867	4804	00	06000	33.80906952	-117.851751	Orange County
321105	Ordering, Referring, Prescribing	N/A	1124641790	0	0	GONZALEZ, LESLY LCSW	4/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114867	N/A	N/A	N/A	N/A	N/A	1501 HOOD ST	None	ARVIN	CA	93203	1635	00	06000	35.20355955	-118.839528	Kern County
321126	Ordering, Referring, Prescribing	N/A	1124669320	0	0	GARRY, ZARA LCSW	11/13/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86509	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
321140	Ordering, Referring, Prescribing	N/A	1124719182	0	0	GOLEZ, PATRICK DMD	2/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108793	N/A	N/A	N/A	N/A	N/A	2414 S FAIRVIEW ST	107A	SANTA ANA	CA	92704	5318	00	06000	33.71437705	-117.9079237	Orange County
321142	Ordering, Referring, Prescribing	N/A	1124743810	0	0	GHAWI, LAUREN NP	6/21/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030688	N/A	N/A	N/A	N/A	N/A	1850 WALNUT STREET	BLDG E	RED BLUFF	CA	96080	3611	00	06000	40.16904822	-122.2542817	Tehama County
321179	Ordering, Referring, Prescribing	N/A	1134136369	0	0	GARG, NARENDRA K	7/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C145211	N/A	N/A	N/A	N/A	N/A	1995 SPRINGBROOK DRIVE	SUITE 119	NAPERVILLE	IL	60564	9316	00	06000	41.73052791	-88.20547316	DuPage County
321283	Ordering, Referring, Prescribing	N/A	1134403793	0	0	GOODMAN, CHARLENE T PSYD	12/28/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27268	N/A	N/A	N/A	N/A	N/A	16350 FILBERT STREET	None	SYLMAR	CA	91342	0200	00	06000	34.31595736	-118.4853828	Los Angeles County
321288	Ordering, Referring, Prescribing	N/A	1134407844	0	0	GUNDA, SATEESH K MD	7/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149946	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
321289	Ordering, Referring, Prescribing	N/A	1134396419	0	0	GARCIA, LISA M MD	5/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A117050	N/A	N/A	N/A	N/A	N/A	1316 3RD STREET PROMENAD	201	SANTA MONICA	CA	90401	0000	00	06000	34.01670895	-118.497462	Los Angeles County
321323	Ordering, Referring, Prescribing	N/A	1134482805	0	0	GUENTHART, ANDREW D MD	6/23/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168013	N/A	N/A	N/A	N/A	N/A	16360 MONTEREY RD	STE. 280	MORGAN HILL	CA	95037	0000	00	06000	37.11778265	-121.6456341	Santa Clara County
321371	Ordering, Referring, Prescribing	N/A	1134559636	0	0	GALADA, MICHAEL R DDS	2/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	65240	N/A	N/A	N/A	N/A	N/A	9331 MISSION GORGE RD	105	SANTEE	CA	92071	1007	00	06000	32.83858255	-116.993979	San Diego County
321391	Ordering, Referring, Prescribing	N/A	1134580343	0	0	GANDARA, ALFONSO LCSW	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94452	N/A	N/A	N/A	N/A	N/A	3751 STOCKER ST	None	VIEW PARK	CA	90008	5101	00	06000	34.00616017	-118.3385751	Los Angeles County
321415	Ordering, Referring, Prescribing	N/A	1134619471	0	0	GAVARRE, ERIC MD	9/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167113	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
321437	Ordering, Referring, Prescribing	N/A	1134640121	0	0	GARCIA DIAZ, MAYRA A LCSW	9/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103890	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
321460	Ordering, Referring, Prescribing	N/A	1134686744	0	0	GOLDFINGER, SARAH N NP	2/28/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011313	N/A	N/A	N/A	N/A	N/A	823 GATEWAY CENTER WAY	None	SAN DIEGO	CA	92102	4541	00	06000	32.71503452	-117.1134945	San Diego County
321506	Ordering, Referring, Prescribing	N/A	1134782253	0	0	GARCIA, KRISTINA C LMFT	10/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127245	N/A	N/A	N/A	N/A	N/A	15350 SHERMAN WAY	200	VAN NUYS	CA	91406	4203	00	06000	34.20109649	-118.467432	Los Angeles County
321508	Ordering, Referring, Prescribing	N/A	1134810815	0	0	GELINI, REBECCA LMFT	10/29/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150981	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
321533	Ordering, Referring, Prescribing	N/A	1134990732	0	0	GOJKOVICH, JESSICA LMSW	1/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120522	N/A	N/A	N/A	N/A	N/A	2460 CLAY BANK RD	None	FAIRFIELD	CA	94533	1655	00	06000	38.274507	-122.0064875	Solano County
321577	Ordering, Referring, Prescribing	N/A	1144342601	0	0	GORDON, DANIEL M MD	6/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G42749	N/A	N/A	N/A	N/A	N/A	630 BERCUT DR	STE C	SACRAMENTO	CA	95811	0110	00	06000	38.600856	-121.497543	Sacramento County
321578	Ordering, Referring, Prescribing	N/A	1144344250	0	0	GONZALEZ, VANESSA Y LMFT	1/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99911	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD	None	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
321580	Ordering, Referring, Prescribing	N/A	1144341710	0	0	GUZMAN, KARINA LCSW	11/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80205	N/A	N/A	N/A	N/A	N/A	1414 S GRAND AVE	380	LOS ANGELES	CA	90015	3067	00	06000	34.03661142	-118.2657227	Los Angeles County
321604	Ordering, Referring, Prescribing	N/A	1144383688	0	0	GERRYTS, SHANA E PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52144	N/A	N/A	N/A	N/A	N/A	1188 N EUCLID ST	None	ANAHEIM	CA	92801	1900	00	06000	33.850314	-117.9416115	Orange County
321609	Ordering, Referring, Prescribing	N/A	1144396037	0	0	GOODWIN, MICHELLE D LCSW	3/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26655	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
321623	Ordering, Referring, Prescribing	N/A	1144427774	0	0	GONZALES, PAOLA LMFT	6/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117160	N/A	N/A	N/A	N/A	N/A	182 E WALNUT AVE	None	RIALTO	CA	92376	3530	00	06000	34.12866149	-117.3689595	San Bernardino County
321653	Ordering, Referring, Prescribing	N/A	1144500067	0	0	GARCIA, ARACELI LCSW	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88282	N/A	N/A	N/A	N/A	N/A	280 17TH ST	None	OAKLAND	CA	94612	4124	00	06000	37.80524764	-122.2655975	Alameda County
321671	Ordering, Referring, Prescribing	N/A	1144524299	0	0	GUZMAN, MARITZA J LMFT	5/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112264	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
321683	Ordering, Referring, Prescribing	N/A	1144571688	0	0	GARCIA MARAVILLAS, CHRISTIAN	10/2/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91936	N/A	N/A	N/A	N/A	N/A	308 E SAN JACINTO AVE	None	PERRIS	CA	92570	5398	00	06000	33.78658073	-117.2226438	Riverside County
321690	Ordering, Referring, Prescribing	N/A	1144580879	0	0	GINSBACH, KIMBERLY A MD	5/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137602	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
321749	Ordering, Referring, Prescribing	N/A	1144667148	0	0	GONZALEZ, ELIZABETH	2/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110117	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
321761	Ordering, Referring, Prescribing	N/A	1144676198	0	0	GONZALEZ GUEMES, ANDREA LMFT	12/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123484	N/A	N/A	N/A	N/A	N/A	2919 MISSION STREET	None	SAN FRANCISCO	CA	94110	3917	00	06000	37.75028364	-122.418239	San Francisco County
321835	Ordering, Referring, Prescribing	N/A	1144773037	0	0	GOHEL, CHARMIN K MD	10/5/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158888	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
321862	Ordering, Referring, Prescribing	N/A	1144804550	0	0	GLOUDEMANS, HOLLY A NP	12/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95017289	N/A	N/A	N/A	N/A	N/A	1014 1/2 N VERMONT AVE	None	LOS ANGELES	CA	90029	0000	00	06000	34.0900257	-118.2916693	Los Angeles County
321895	Ordering, Referring, Prescribing	N/A	1144858705	0	0	GOODSON, DAVID A MD MPH	4/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177837	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1467	00	06000	38.555181	-121.4566785	Sacramento County
321901	Ordering, Referring, Prescribing	N/A	1144865502	0	0	GOLOVATSCKA, VIKTORIYA	7/1/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95143822	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
321906	Ordering, Referring, Prescribing	N/A	1144875535	0	0	GILL, MANPREET MD	2/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180790	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
321937	Ordering, Referring, Prescribing	N/A	1144991571	0	0	GARCIA, ELIZABETH M NP	9/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018567	N/A	N/A	N/A	N/A	N/A	732 MOTT ST	100	SAN FERNANDO	CA	91340	3742	00	06000	34.27661761	-118.4442372	Los Angeles County
321943	Ordering, Referring, Prescribing	N/A	1154008118	0	0	GARCIA, JULIAN NP	5/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025395	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
321966	Ordering, Referring, Prescribing	N/A	1154081297	0	0	GRADY, JOSEPH LMFT	3/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99955	N/A	N/A	N/A	N/A	N/A	1865 HOTEL CIR S	None	SAN DIEGO	CA	92108	3319	00	06000	32.7590267	-117.1796706	San Diego County
321974	Ordering, Referring, Prescribing	N/A	1154138147	0	0	GARZA, SETH C DC	10/16/2024	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC37094	N/A	N/A	N/A	N/A	N/A	355 CAMPUS DR	SUITE E	HANFORD	CA	93230	4376	00	06000	36.3271295	-119.6633596	Kings County
321984	Ordering, Referring, Prescribing	N/A	1154315851	0	0	GONZALEZ, HUGO A MD	1/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G60620	N/A	N/A	N/A	N/A	N/A	1300 W OCEAN AVE	None	LOMPOC	CA	93436	5678	00	06000	34.63907053	-120.473361	Santa Barbara County
322014	Ordering, Referring, Prescribing	N/A	1154428613	0	0	GLADSTEIN, JAY MD	9/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A83112	N/A	N/A	N/A	N/A	N/A	5901 W OLYMPIC BLVD STE	STE 310	LOS ANGELES	CA	90036	4664	00	06000	34.05764121	-118.3603115	Los Angeles County
322103	Ordering, Referring, Prescribing	N/A	1154596229	0	0	GRAVEN, HOPE L LMFT	12/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48648	N/A	N/A	N/A	N/A	N/A	6160 MISSION GORGE RD	SUITE 100	SAN DIEGO	CA	92120	3410	00	06000	32.7868143	-117.0977635	San Diego County
322204	Ordering, Referring, Prescribing	N/A	1154771608	0	0	GEIGER, MIRIAM R LMFT	8/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120935	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	SUITE 259	OAKLAND	CA	94601	3424	00	06000	37.77617499	-122.2247899	Alameda County
322249	Ordering, Referring, Prescribing	N/A	1154849370	0	0	GLADWIN, KATHERINE NP	8/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007113	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
322261	Ordering, Referring, Prescribing	N/A	1154858082	0	0	GARCIA, JENNY A	7/30/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103553	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
322267	Ordering, Referring, Prescribing	N/A	1154867026	0	0	GURAY, ELLEN N PA	7/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA54160	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
322297	Ordering, Referring, Prescribing	N/A	1154939205	0	0	GOLIK, STEPHINE A PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82587	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
322327	Ordering, Referring, Prescribing	N/A	1154987212	0	0	GROCE, DANIELLE L NP	9/25/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012913	N/A	N/A	N/A	N/A	N/A	847 W CHILDS AVE	None	MERCED	CA	95341	6862	00	06000	37.28825369	-120.4963159	Merced County
322348	Ordering, Referring, Prescribing	N/A	1164033965	0	0	GARCIA, RAQUEL A	6/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014335	N/A	N/A	N/A	N/A	N/A	600 B STREET	BUILDING A-C	LIVINGSTON	CA	95334	9593	00	06000	37.38589253	-120.734559	Merced County
322354	Ordering, Referring, Prescribing	N/A	1164041265	0	0	GOLDSTEIN, BORUCH	6/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186744	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
322365	Ordering, Referring, Prescribing	N/A	1164059028	0	0	GONZALEZ, ALEJANDRA R MD	11/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183148	N/A	N/A	N/A	N/A	N/A	2970 HILLTOP MALL ROAD	305	RICHMOND	CA	94806	5274	00	06000	37.97819764	-122.329244	Contra Costa County
322367	Ordering, Referring, Prescribing	N/A	1164067567	0	0	GRUEN, AUDREY LCSW	9/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW13328	N/A	N/A	N/A	N/A	N/A	11911 SAN VICENTE BLVD.	SUITE 242	LOS ANGELES	CA	90049	5004	00	06000	34.05286226	-118.4701315	Los Angeles County
322399	Ordering, Referring, Prescribing	N/A	1164141719	0	0	GREENELSH, SHELBY PA	6/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61309	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
322442	Ordering, Referring, Prescribing	N/A	1164506499	0	0	GARCIA, RAUL A PHD	12/15/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17284	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
322460	Ordering, Referring, Prescribing	N/A	1164545729	0	0	GOFF, YVONNE	2/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	38003	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
322467	Ordering, Referring, Prescribing	N/A	1164554838	0	0	GAMBOA, YANET R LMFT	1/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49428	N/A	N/A	N/A	N/A	N/A	8337 TELEGRAPH RD	None	PICO RIVERA	CA	90660	4909	00	06000	33.96454327	-118.1134473	Los Angeles County
322472	Ordering, Referring, Prescribing	N/A	1164557559	0	0	GUTIERREZ, SILVIA G PHD	3/9/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY18553	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	FIFTH FLOOR	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
322518	Ordering, Referring, Prescribing	N/A	1164639803	0	0	GIDAN, JONATHAN M DDS	2/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	29280	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
322519	Ordering, Referring, Prescribing	N/A	1164649166	0	0	GARCIA, JULIA H LCSW	2/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22094	N/A	N/A	N/A	N/A	N/A	209 E. 7TH STREET	None	MADERA	CA	93638	3780	00	06000	36.96069768	-120.0559841	Madera County
322525	Ordering, Referring, Prescribing	N/A	1164667697	0	0	GREEN, WENDY L MD	12/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A36437	N/A	N/A	N/A	N/A	N/A	3831 HUGHES AVE	601	CULVER CITY	CA	90232	6844	00	06000	34.02243278	-118.3981492	Los Angeles County
322528	Ordering, Referring, Prescribing	N/A	1164669248	0	0	GONZALEZ, MADELEINE LCSW	4/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76090	N/A	N/A	N/A	N/A	N/A	11701 LA CIENEGA BLVD	None	LOS ANGELES	CA	90045	6260	00	06000	33.928227	-118.3701255	Los Angeles County
322544	Ordering, Referring, Prescribing	N/A	1164705133	0	0	GARCIA, LORENA LCSW	1/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	67997	N/A	N/A	N/A	N/A	N/A	8019 COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
322561	Ordering, Referring, Prescribing	N/A	1164727210	0	0	GARDNER, NICOLE L NP	1/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012848	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
322601	Ordering, Referring, Prescribing	N/A	1164806113	0	0	GOLDSTEIN, JESSA M LMFT	5/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109065	N/A	N/A	N/A	N/A	N/A	11175 SAN PABLO AVE.	None	EL CERRITO	CA	94530	2157	00	06000	37.91926262	-122.31424	Contra Costa County
322607	Ordering, Referring, Prescribing	N/A	1164808705	0	0	GARCIA, ANTHONY LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112980	N/A	N/A	N/A	N/A	N/A	2142 N BLYTHE AVE	None	FRESNO	CA	93722	5402	00	06000	36.76693886	-119.871282	Fresno County
322616	Ordering, Referring, Prescribing	N/A	1164824538	0	0	GINSBURG-LAVER, STUART	10/15/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150608	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD	102	VAN NUYS	CA	91405	3937	00	06000	34.19649	-118.448787	Los Angeles County
322678	Ordering, Referring, Prescribing	N/A	1164926929	0	0	GARCIA, MARISA C MSW LCSW	1/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112848	N/A	N/A	N/A	N/A	N/A	1360 S ANAHEIM BLVD	STE 101	ANAHEIM	CA	92805	6205	00	06000	33.8143261	-117.9066647	Orange County
322702	Ordering, Referring, Prescribing	N/A	1164972121	0	0	GUAN, ALEJANDRO PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	75430	N/A	N/A	N/A	N/A	N/A	2201 VERNE ROBERTS CIR	None	ANTIOCH	CA	94509	7911	00	06000	38.00927837	-121.8352825	Contra Costa County
322710	Ordering, Referring, Prescribing	N/A	1164984423	0	0	GERGEN, MARGARETTA E DO	11/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23629	N/A	N/A	N/A	N/A	N/A	1250 6TH AVE	SUITE 100	SAN DIEGO	CA	92101	4300	00	06000	32.71854144	-117.1593008	San Diego County
322711	Ordering, Referring, Prescribing	N/A	1164986766	0	0	GARCIA, DEBBIE NP	2/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009810	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
322731	Ordering, Referring, Prescribing	N/A	1174017677	0	0	GONZALES, JORDAN A	10/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122780	N/A	N/A	N/A	N/A	N/A	400 EDMONDS ROAD	None	REDWOOD CITY	CA	94062	3803	00	06000	37.47261402	-122.2862935	San Mateo County
322764	Ordering, Referring, Prescribing	N/A	1174078703	0	0	GROSKOPF, CHERYL LMFT	10/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122530	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
322783	Ordering, Referring, Prescribing	N/A	1174108088	0	0	GARCIA, RICARDO LMFT	2/26/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	153493	N/A	N/A	N/A	N/A	N/A	2620 INDUSTRY WAY	STE C	LYNWOOD	CA	90262	4042	00	06000	33.92360701	-118.2254995	Los Angeles County
322785	Ordering, Referring, Prescribing	N/A	1174105589	0	0	GALLEGOS, CYNTHIA V NP	12/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95016217	N/A	N/A	N/A	N/A	N/A	8788 JAMACHA ROAD	None	SPRING VALLEY	CA	91977	4035	00	06000	32.71482507	-117.0098243	San Diego County
322788	Ordering, Referring, Prescribing	N/A	1174118194	0	0	GALLEGOS, KRISTEN OT	12/18/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	21967	N/A	N/A	N/A	N/A	N/A	2686 SPRING STREET	None	REDWOOD CITY	CA	94063	3522	00	06000	37.48231745	-122.2081659	San Mateo County
322820	Ordering, Referring, Prescribing	N/A	1174135974	0	0	GONZALEZ, VALO S LCSW	6/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123327	N/A	N/A	N/A	N/A	N/A	1670 EAST 120TH STREET W	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
322870	Ordering, Referring, Prescribing	N/A	1174509103	0	0	GUSTAFSON, JULIA A NP	9/2/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	5485	N/A	N/A	N/A	N/A	N/A	18880 CHERRY VALLEY BLVD	None	TUOLUMNE	CA	95379	9506	00	06000	37.96511668	-120.2399015	Tuolumne County
322886	Ordering, Referring, Prescribing	N/A	1174611677	0	0	GARCIA, CLAUDIA LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23676	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
322888	Ordering, Referring, Prescribing	N/A	1174614515	0	0	GALANT, DANIEL PSYD	12/23/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY18543	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
322899	Ordering, Referring, Prescribing	N/A	1174646301	0	0	GALAPON, DIXIE L PSYD	6/28/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	16711	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
322901	Ordering, Referring, Prescribing	N/A	1174646574	0	0	GATT- AUZENNE, ELIZABETH LMFT	2/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44438	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
322904	Ordering, Referring, Prescribing	N/A	1174650089	0	0	GARGANTIEL, PAOLO R LCSW	12/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23509	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DRIVE STE 20	None	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
322934	Ordering, Referring, Prescribing	N/A	1174699250	0	0	GRANT, SALLY E NP	11/19/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12271	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
322940	Ordering, Referring, Prescribing	N/A	1174708549	0	0	GILL, RITA K NP	9/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP18516	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
322971	Ordering, Referring, Prescribing	N/A	1174785059	0	0	GONZALEZ, OSCAR LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28258	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
322976	Ordering, Referring, Prescribing	N/A	1174794796	0	0	GALLAGHER, KATHERINE M MD	10/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110830	N/A	N/A	N/A	N/A	N/A	1580 VALENCIA ST	STE 701	SAN FRANCISCO	CA	94110	4421	00	06000	37.74746923	-122.4202583	San Francisco County
322982	Ordering, Referring, Prescribing	N/A	1174801179	0	0	GROVER, ERIC R DO	8/27/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13265	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
322991	Ordering, Referring, Prescribing	N/A	1174813588	0	0	GOYAL, AMIT MD	1/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C183924	N/A	N/A	N/A	N/A	N/A	1700 N ROSE AVE	STE 470	OXNARD	CA	93030	1111	00	06000	34.21746	-119.155545	Ventura County
323006	Ordering, Referring, Prescribing	N/A	1174846752	0	0	GOLAN, ELANA M LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74805	N/A	N/A	N/A	N/A	N/A	6762 LEXINGTON AVENUE	STE A	LOS ANGELES	CA	90038	1217	00	06000	34.09253848	-118.3378635	Los Angeles County
323098	Ordering, Referring, Prescribing	N/A	1174963714	0	0	GROOM, RUSSELL C PSYD	5/7/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29338	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
323120	Ordering, Referring, Prescribing	N/A	1174991772	0	0	GALEANA, ANDREA PSYD	3/30/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31722	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
323121	Ordering, Referring, Prescribing	N/A	1174988034	0	0	GRATTAROLA, LINDSEY S LMFT	5/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125307	N/A	N/A	N/A	N/A	N/A	115 E HICKORY ST	SUITE E	LOMPOC	CA	93436	7274	00	06000	34.63573137	-120.4570207	Santa Barbara County
323152	Ordering, Referring, Prescribing	N/A	1184027310	0	0	GRANICK, PAMELA	3/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124989	N/A	N/A	N/A	N/A	N/A	670 PLACERVILLE DR	None	PLACERVILLE	CA	95667	4200	00	06000	38.73161765	-120.8213885	El Dorado County
323195	Ordering, Referring, Prescribing	N/A	1184087652	0	0	GALLETLY, SUZANNE M NP	11/11/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95004816	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH RD	G	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
323196	Ordering, Referring, Prescribing	N/A	1184090813	0	0	GONZALEZ, DANIELLE C LMFT	6/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126370	N/A	N/A	N/A	N/A	N/A	730 LA GUARDIA ST	STE 103	SALINAS	CA	93905	3354	00	06000	36.65807779	-121.6106308	Monterey County
323213	Ordering, Referring, Prescribing	N/A	1184105249	0	0	GLASS, KELSEY P LCSW	7/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102606	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
323250	Ordering, Referring, Prescribing	N/A	1184160673	0	0	GARRISON, CYNTHIA LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114357	N/A	N/A	N/A	N/A	N/A	851 N OAKLAND AVE	None	PASADENA	CA	91104	4343	00	06000	34.16031813	-118.1403347	Los Angeles County
323266	Ordering, Referring, Prescribing	N/A	1184185787	0	0	GOMEZ, JONATHAN D MD	5/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176609	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	COTTAGE H	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
323272	Ordering, Referring, Prescribing	N/A	1184199184	0	0	GORDON, NAYA LCSW	3/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107433	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
323288	Ordering, Referring, Prescribing	N/A	1184234593	0	0	GASH, JESSICA PA	9/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59444	N/A	N/A	N/A	N/A	N/A	1250 PEACH ST	STE A	SAN LUIS OBISPO	CA	93401	2871	00	06000	35.28647825	-120.6599674	San Luis Obispo County
323298	Ordering, Referring, Prescribing	N/A	1184252256	0	0	GAITONDE, ANISHA J MD	5/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186586	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
323327	Ordering, Referring, Prescribing	N/A	1184292286	0	0	GENSLER, DANIEL M NP	6/15/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017554	N/A	N/A	N/A	N/A	N/A	3415 MARTIN LUTHER KING	None	SACRAMENTO	CA	95817	3648	00	06000	38.54376	-121.4644095	Sacramento County
323341	Ordering, Referring, Prescribing	N/A	1184366981	0	0	GOTTLIEB, RACHEL MD MPH	8/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL8945	N/A	N/A	N/A	N/A	N/A	455 OCONNOR DR	SUITE 200	SAN JOSE	CA	95128	1633	00	06000	37.326654	-121.939897	Santa Clara County
323348	Ordering, Referring, Prescribing	N/A	1184388332	0	0	GESSEL, SUNNI E	10/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018928	N/A	N/A	N/A	N/A	N/A	13975 MONO WAY	STE. H	SONORA	CA	95370	2824	00	06000	37.97831488	-120.3396851	Tuolumne County
323368	Ordering, Referring, Prescribing	N/A	1184491094	0	0	GARCIA REYES, LETICIA PA	12/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63802	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
323408	Ordering, Referring, Prescribing	N/A	1184748410	0	0	GONZALEZ, CLAUDIA X LCSW	9/11/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68072	N/A	N/A	N/A	N/A	N/A	1414 S GRAND AVE STE 380	None	LOS ANGELES	CA	90015	3072	00	06000	34.03661142	-118.2657227	Los Angeles County
323425	Ordering, Referring, Prescribing	N/A	1184768863	0	0	GRAY, ANGELIQUE M LCSW	9/23/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79624	N/A	N/A	N/A	N/A	N/A	1441 LIBERTY ST.	None	REDDING	CA	96001	0848	00	06000	40.5857177	-122.3870781	Shasta County
323441	Ordering, Referring, Prescribing	N/A	1184817504	0	0	GARNICA, ANDREA T LCSW	5/3/2016	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	64305	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	4505	00	06000	34.06299829	-117.7215562	Los Angeles County
323483	Ordering, Referring, Prescribing	N/A	1184892481	0	0	GAILEY, KENNETH LMFT	10/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85394	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
323502	Ordering, Referring, Prescribing	N/A	1184914202	0	0	GARZON LOPEZ, AGUSTINA C MD	7/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132471	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
323519	Ordering, Referring, Prescribing	N/A	1184941379	0	0	GBEGNON, AKPENE MD	5/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170668	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
323537	Ordering, Referring, Prescribing	N/A	1184972200	0	0	GALANOI, NEDA MD	6/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130796	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
323538	Ordering, Referring, Prescribing	N/A	1184976763	0	0	GOMEZ, FRANCISCA LCSW	10/17/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126798	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
323540	Ordering, Referring, Prescribing	N/A	1184980674	0	0	GARZA, EDGAR O PA	4/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	22175	N/A	N/A	N/A	N/A	N/A	2237 W. BALL RD.	None	ANAHEIM	CA	92804	5314	00	06000	33.817798	-117.9610599	Orange County
323541	Ordering, Referring, Prescribing	N/A	1184983827	0	0	GHAZNAVI, MANZER H MD	1/20/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126705	N/A	N/A	N/A	N/A	N/A	14659 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1652	00	06000	34.32412624	-118.4525494	Los Angeles County
323583	Ordering, Referring, Prescribing	N/A	1194058925	0	0	GAYLE, GREGORY	9/23/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26970	N/A	N/A	N/A	N/A	N/A	2940 SUMMIT ST	SUITE 2D	OAKLAND	CA	94609	3416	00	06000	37.81849213	-122.2647718	Alameda County
323616	Ordering, Referring, Prescribing	N/A	1194121913	0	0	GORDON, JENNI R LMFT	9/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90971	N/A	N/A	N/A	N/A	N/A	1400 OREGON ST	None	REDDING	CA	96001	1620	00	06000	40.58426259	-122.3947721	Shasta County
323618	Ordering, Referring, Prescribing	N/A	1194126615	0	0	GONZALEZ, MARLENE M PSYD	2/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30636	N/A	N/A	N/A	N/A	N/A	505 N EUCLID ST	300	ANAHEIM	CA	92801	5506	00	06000	33.8379454	-117.9416147	Orange County
323630	Ordering, Referring, Prescribing	N/A	1194150888	0	0	GORDIN, YANA LMFT	11/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122949	N/A	N/A	N/A	N/A	N/A	1891 EFFIE ST	None	LOS ANGELES	CA	90026	1793	00	06000	34.08461594	-118.2570874	Los Angeles County
323644	Ordering, Referring, Prescribing	N/A	1194177584	0	0	GONZALEZ, MARIELENA	12/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106092	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVE	300	MORENO VALLEY	CA	92555	3901	00	06000	33.91013953	-117.193383	Riverside County
323645	Ordering, Referring, Prescribing	N/A	1194175299	0	0	GONZALEZ, ELIZABETH LMFT	5/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119242	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
323666	Ordering, Referring, Prescribing	N/A	1194208744	0	0	GUZMAN, ASHLEY B NP	7/31/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009625	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
323675	Ordering, Referring, Prescribing	N/A	1194222448	0	0	GARCIA, STEPHANIE D MD	8/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165824	N/A	N/A	N/A	N/A	N/A	1403 LOMITA BLVD	200	HARBOR CITY	CA	90710	2076	00	06000	33.79783692	-118.30188	Los Angeles County
323683	Ordering, Referring, Prescribing	N/A	1194233494	0	0	GHAMARI, NEDA LMFT	7/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120071	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
323685	Ordering, Referring, Prescribing	N/A	1194238683	0	0	GAMMINO, MICHAEL E LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16284	N/A	N/A	N/A	N/A	N/A	3610 SACRAMENTO STREET	None	SAN FRANCISCO	CA	94118	1734	00	06000	37.78754365	-122.4522383	San Francisco County
323713	Ordering, Referring, Prescribing	N/A	1194272492	0	0	GO, DOUGLAS OD	2/25/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33565	N/A	N/A	N/A	N/A	N/A	2458 MISSION	None	SAN FRANCISCO	CA	94110	0001	00	06000	37.75766352	-122.4189992	San Francisco County
323734	Ordering, Referring, Prescribing	N/A	1194316588	0	0	GRAHAM, KAMERON L NP	2/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016555	N/A	N/A	N/A	N/A	N/A	5 MEDICAL PLAZA	STE 170	ROSEVILLE	CA	95661	2867	00	06000	38.76604411	-121.2466761	Placer County
323763	Ordering, Referring, Prescribing	N/A	1194417303	0	0	GUZMAN, LUIS A DMD	5/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108807	N/A	N/A	N/A	N/A	N/A	300 HARTLE CT	None	NAPA	CA	94559	4078	00	06000	38.28326249	-122.2801759	Napa County
323771	Ordering, Referring, Prescribing	N/A	1194440776	0	0	GILL, PRABNEET PHARMD	4/2/2024	Taxonomy not applicable	NA	n/a	000	Unknown	84783	N/A	N/A	N/A	N/A	N/A	2121 N D ST	None	SAN BERNARDINO	CA	92405	3915	00	06000	34.13517012	-117.2918777	San Bernardino County
323803	Ordering, Referring, Prescribing	N/A	1194743666	0	0	GOLDSTEIN, SETH DC	10/22/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	14378	N/A	N/A	N/A	N/A	N/A	1133 N PALM CANYON DRIVE	SUITE A	PALM SPRINGS	CA	92262	4431	00	06000	33.838164	-116.546796	Riverside County
323805	Ordering, Referring, Prescribing	N/A	1194751289	0	0	GONZALES, PATRICK D MD	5/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A50669	N/A	N/A	N/A	N/A	N/A	29798 HAUN RD STE 106	STE 106	MENIFEE	CA	92586	6541	00	06000	33.68799332	-117.1748881	Riverside County
323807	Ordering, Referring, Prescribing	N/A	1194777003	0	0	GONZALEZ, ARASELIA NP	5/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	359314	N/A	N/A	N/A	N/A	N/A	1451 E EL MONTE WY	None	DINUBA	CA	93618	1812	00	06000	36.54552557	-119.3797841	Tulare County
323818	Ordering, Referring, Prescribing	N/A	1194811083	0	0	GANDHI, MORENA G	2/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0424088	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
323830	Ordering, Referring, Prescribing	N/A	1194851642	0	0	GUILLEN, LETICIA LCSW	3/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29433	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
323832	Ordering, Referring, Prescribing	N/A	1194854059	0	0	GREENE, SHARON M LCSW	2/23/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21635	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
323850	Ordering, Referring, Prescribing	N/A	1194866814	0	0	GONZALEZ, ROSALVA LMFT	2/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124214	N/A	N/A	N/A	N/A	N/A	1400S. GRAND AVE	SUITE 600	LOS ANGELES	CA	90015	3048	00	06000	34.03692236	-118.2655238	Los Angeles County
323854	Ordering, Referring, Prescribing	N/A	1194870949	0	0	GIN, KELLEY B PSYD	2/9/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20624	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH STREET	259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
323897	Ordering, Referring, Prescribing	N/A	1194956425	0	0	GALLEGOS, LILIA P LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90669	N/A	N/A	N/A	N/A	N/A	1 TOWER RD	None	SAN MATEO	CA	94401	0000	00	06000	37.51109169	-122.3335441	San Mateo County
323916	Ordering, Referring, Prescribing	N/A	1194999276	0	0	GUARDADO-SOTO, RAQUEL E PHD	11/22/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26883	N/A	N/A	N/A	N/A	N/A	1963 4TH AVE	None	SAN DIEGO	CA	92101	2394	00	06000	32.72572745	-117.1608615	San Diego County
323920	Ordering, Referring, Prescribing	N/A	1205008315	0	0	GARCIA GOMEZ, VERONICA LMFT	5/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92451	N/A	N/A	N/A	N/A	N/A	915 54TH AVE	None	OAKLAND	CA	94601	5643	00	06000	37.76471289	-122.2091638	Alameda County
323941	Ordering, Referring, Prescribing	N/A	1205074069	0	0	GORDEN, MEGHAN LMFT	7/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53279	N/A	N/A	N/A	N/A	N/A	5300 ANGELES VISTA BLVD	None	VIEW PARK	CA	90043	1648	00	06000	33.99473949	-118.34271	Los Angeles County
323946	Ordering, Referring, Prescribing	N/A	1205087103	0	0	GIAMBONE, LESLIE J LCSW	12/8/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28015	N/A	N/A	N/A	N/A	N/A	830 ATLANTIC AVENUE	None	LONG BEACH	CA	90813	4513	00	06000	33.77718	-118.185023	Los Angeles County
323949	Ordering, Referring, Prescribing	N/A	1205093051	0	0	GEORGE, MELISSA M NP	10/18/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95102387	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT	STE 100	SACRAMENTO	CA	95834	1656	00	06000	38.637702	-121.474773	Sacramento County
323951	Ordering, Referring, Prescribing	N/A	1205096443	0	0	GARCIA, JOICE DDS	2/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	51772	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
324005	Ordering, Referring, Prescribing	N/A	1205182185	0	0	GRAY, LAURYN A LCSW	3/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100815	N/A	N/A	N/A	N/A	N/A	3132 JEFFERSON STREET	None	SAN DIEGO	CA	92110	4421	00	06000	32.75567499	-117.203517	San Diego County
324040	Ordering, Referring, Prescribing	N/A	1205254968	0	0	GUTIERREZ, MARIO MD	5/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145700	N/A	N/A	N/A	N/A	N/A	760 E ALMOND AVE	None	MADERA	CA	93637	5617	00	06000	36.94546284	-120.04872	Madera County
324053	Ordering, Referring, Prescribing	N/A	1205275476	0	0	GRIFFIN, DIAMOND	2/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92676	N/A	N/A	N/A	N/A	N/A	8019 COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
324066	Ordering, Referring, Prescribing	N/A	1205288370	0	0	GRICHINE, VANESSA OD FAAO	3/16/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33473	N/A	N/A	N/A	N/A	N/A	2414 SOUTH FAIRVIEW	103	SANTA ANA	CA	92704	0140	00	06000	33.71437705	-117.9079237	Orange County
324109	Ordering, Referring, Prescribing	N/A	1205349461	0	0	GONZALEZ, ARACELI LCSW	12/11/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127701	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
324114	Ordering, Referring, Prescribing	N/A	1205367661	0	0	GLASS, MELISSA C MD	1/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165055	N/A	N/A	N/A	N/A	N/A	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	00	06000	37.76333626	-122.253868	Alameda County
324141	Ordering, Referring, Prescribing	N/A	1205406444	0	0	GONG, WAILAN PHARMD	10/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49536	N/A	N/A	N/A	N/A	N/A	4860 Y STREET	SUITE 1200	SACRAMENTO	CA	95817	2309	00	06000	38.552211	-121.449429	Sacramento County
324171	Ordering, Referring, Prescribing	N/A	1205478211	0	0	GILL, SAYURI LCSW	11/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88423	N/A	N/A	N/A	N/A	N/A	1780 VERNON ST	STE. 1	ROSEVILLE	CA	95678	6311	00	06000	38.732967	-121.2997685	Placer County
324172	Ordering, Referring, Prescribing	N/A	1205472990	0	0	GIL CASTANO, YENNIFER Y MD	4/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185412	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD STE 100	None	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
324256	Ordering, Referring, Prescribing	N/A	1205954807	0	0	GARVIN, MICHELLE J LMFT	1/24/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47720	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
324277	Ordering, Referring, Prescribing	N/A	1205991353	0	0	GUO, WEI L	3/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	16733	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
324291	Ordering, Referring, Prescribing	N/A	1215010756	0	0	GUERRERO, TATIANA	3/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	17713	N/A	N/A	N/A	N/A	N/A	1840 N HACIENDA BLVD	STE 3	LA PUENTE	CA	91744	1143	00	06000	34.05164127	-117.9426446	Los Angeles County
324305	Ordering, Referring, Prescribing	N/A	1215054341	0	0	GONZALEZ, CHRISTINE S LMFT	1/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46623	N/A	N/A	N/A	N/A	N/A	940 AVENUE 64	None	PASADENA	CA	91105	2711	00	06000	34.124895	-118.174671	Los Angeles County
324366	Ordering, Referring, Prescribing	N/A	1215154505	0	0	GHOBADI, JALEH M LMFT	8/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48592	N/A	N/A	N/A	N/A	N/A	300 S C ST	None	TUSTIN	CA	92780	3695	00	06000	33.74318295	-117.8249377	Orange County
324367	Ordering, Referring, Prescribing	N/A	1215171160	0	0	GONZALEZ, LUIS A LCSW	3/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76309	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	SUITE 200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
324368	Ordering, Referring, Prescribing	N/A	1215188347	0	0	GARTH, MARC ELLYN PHD	4/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	18706	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
324401	Ordering, Referring, Prescribing	N/A	1215225719	0	0	GARCIA, MARIA E LMFT	12/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77389	N/A	N/A	N/A	N/A	N/A	828 S BASCOM AVE	100	SAN JOSE	CA	95128	2651	00	06000	37.31225204	-121.9317854	Santa Clara County
324414	Ordering, Referring, Prescribing	N/A	1215240338	0	0	GRENTZER, JACLYN M MD	8/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145051	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
324446	Ordering, Referring, Prescribing	N/A	1215308408	0	0	GARCIA, JESSICA M LCSW	1/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81338	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
324457	Ordering, Referring, Prescribing	N/A	1215318530	0	0	GRIGORYAN, GAYANE LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88906	N/A	N/A	N/A	N/A	N/A	1233 S LA CIENEGA BLVD	None	LOS ANGELES	CA	90035	2520	00	06000	34.05475403	-118.3762195	Los Angeles County
324501	Ordering, Referring, Prescribing	N/A	1215369780	0	0	GAMEZ, ADRIANA MSW LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87917	N/A	N/A	N/A	N/A	N/A	1171 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.08088949	-118.2118988	Los Angeles County
324506	Ordering, Referring, Prescribing	N/A	1215389085	0	0	GHEYATH, BASHAER MD	4/11/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161977	N/A	N/A	N/A	N/A	N/A	10535 HOSPITAL WAY	None	MATHER	CA	95655	4200	00	06000	38.572443	-121.2965235	Sacramento County
324516	Ordering, Referring, Prescribing	N/A	1215402177	0	0	GEORGE, JENNIFER A PT	2/6/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT294245	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
324517	Ordering, Referring, Prescribing	N/A	1215399639	0	0	GONZALEZ GALLARDO, KELVIS MD	10/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157046	N/A	N/A	N/A	N/A	N/A	148 E KINGS ST	None	AVENAL	CA	93204	1529	00	06000	36.00249425	-120.1366109	Kings County
324524	Ordering, Referring, Prescribing	N/A	1215419098	0	0	GEORGE, ERIC M	11/9/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	103165	N/A	N/A	N/A	N/A	N/A	90 VIA JUANA RD	None	SANTA YNEZ	CA	93460	9679	00	06000	34.60546842	-120.0931812	Santa Barbara County
324557	Ordering, Referring, Prescribing	N/A	1215483706	0	0	GONZALEZ, CLAUDIA	9/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122644	N/A	N/A	N/A	N/A	N/A	550 QUARRY RD	None	SAN CARLOS	CA	94070	6221	00	06000	37.51749579	-122.2670107	San Mateo County
324570	Ordering, Referring, Prescribing	N/A	1215497458	0	0	GANJAEI, KIMIA G MD	3/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177112	N/A	N/A	N/A	N/A	N/A	2135 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.55759437	-121.4605768	Sacramento County
324571	Ordering, Referring, Prescribing	N/A	1215496260	0	0	GONG, SAMUEL MD	9/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176710	N/A	N/A	N/A	N/A	N/A	2271 S DEPOT ST	None	SANTA MARIA	CA	93455	0001	00	06000	34.91728273	-120.4435243	Santa Barbara County
324584	Ordering, Referring, Prescribing	N/A	1215526181	0	0	GRAVES, TERRI LMFT	7/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT14837	N/A	N/A	N/A	N/A	N/A	7001A EAST PKWY	None	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
324617	Ordering, Referring, Prescribing	N/A	1215592514	0	0	GORMAN, JESSICA LMFT	5/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139698	N/A	N/A	N/A	N/A	N/A	4900 CALIFORNIA AVE TOWE	STE 200	BAKERSFIELD	CA	93309	7024	00	06000	35.36440586	-119.0562732	Kern County
324652	Ordering, Referring, Prescribing	N/A	1215763040	0	0	GLANTZ, COURTNEY NP	9/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032077	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
324654	Ordering, Referring, Prescribing	N/A	1215777859	0	0	GUIRGES, CHRISTINE M PA-C	4/1/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64312	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	STE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
324665	Ordering, Referring, Prescribing	N/A	1215933015	0	0	GRUBBS, JAMES H MD	10/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G31012	N/A	N/A	N/A	N/A	N/A	2235 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5458	00	06000	38.425491	-122.7519	Sonoma County
324667	Ordering, Referring, Prescribing	N/A	1215979422	0	0	GURALNICK, SUSAN MD	3/5/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G153750	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
324670	Ordering, Referring, Prescribing	N/A	1225001522	0	0	GONZALEZ, ANA I DO	11/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A10351	N/A	N/A	N/A	N/A	N/A	2712 MISSION ST	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
324695	Ordering, Referring, Prescribing	N/A	1225117740	0	0	GRANT, PATRICE M PHD	3/16/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15276	N/A	N/A	N/A	N/A	N/A	11303 W WASHINGTON BLVD	200	LOS ANGELES	CA	90066	6003	00	06000	34.00408212	-118.4147433	Los Angeles County
324714	Ordering, Referring, Prescribing	N/A	1225155377	0	0	GUTIERREZ, ADRIANA LMFT	11/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118656	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
324729	Ordering, Referring, Prescribing	N/A	1225173206	0	0	GARRIDO, VICTOR M LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26017	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
324732	Ordering, Referring, Prescribing	N/A	1225169931	0	0	GINOSYAN, ANAIT LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84764	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
324777	Ordering, Referring, Prescribing	N/A	1225255359	0	0	GARG, RASHMI MD	1/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67689	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
324811	Ordering, Referring, Prescribing	N/A	1225328859	0	0	GARCIA, APRIL M LMFT	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87948	N/A	N/A	N/A	N/A	N/A	3360 N HWY 59 STE K	None	MERCED	CA	95348	9405	00	06000	37.32547941	-120.5047136	Merced County
324813	Ordering, Referring, Prescribing	N/A	1225338031	0	0	GHARIBIAN, DINO T	2/2/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D59345	N/A	N/A	N/A	N/A	N/A	334 N CENTRAL AVE	STE 207	GLENDALE	CA	91203	3120	00	06000	34.1511625	-118.2579085	Los Angeles County
324876	Ordering, Referring, Prescribing	N/A	1225452824	0	0	GILL, SANDEEP S	11/26/2017	Taxonomy not applicable	NA	n/a	000	Unknown	69725	N/A	N/A	N/A	N/A	N/A	2600 MITCHELL RD	STE G	CERES	CA	95307	9466	00	06000	37.59373003	-120.9386747	Stanislaus County
324883	Ordering, Referring, Prescribing	N/A	1225458839	0	0	GALLOWAY, NICHOLAS R MD	3/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161128	N/A	N/A	N/A	N/A	N/A	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
324896	Ordering, Referring, Prescribing	N/A	1225476955	0	0	GALVAN, GRISELDA PSYD	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100013	N/A	N/A	N/A	N/A	N/A	649 E ALBERTONI ST	100	CARSON	CA	90746	1538	00	06000	33.87194399	-118.2643054	Los Angeles County
324909	Ordering, Referring, Prescribing	N/A	1225496227	0	0	GARBIN, EVELINE LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100611	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	500	THOUSAND OAKS	CA	91360	4402	00	06000	34.17854676	-118.8805015	Ventura County
324951	Ordering, Referring, Prescribing	N/A	1225553605	0	0	GONZALES, TASHA NP	1/27/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010359	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
324975	Ordering, Referring, Prescribing	N/A	1225577943	0	0	GARCIA, KARINA R LCSW	2/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113747	N/A	N/A	N/A	N/A	N/A	864 E. SANTA CLARA ST.	None	VENTURA	CA	93001	2939	00	06000	34.27952351	-119.287537	Ventura County
324988	Ordering, Referring, Prescribing	N/A	1225593767	0	0	GARCIA, JORGE O CNP	3/7/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011188	N/A	N/A	N/A	N/A	N/A	470 CHADBOURNE RD	A	FAIRFIELD	CA	94534	9600	00	06000	38.23474317	-122.0838031	Solano County
325005	Ordering, Referring, Prescribing	N/A	1225655129	0	0	GRIGSBY, LATISHA A LCSW	4/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121933	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
325024	Ordering, Referring, Prescribing	N/A	1225695406	0	0	GIMENEZ, COURTNEY LCSW	4/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114715	N/A	N/A	N/A	N/A	N/A	100 POPLAR AVE	None	MODESTO	CA	95354	0510	00	06000	37.64602395	-121.000188	Stanislaus County
325030	Ordering, Referring, Prescribing	N/A	1225716418	0	0	GILL, PUNEET DO	10/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	4081	N/A	N/A	N/A	N/A	N/A	455 O'CONNOR DRIVE	200	SAN JOSE	CA	95128	0001	00	06000	37.326654	-121.939897	Santa Clara County
325048	Ordering, Referring, Prescribing	N/A	1225800451	0	0	GASKELL, KELLI LCSW	3/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109379	N/A	N/A	N/A	N/A	N/A	20 N SAN PEDRO RD	None	SAN RAFAEL	CA	94903	4188	00	06000	37.9954669	-122.5298321	Marin County
325082	Ordering, Referring, Prescribing	N/A	1235240458	0	0	GAO, MAHER MD	12/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C166987	N/A	N/A	N/A	N/A	N/A	847 W. CHILDS AVE.	None	MERCED	CA	95341	6805	00	06000	37.28825369	-120.4963159	Merced County
325085	Ordering, Referring, Prescribing	N/A	1235254871	0	0	GHUKASSIAN, MATTHEW LMFT	6/10/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50055	N/A	N/A	N/A	N/A	N/A	1577 E CHEVY CHASE DR	120	GLENDALE	CA	91206	4172	00	06000	34.15313959	-118.2299467	Los Angeles County
325099	Ordering, Referring, Prescribing	N/A	1235259821	0	0	GALINDO, ARTHUR A LCSW	2/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25647	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
325127	Ordering, Referring, Prescribing	N/A	1235330960	0	0	GLEASON, LISA MD	9/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A108043	N/A	N/A	N/A	N/A	N/A	685 MORRO AVE	STE C	MORRO BAY	CA	93442	2233	00	06000	35.364564	-120.8511755	San Luis Obispo County
325129	Ordering, Referring, Prescribing	N/A	1235331976	0	0	GLAS, FIONA C LCSW	1/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23767	N/A	N/A	N/A	N/A	N/A	2712 MISSION STREET	None	SAN FRANCISCO	CA	94110	3219	00	06000	37.75336705	-122.4185922	San Francisco County
325139	Ordering, Referring, Prescribing	N/A	1235339029	0	0	GARCIA, BRAULIO MSW LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25135	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
325149	Ordering, Referring, Prescribing	N/A	1235376450	0	0	GARDNERMENDOZA, VERONICA B LCSW	9/11/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28067	N/A	N/A	N/A	N/A	N/A	500 E OLIVE AVE	STE 240	BURBANK	CA	91501	3316	00	06000	34.1845331	-118.3048131	Los Angeles County
325155	Ordering, Referring, Prescribing	N/A	1235384132	0	0	GEBRU, MICHAEL A PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60380	N/A	N/A	N/A	N/A	N/A	2447 TELEGRAPH AVE	None	OAKLAND	CA	94612	2404	00	06000	37.81421479	-122.2684293	Alameda County
325224	Ordering, Referring, Prescribing	N/A	1235494980	0	0	GALVEZ, STEPHANIE A	10/28/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64323	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
325246	Ordering, Referring, Prescribing	N/A	1235526500	0	0	GARCIA, ANDREA N MD	11/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A135739	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
325255	Ordering, Referring, Prescribing	N/A	1235541996	0	0	GRACIANO, ELIZABETH LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108448	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	SUITE 200	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
325328	Ordering, Referring, Prescribing	N/A	1235651266	0	0	GOLDMAN, MONET K LMFT	10/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122804	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	STE 280	SAN MATEO	CA	94403	1289	00	06000	37.54524373	-122.3205511	San Mateo County
325340	Ordering, Referring, Prescribing	N/A	1235671272	0	0	GARZA, STEVE LCSW	5/5/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107954	N/A	N/A	N/A	N/A	N/A	50 BELLEFONTAINE ST STE	STE 205	PASADENA	CA	91105	3132	00	06000	34.13155953	-118.1517525	Los Angeles County
325393	Ordering, Referring, Prescribing	N/A	1235795881	0	0	GILL, HARMINDER K MD	2/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176540	N/A	N/A	N/A	N/A	N/A	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
325402	Ordering, Referring, Prescribing	N/A	1235825076	0	0	GELLER, WHITNEY N PHD	7/18/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34287	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
325421	Ordering, Referring, Prescribing	N/A	1235917196	0	0	GREEN, CHANEL PA-C	3/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64293	N/A	N/A	N/A	N/A	N/A	700 W 19TH ST	None	COSTA MESA	CA	92627	3517	00	06000	33.64342564	-117.9280911	Orange County
325424	Ordering, Referring, Prescribing	N/A	1245000504	0	0	GAOIRAN, SOPHIA NP	12/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028475	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
325446	Ordering, Referring, Prescribing	N/A	1245258219	0	0	GRIGGS, BENJAMIN G MD	11/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C42608	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE.	None	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
325447	Ordering, Referring, Prescribing	N/A	1245264530	0	0	GILMORE, CAROL A MD	2/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C41580	N/A	N/A	N/A	N/A	N/A	1001 E GRAND AVE	None	ESCONDIDO	CA	92025	4604	00	06000	33.12634291	-117.0682058	San Diego County
325534	Ordering, Referring, Prescribing	N/A	1245436591	0	0	GOPAL, ARUN MD	4/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A121687	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
325541	Ordering, Referring, Prescribing	N/A	1245462647	0	0	GARBELL, GINA M PSY	7/5/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	18909	N/A	N/A	N/A	N/A	N/A	4600 PANAMA LN	STE 102B	BAKERSFIELD	CA	93313	3509	00	06000	35.29596129	-119.0543102	Kern County
325583	Ordering, Referring, Prescribing	N/A	1245533728	0	0	GARCIA, PRISCILLA MSW LCSW	3/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73839	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3673	00	06000	37.03080985	-121.5741639	Santa Clara County
325608	Ordering, Referring, Prescribing	N/A	1245580919	0	0	GRIGG, JOHN	3/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	36599	N/A	N/A	N/A	N/A	N/A	57590 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	7428	00	06000	34.12539561	-116.4079258	San Bernardino County
325621	Ordering, Referring, Prescribing	N/A	1245599570	0	0	GARCIA, CARLA P LCSW	6/25/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88713	N/A	N/A	N/A	N/A	N/A	1300 BAKER ST	None	BAKERSFIELD	CA	93305	4326	00	06000	35.38256022	-118.990868	Kern County
325631	Ordering, Referring, Prescribing	N/A	1245607738	0	0	GILMORE, VIVIAN I LMFT	4/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132460	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	SUITE 300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
325645	Ordering, Referring, Prescribing	N/A	1245628726	0	0	GUERRERO, BETTINA G LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106858	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
325648	Ordering, Referring, Prescribing	N/A	1245625144	0	0	GREENE, GARY LMFT	2/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111668	N/A	N/A	N/A	N/A	N/A	14181 TELEGRAPH ROAD	None	WHITTIER	CA	90604	2554	00	06000	33.92892082	-118.0299538	Los Angeles County
325659	Ordering, Referring, Prescribing	N/A	1245651017	0	0	GAUTHIER, DAFNA	11/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	5915	N/A	N/A	N/A	N/A	N/A	225 30TH ST	306	SACRAMENTO	CA	95816	3359	00	06000	38.58102	-121.4628165	Sacramento County
325678	Ordering, Referring, Prescribing	N/A	1245682178	0	0	GUAJARDO, LAUREN	12/19/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT33846	N/A	N/A	N/A	N/A	N/A	215 W. BEAMER STREET	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
325679	Ordering, Referring, Prescribing	N/A	1245689488	0	0	GALLARES, DANIEL D MD	3/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165925	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
325689	Ordering, Referring, Prescribing	N/A	1245708924	0	0	GILL, KENDAL C NP	11/6/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010358	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
325701	Ordering, Referring, Prescribing	N/A	1245726488	0	0	GUZMAN-WILEY, ANA I LCSW	3/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100509	N/A	N/A	N/A	N/A	N/A	1002 E GRAND AVE	None	ESCONDIDO	CA	92025	4605	00	06000	33.12639838	-117.0682191	San Diego County
325723	Ordering, Referring, Prescribing	N/A	1245757640	0	0	GALVAN, JONNIE B OT	3/9/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	17624	N/A	N/A	N/A	N/A	N/A	1420 S MILLIKEN AVE	SUITE 508	ONTARIO	CA	91761	2336	00	06000	34.047684	-117.55872	San Bernardino County
325744	Ordering, Referring, Prescribing	N/A	1245774959	0	0	GREER, CHRISTOPHER	10/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104054	N/A	N/A	N/A	N/A	N/A	5905 SOQUEL DRIVE	STE. 350	SOQUEL	CA	95073	2850	00	06000	36.98881452	-121.9364193	Santa Cruz County
325750	Ordering, Referring, Prescribing	N/A	1245780923	0	0	GUERRA, JOANNA F LCSW	3/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107234	N/A	N/A	N/A	N/A	N/A	370 CRENSHAW BLVD SUIT E	None	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
325755	Ordering, Referring, Prescribing	N/A	1245783687	0	0	GUIDICATTI, KELSEY L LMFT	4/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125351	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
325763	Ordering, Referring, Prescribing	N/A	1245795954	0	0	GALAY, NICOLE	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79963	N/A	N/A	N/A	N/A	N/A	1050 REDWOOD STREET	None	VALLEJO	CA	94590	2955	00	06000	38.12243542	-122.2500918	Solano County
325828	Ordering, Referring, Prescribing	N/A	1245945096	0	0	GAMBLE, CIERRA PA	2/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62418	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
325849	Ordering, Referring, Prescribing	N/A	1255020491	0	0	GILL, HARMANPREET S	5/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025247	N/A	N/A	N/A	N/A	N/A	4639 W PINE AVE	None	FRESNO	CA	93722	7362	00	06000	36.76122148	-119.876787	Fresno County
325867	Ordering, Referring, Prescribing	N/A	1255054490	0	0	GREGG, MELISSA NP	4/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019125	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
325872	Ordering, Referring, Prescribing	N/A	1255064390	0	0	GIL, CRYSTAL PA	7/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63038	N/A	N/A	N/A	N/A	N/A	1014 N BROADWAY	None	SANTA ANA	CA	92701	3408	00	06000	33.75354748	-117.8697553	Orange County
325895	Ordering, Referring, Prescribing	N/A	1255370680	0	0	GOLDWASSER, HARRY D MD	6/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G132642	N/A	N/A	N/A	N/A	N/A	MAIL STOP 4038	47825 OASIS ST	INDIIO	CA	92201	6950	00	06000	0	0	None
325911	Ordering, Referring, Prescribing	N/A	1255428785	0	0	GRIGOR, ELIZABETH MD	11/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88651	N/A	N/A	N/A	N/A	N/A	10605 BALBOA BLVD	None	GRANADA HILLS	CA	91344	6342	00	06000	34.263378	-118.5022965	Los Angeles County
325925	Ordering, Referring, Prescribing	N/A	1255459202	0	0	GOLDEN, CARL R LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61942	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
325926	Ordering, Referring, Prescribing	N/A	1255455663	0	0	GONZALEZ LECHUGA, LORENA LCSW	3/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21880	N/A	N/A	N/A	N/A	N/A	1650 K LAS PLUMAS AVE	None	SAN JOSE	CA	95133	1657	00	06000	37.36163624	-121.8663794	Santa Clara County
325930	Ordering, Referring, Prescribing	N/A	1255459863	0	0	GRIFFIN-ORTIZ, HOPE E LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19742	N/A	N/A	N/A	N/A	N/A	951 B BLANCO CIRCLE	None	SALINAS	CA	93901	4451	00	06000	36.65589725	-121.6366313	Monterey County
325931	Ordering, Referring, Prescribing	N/A	1255462305	0	0	GUTIERREZ, MONICA LCSW	1/18/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27803	N/A	N/A	N/A	N/A	N/A	2690 CIENRGA RD.	None	HOLLISTER	CA	95023	8949	00	06000	36.82375129	-121.4010426	San Benito County
325937	Ordering, Referring, Prescribing	N/A	1255471447	0	0	GALEANO, JOAQUIN PSYD	3/3/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22546	N/A	N/A	N/A	N/A	N/A	333 S. FARRELL DRIVE	None	PALM SPRINGS	CA	92262	7905	00	06000	33.8189007	-116.51811	Riverside County
325943	Ordering, Referring, Prescribing	N/A	1255481495	0	0	GONZALES, HUGO L LMFT	8/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78447	N/A	N/A	N/A	N/A	N/A	3150 HILLTOP MALL RD.	04	RICHMOND	CA	94806	1921	00	06000	37.9802423	-122.3244075	Contra Costa County
325984	Ordering, Referring, Prescribing	N/A	1255581484	0	0	GONZALEZ-PEREZ, CLAUDIA MSW LCSW	10/24/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	67568	N/A	N/A	N/A	N/A	N/A	5801 SUNDALE AVE	None	BAKERSFIELD	CA	93309	2924	00	06000	35.34387226	-119.0654328	Kern County
326000	Ordering, Referring, Prescribing	N/A	1255588026	0	0	GUTIERREZ, MIRIAM PSYD	5/27/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26079	N/A	N/A	N/A	N/A	N/A	5110 W GOLDLEAF CIR	None	LOS ANGELES	CA	90056	1282	00	06000	33.98790164	-118.367233	Los Angeles County
326041	Ordering, Referring, Prescribing	N/A	1255674495	0	0	GRIFFITH, QYANA K MD	2/17/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A134168	N/A	N/A	N/A	N/A	N/A	720 WOOD STREET	None	EUEKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
326065	Ordering, Referring, Prescribing	N/A	1255724514	0	0	GARDINER, CHRISTOPHER R	10/14/2016	Taxonomy not applicable	NA	n/a	000	Unknown	52114	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
326066	Ordering, Referring, Prescribing	N/A	1255725388	0	0	GOMEZ, JEANETTE V NP	2/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001973	N/A	N/A	N/A	N/A	N/A	3022 INTERNATIONAL BLVD	210	OAKLAND	CA	94601	2224	00	06000	37.77849802	-122.22763	Alameda County
326143	Ordering, Referring, Prescribing	N/A	1255847034	0	0	GOMEZ, DESIREE A LMFT	4/18/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT146464	N/A	N/A	N/A	N/A	N/A	1510 N. LAFAYETTE AVE	None	FRESNO	CA	93728	1123	00	06000	36.763731	-119.837761	Fresno County
326156	Ordering, Referring, Prescribing	N/A	1255858965	0	0	GAYTAN, LYSSETTE LCSW	3/10/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100460	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD STE K	None	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
326188	Ordering, Referring, Prescribing	N/A	1255906236	0	0	GONZALEZ, YESSENIA PA	4/11/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64362	N/A	N/A	N/A	N/A	N/A	263 N VILLA AVE	None	WILLOWS	CA	95988	2607	00	06000	39.52254122	-122.2089532	Glenn County
326211	Ordering, Referring, Prescribing	N/A	1255939997	0	0	GIOVANAZZI, ALEXANDRA LMFT	11/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134037	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
326216	Ordering, Referring, Prescribing	N/A	1255965828	0	0	GROSS, HANNAH E PA	6/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57740	N/A	N/A	N/A	N/A	N/A	400 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
326234	Ordering, Referring, Prescribing	N/A	1255993127	0	0	GOZUN, MABELLE	8/20/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112851	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
326251	Ordering, Referring, Prescribing	N/A	1265018105	0	0	GRADY, FREDERICK MD	8/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL6281	N/A	N/A	N/A	N/A	N/A	797 S FAIR OAKS AVE	None	PASADENA	CA	91105	2617	00	06000	34.131942	-118.1503885	Los Angeles County
326297	Ordering, Referring, Prescribing	N/A	1265153753	0	0	GUTIERREZ, DAVID NP	2/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95154371	N/A	N/A	N/A	N/A	N/A	12511 BROOKHURST ST	None	GARDEN GROVE	CA	92840	4806	00	06000	33.78109145	-117.9586735	Orange County
326309	Ordering, Referring, Prescribing	N/A	1265181887	0	0	GLASHEEN, PAUL MD	8/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188900	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON RD	None	SACRAMENTO	CA	21131	1123	00	06000	38.555181	-121.4566785	Sacramento County
326324	Ordering, Referring, Prescribing	N/A	1265402150	0	0	GANDHI, DIPESHKUMAR K MD	10/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44920	N/A	N/A	N/A	N/A	N/A	949 CALHOUN PLACE	SUITE D	HEMET	CA	92543	4403	00	06000	33.7502744	-116.9618423	Riverside County
326329	Ordering, Referring, Prescribing	N/A	1265422695	0	0	GUZZETTA, RICHARD V MD	2/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G40600	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
326391	Ordering, Referring, Prescribing	N/A	1265591655	0	0	GABUYA, RODUAR P PSYD	2/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17694	N/A	N/A	N/A	N/A	N/A	532 E COLORADO AVENUE	8TH FLOOR	PASADENA	CA	91101	2044	00	06000	34.14582052	-118.139274	Los Angeles County
326394	Ordering, Referring, Prescribing	N/A	1265608632	0	0	GANNON, CHRISTINE M LCSW	3/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81120	N/A	N/A	N/A	N/A	N/A	2060 CAMPUS DR.	None	YREKA	CA	96097	9538	00	06000	41.7050458	-122.6481121	Siskiyou County
326399	Ordering, Referring, Prescribing	N/A	1265626329	0	0	GEBRI, NASHWA DDS	1/7/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS55696	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	FL 1,3	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
326454	Ordering, Referring, Prescribing	N/A	1265716930	0	0	GARCIA, SANDRA LCSW	2/14/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70920	N/A	N/A	N/A	N/A	N/A	7559 VERANO WAY	None	HUNTINGTON PARK	CA	90255	5649	00	06000	33.970554	-118.232081	Los Angeles County
326487	Ordering, Referring, Prescribing	N/A	1265775282	0	0	GARNICA-VAZQUEZ, FATIMA C LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT95659	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
326505	Ordering, Referring, Prescribing	N/A	1265805014	0	0	GOLDING, MAXWELL LMFT	7/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113852	N/A	N/A	N/A	N/A	N/A	1227 DE LA VINA ST	None	SANTA BARBARA	CA	93101	3129	00	06000	34.42190785	-119.7076889	Santa Barbara County
326516	Ordering, Referring, Prescribing	N/A	1265823033	0	0	GONZALEZ, DAISY LCSW	12/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127565	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
326532	Ordering, Referring, Prescribing	N/A	1265849806	0	0	GOORSKY, MARGARET M LCSW	4/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16741	N/A	N/A	N/A	N/A	N/A	200 SOUTH WELLS ROAD	250	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
326553	Ordering, Referring, Prescribing	N/A	1265876437	0	0	GRAHAM, TRAVIS LAC	1/5/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC18982	N/A	N/A	N/A	N/A	N/A	1908 N BEALE ROAD	SUITE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
326562	Ordering, Referring, Prescribing	N/A	1265885537	0	0	GRANILLO, CHRISTINA E LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103033	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
326587	Ordering, Referring, Prescribing	N/A	1265923189	0	0	GOODRUM, JASON MD	3/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185155	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
326606	Ordering, Referring, Prescribing	N/A	1265971915	0	0	GARCIA, ANGELA N NP	12/13/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	683178	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
326610	Ordering, Referring, Prescribing	N/A	1265977177	0	0	GREEN, SEAN G PHARMD	7/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69852	N/A	N/A	N/A	N/A	N/A	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
326627	Ordering, Referring, Prescribing	N/A	1265997100	0	0	GONZALEZ, YANET C LMFT	7/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140257	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
326636	Ordering, Referring, Prescribing	N/A	1275025611	0	0	GALVEZ, ESTEFANIA LMFT	12/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136524	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
326642	Ordering, Referring, Prescribing	N/A	1275037491	0	0	GUGLIELMINO, KATHLEEN MD	8/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178225	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
326716	Ordering, Referring, Prescribing	N/A	1275185050	0	0	GARCIA, MA RAQUEL R CNP	1/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012238	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2059	00	06000	33.83155851	-118.2920625	Los Angeles County
326753	Ordering, Referring, Prescribing	N/A	1275339178	0	0	GUPTA, MEGHANA DDS	3/31/2025	Taxonomy not applicable	NA	n/a	000	Unknown	DDS111326	N/A	N/A	N/A	N/A	N/A	1685 EAST HOME AVE	None	FRESNO	CA	93728	2027	00	06000	36.76325049	-119.7908582	Fresno County
326776	Ordering, Referring, Prescribing	N/A	1275602898	0	0	GRIFFIN, DENNIS J MSW LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25973	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
326787	Ordering, Referring, Prescribing	N/A	1275608986	0	0	GALINDO, ALFONSO G	7/6/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D40352	N/A	N/A	N/A	N/A	N/A	2950 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	2228	00	06000	37.77893032	-122.2284286	Alameda County
326821	Ordering, Referring, Prescribing	N/A	1275673543	0	0	GUTIERREZ, NINNETTE LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23793	N/A	N/A	N/A	N/A	N/A	1136 FREMONT AVENUE	#101	SOUTH PASADENA	CA	91030	3249	00	06000	34.11236286	-118.1531171	Los Angeles County
326842	Ordering, Referring, Prescribing	N/A	1275729329	0	0	GAERLAN-FINCH, VINESSA NP	3/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024757	N/A	N/A	N/A	N/A	N/A	1760 TERMINO AVE	None	LONG BEACH	CA	90804	2182	00	06000	33.78889871	-118.1458784	Los Angeles County
326843	Ordering, Referring, Prescribing	N/A	1275724775	0	0	GILMORE, KAREN J LCSW	8/13/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17718	N/A	N/A	N/A	N/A	N/A	37926 47TH ST E	None	PALMDALE	CA	93552	3272	00	06000	34.57140358	-118.0449908	Los Angeles County
326846	Ordering, Referring, Prescribing	N/A	1275730335	0	0	GUPTA, NAVDEEP MD	1/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C167749	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
326848	Ordering, Referring, Prescribing	N/A	1275748261	0	0	GARUBA, MARIAM I MD	4/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	172191	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD B	200	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
326896	Ordering, Referring, Prescribing	N/A	1275833782	0	0	GLAZE, TIMOTHY	9/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	40987	N/A	N/A	N/A	N/A	N/A	8011 UNIVERSITY AVE	None	LA MESA	CA	91942	5520	00	06000	32.76600931	-117.02485	San Diego County
326899	Ordering, Referring, Prescribing	N/A	1275836249	0	0	GOMEZ, LUISANA PA-C	2/19/2020	Taxonomy not applicable	NA	n/a	000	Unknown	20958	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
326901	Ordering, Referring, Prescribing	N/A	1275842411	0	0	GREEN, JULIA A LCSW	10/26/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	84348	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
326910	Ordering, Referring, Prescribing	N/A	1275863797	0	0	GONZALES, ERNEST E LMFT	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105854	N/A	N/A	N/A	N/A	N/A	3125 MYERS ST.	None	RIVERSIDE	CA	92505	5527	00	06000	33.90932558	-117.4428095	Riverside County
326919	Ordering, Referring, Prescribing	N/A	1275884868	0	0	GREENBERG, KRISTINA L LCSW	4/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93525	N/A	N/A	N/A	N/A	N/A	3068 JOHNSON AVE	None	COSTA MESA	CA	92626	2819	00	06000	33.68348326	-117.8995078	Orange County
326984	Ordering, Referring, Prescribing	N/A	1275969586	0	0	GUZMAN, MARIBEL LCSW	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83899	N/A	N/A	N/A	N/A	N/A	21840 NORMANDIE AVE	SUITE 500	TORRANCE	CA	90502	2047	00	06000	33.82982744	-118.2991395	Los Angeles County
326993	Ordering, Referring, Prescribing	N/A	1275985582	0	0	GUILLEN MEZA, MARICELA LCSW	3/4/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100385	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
327012	Ordering, Referring, Prescribing	N/A	1285004036	0	0	GHARAKHANI, ANNIE PSYD	2/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28959	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
327040	Ordering, Referring, Prescribing	N/A	1285008516	0	0	GODINEZ, DIANA LMFT	12/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123784	N/A	N/A	N/A	N/A	N/A	3787 SOUTH VERMONT AVENU	None	LOS ANGELES	CA	90005	1101	00	06000	34.01739	-118.291567	Los Angeles County
327072	Ordering, Referring, Prescribing	N/A	1285079509	0	0	GORGES, RANDA A MD	2/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138815	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
327089	Ordering, Referring, Prescribing	N/A	1285112300	0	0	GARRETT, DRAVEN M LMFT	7/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108946	N/A	N/A	N/A	N/A	N/A	399 TAYLOR BLVD	210	PLEASANT HILL	CA	94523	2297	00	06000	37.96117359	-122.0721927	Contra Costa County
327090	Ordering, Referring, Prescribing	N/A	1285111468	0	0	GOLDBERG, CASEY B LMFT	2/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124399	N/A	N/A	N/A	N/A	N/A	6736 LAUREL CANYON BLVD	200	LOS ANGELES	CA	91606	1576	00	06000	34.193493	-118.3964925	Los Angeles County
327138	Ordering, Referring, Prescribing	N/A	1285196311	0	0	GUTIERREZ, TANIA M DO	3/17/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19345	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
327141	Ordering, Referring, Prescribing	N/A	1285196881	0	0	GERMANOS, MARINA C MD	8/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181503	N/A	N/A	N/A	N/A	N/A	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	00	06000	32.83133206	-117.1252363	San Diego County
327151	Ordering, Referring, Prescribing	N/A	1285215947	0	0	GANNAGE, CATHERINE A MD	10/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7652	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
327207	Ordering, Referring, Prescribing	N/A	1285302901	0	0	GHANEM, MANIA OD	3/16/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT35021	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
327213	Ordering, Referring, Prescribing	N/A	1285357962	0	0	GUIDO, PAUL A PHD	1/13/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY8535	N/A	N/A	N/A	N/A	N/A	324 E CARRILLO ST	None	SANTA BARBARA	CA	93101	1433	00	06000	34.42529487	-119.6977685	Santa Barbara County
327217	Ordering, Referring, Prescribing	N/A	1285372912	0	0	GAYED, MONICA M MD	2/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL11411	N/A	N/A	N/A	N/A	N/A	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	00	06000	34.01966132	-118.1536008	Los Angeles County
327222	Ordering, Referring, Prescribing	N/A	1285373365	0	0	GOELMAN, SHAINA LMFT	2/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130909	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
327233	Ordering, Referring, Prescribing	N/A	1285399287	0	0	GARCIA, GISELLE N PHARMD	10/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85422	N/A	N/A	N/A	N/A	N/A	12109 APPLE VALLEY RD	None	APPLE VALLEY	CA	92308	6702	00	06000	34.47176263	-117.2423444	San Bernardino County
327241	Ordering, Referring, Prescribing	N/A	1285621060	0	0	GRAYSON, GEORGE I MD	6/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G24220	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS ST	None	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
327242	Ordering, Referring, Prescribing	N/A	1285616458	0	0	GILBERT, MARIANE NP	10/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	5558	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
327250	Ordering, Referring, Prescribing	N/A	1285655654	0	0	GRAY, RUTH E DC	5/4/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	17933	N/A	N/A	N/A	N/A	N/A	150 TEJAS PL	None	NIPOMO	CA	93444	9123	00	06000	35.02661565	-120.4990048	San Luis Obispo County
327253	Ordering, Referring, Prescribing	N/A	1285654764	0	0	GARNETT, MARY JANE AU	8/20/2018	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	AU 473	N/A	N/A	N/A	N/A	N/A	4045 LONE TREE WAY	STE. D	ANTIOCH	CA	94531	6206	00	06000	37.976122	-121.8012402	Contra Costa County
327254	Ordering, Referring, Prescribing	N/A	1285672345	0	0	GOODWIN, ANIKA S MD	10/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C159294	N/A	N/A	N/A	N/A	N/A	8300 EL CAMINO REAL	None	ATASCADERO	CA	93422	5358	00	06000	35.47529312	-120.6549045	San Luis Obispo County
327296	Ordering, Referring, Prescribing	N/A	1285780296	0	0	GEVERTS, LINDA J NP	2/11/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN445547	N/A	N/A	N/A	N/A	N/A	4555 PRECISSI LANE	None	STOCKTON	CA	95207	6239	00	06000	37.98919284	-121.3152121	San Joaquin County
327312	Ordering, Referring, Prescribing	N/A	1285815464	0	0	GONZALEZ, WILLIAM LCSW	10/2/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76421	N/A	N/A	N/A	N/A	N/A	33030 MISSION TRL	None	WILDOMAR	CA	92595	8423	00	06000	33.64104518	-117.2910774	Riverside County
327313	Ordering, Referring, Prescribing	N/A	1285809814	0	0	GAYLER, JAMES L LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52087	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
327314	Ordering, Referring, Prescribing	N/A	1285817924	0	0	GREEN, MARYELLEN B NP	9/4/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	347863	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
327331	Ordering, Referring, Prescribing	N/A	1285854216	0	0	GIAGOU, NATALIYA MD	6/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113100	N/A	N/A	N/A	N/A	N/A	2101 GEER RD	120	TURLOCK	CA	95382	2454	00	06000	37.512324	-120.8489985	Stanislaus County
327333	Ordering, Referring, Prescribing	N/A	1285851402	0	0	GOMEZ, CECILIA LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101862	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
327378	Ordering, Referring, Prescribing	N/A	1285930057	0	0	GEORGE, AJNI	4/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH54604	N/A	N/A	N/A	N/A	N/A	4309 CLAYTON RD	None	CONCORD	CA	94521	2842	00	06000	37.96457611	-121.9917154	Contra Costa County
327391	Ordering, Referring, Prescribing	N/A	1285942615	0	0	GARCIA, MARU LMFT	11/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106100	N/A	N/A	N/A	N/A	N/A	1200 N STATE STREET	SUITE 1016	LOS ANGELES	CA	90033	1001	00	06000	34.05855992	-118.209755	Los Angeles County
327431	Ordering, Referring, Prescribing	N/A	1295032597	0	0	GRAUERHOLZ, ANNA LMFT	11/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52947	N/A	N/A	N/A	N/A	N/A	108 W. VICTORIA STREET	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
327454	Ordering, Referring, Prescribing	N/A	1295068377	0	0	GIAQUINTO, ANACRISTINA	4/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79290	N/A	N/A	N/A	N/A	N/A	225 CABRILLO HWY S	SUITE 200A	HALF MOON BAY	CA	94019	8200	00	06000	37.46542425	-122.4337617	San Mateo County
327485	Ordering, Referring, Prescribing	N/A	1295143469	0	0	GAEDE, STUART LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT31426	N/A	N/A	N/A	N/A	N/A	1812 PARK AVE	None	REDLANDS	CA	92373	9999	00	06000	34.05931058	-117.216243	San Bernardino County
327495	Ordering, Referring, Prescribing	N/A	1295159747	0	0	GUTIEREZ, JOSEPH A LMFT	8/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133632	N/A	N/A	N/A	N/A	N/A	1303 SAN CARLOS AVE	None	SAN CARLOS	CA	94071	2317	00	06000	37.50572931	-122.2621879	San Mateo County
327497	Ordering, Referring, Prescribing	N/A	1295163400	0	0	GALERIO, PETER J NP	5/2/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN678420	N/A	N/A	N/A	N/A	N/A	21138 PASO ROBLES HWY	None	LOST HILLS	CA	93249	0306	00	06000	35.6161173	-119.695251	Kern County
327547	Ordering, Referring, Prescribing	N/A	1295249639	0	0	GASS, JESSICA PT	11/28/2018	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT294424	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
327555	Ordering, Referring, Prescribing	N/A	1295252856	0	0	GARIBAY, KEVIN I LCSW	6/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102021	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
327556	Ordering, Referring, Prescribing	N/A	1295260792	0	0	GONZALEZ, JAMES PHARMD	3/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	68271	N/A	N/A	N/A	N/A	N/A	3610 ADAMS AVE	None	SAN DIEGO	CA	92116	2212	00	06000	32.76335447	-117.1146375	San Diego County
327590	Ordering, Referring, Prescribing	N/A	1295314615	0	0	GIRON, MIANI MD	4/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181851	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
327619	Ordering, Referring, Prescribing	N/A	1295370112	0	0	GEOULA, REBECCA PA	2/7/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57820	N/A	N/A	N/A	N/A	N/A	400 WEST 30TH STREET	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
327622	Ordering, Referring, Prescribing	N/A	1295389195	0	0	GOMEZ PEREZ, MELISSA C LMFT	11/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT136100	N/A	N/A	N/A	N/A	N/A	185 MARTINVALE LN	None	SAN JOSE	CA	95119	1319	00	06000	37.22953469	-121.7790244	Santa Clara County
327632	Ordering, Referring, Prescribing	N/A	1295453033	0	0	GOVETT, RACHEL E OT	1/19/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT1215	N/A	N/A	N/A	N/A	N/A	1524 MCHENRY AVE	370	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
327662	Ordering, Referring, Prescribing	N/A	1295722718	0	0	GULLICK, NICOLE M MD	8/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C137948	N/A	N/A	N/A	N/A	N/A	90 VIA JUANA	None	SANTA YNEZ	CA	93460	9679	00	06000	34.60546842	-120.0931812	Santa Barbara County
327680	Ordering, Referring, Prescribing	N/A	1295777068	0	0	GRIVETT, ELIZABETH A	6/24/2015	Taxonomy not applicable	NA	n/a	000	Unknown	13761	N/A	N/A	N/A	N/A	N/A	700 SOUTH TUSTIN STREET	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
327690	Ordering, Referring, Prescribing	N/A	1295804078	0	0	GACIAS, EMMALINE D DMD	8/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	43442	N/A	N/A	N/A	N/A	N/A	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	00	06000	33.70481104	-117.9882948	Orange County
327757	Ordering, Referring, Prescribing	N/A	1295975860	0	0	GEVORKYAN, KRISTINE PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49806	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
327768	Ordering, Referring, Prescribing	N/A	1295992212	0	0	GONZALEZ, KARINA R LMFT	1/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82189	N/A	N/A	N/A	N/A	N/A	1910 OLYMPIC BLVD.	SUITE 365	WALNUT CREEK	CA	94596	5090	00	06000	37.89453628	-122.0662326	Contra Costa County
327801	Ordering, Referring, Prescribing	N/A	1306065990	0	0	GARLOFF, ANITA E NP	9/23/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	558558	N/A	N/A	N/A	N/A	N/A	1922 THE ALAMEDA	440	SAN JOSE	CA	95126	1462	00	06000	37.34128547	-121.9236047	Santa Clara County
327805	Ordering, Referring, Prescribing	N/A	1306082771	0	0	GARCIA, MARIA E LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47445	N/A	N/A	N/A	N/A	N/A	680 LANGSDORF DR	200	FULLERTON	CA	92831	3702	00	06000	33.87673088	-117.8824577	Orange County
327845	Ordering, Referring, Prescribing	N/A	1306146808	0	0	GUTIERREZ, ANDREA S PHARMD	3/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61220	N/A	N/A	N/A	N/A	N/A	1300 NORTH DUTTON AVE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
327883	Ordering, Referring, Prescribing	N/A	1306198734	0	0	GUITRON, LOUIS NP	10/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001208	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
327886	Ordering, Referring, Prescribing	N/A	1306203336	0	0	GONZALEZ, MARIA A LCSW	5/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101635	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
327936	Ordering, Referring, Prescribing	N/A	1306278924	0	0	GENTRY, CHRISTOPHER NP	11/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004354	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
327940	Ordering, Referring, Prescribing	N/A	1306296884	0	0	GUZMAN JOVEL, ALMA P LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88668	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
327968	Ordering, Referring, Prescribing	N/A	1306328026	0	0	GARZA, CHRISTOPHER D NP	2/11/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	950200005	N/A	N/A	N/A	N/A	N/A	820 34TH STREET	None	BAKERSFIELD	CA	93301	2283	00	06000	35.39053308	-119.0117133	Kern County
327971	Ordering, Referring, Prescribing	N/A	1306332713	0	0	GORDULA, ANNE GELEEN PSYD	8/2/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34426	N/A	N/A	N/A	N/A	N/A	18350 MT LANGLEY ST	SUITE 220	FOUNTAIN VALLEY	CA	92708	6900	00	06000	33.69633523	-117.9420534	Orange County
327978	Ordering, Referring, Prescribing	N/A	1306353297	0	0	GORDON, DANIELLE M	2/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55372	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2006	00	06000	37.86680859	-122.2969443	Alameda County
327993	Ordering, Referring, Prescribing	N/A	1306386800	0	0	GAMBINA, KARISSA R LMFT	12/31/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117142	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
328000	Ordering, Referring, Prescribing	N/A	1306405220	0	0	GARCIA, JESSICA LMFT	11/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130935	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
328003	Ordering, Referring, Prescribing	N/A	1306406657	0	0	GOLDBERG, LIOR MD	1/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL983	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
328014	Ordering, Referring, Prescribing	N/A	1306426762	0	0	GILL, JASDEEP K PA-C	6/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61281	N/A	N/A	N/A	N/A	N/A	625 34TH ST STE 100 & 20	None	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
328020	Ordering, Referring, Prescribing	N/A	1306455829	0	0	GOO, CATHLYN PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82400	N/A	N/A	N/A	N/A	N/A	4616 DE LONGPRE AVE	None	LOS ANGELES	CA	90027	6076	00	06000	34.0969945	-118.2901545	Los Angeles County
328023	Ordering, Referring, Prescribing	N/A	1306470083	0	0	GENGLER, KIMBERLY LMFT	4/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132419	N/A	N/A	N/A	N/A	N/A	1033 LAUREL STREET	None	SAN CARLOS	CA	94070	2317	00	06000	37.50079437	-122.2542324	San Mateo County
328033	Ordering, Referring, Prescribing	N/A	1306484530	0	0	GALANTER, KAYLA PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81196	N/A	N/A	N/A	N/A	N/A	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	2001	00	06000	37.94947636	-121.7752571	Contra Costa County
328059	Ordering, Referring, Prescribing	N/A	1306516182	0	0	GENEROSO, ERIKA MARIE G PHARMD	8/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84781	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
328060	Ordering, Referring, Prescribing	N/A	1306547757	0	0	GEORGETTI, DIANNE G	9/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022480	N/A	N/A	N/A	N/A	N/A	3800 KILROY AIRPORT WAY	100	LONG BEACH	CA	90806	2494	00	06000	33.80725242	-118.14497	Los Angeles County
328078	Ordering, Referring, Prescribing	N/A	1306615836	0	0	GREEN, JOAN NICOLE	12/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028476	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
328181	Ordering, Referring, Prescribing	N/A	1316044282	0	0	GOMEZ, ERICA A	9/4/2015	Taxonomy not applicable	NA	n/a	000	Unknown	17475	N/A	N/A	N/A	N/A	N/A	5151 STATE UNIVERSITY DR	None	LOS ANGELES	CA	90032	4226	00	06000	34.066206	-118.1683485	Los Angeles County
328185	Ordering, Referring, Prescribing	N/A	1316058662	0	0	GRISBACH-SMITH, CHRISTINE M	2/14/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN357125	N/A	N/A	N/A	N/A	N/A	1125 TENTH STREET	None	SACRAMENTO	CA	95814	3503	00	06000	38.57890563	-121.4939739	Sacramento County
328190	Ordering, Referring, Prescribing	N/A	1316060478	0	0	GULINO, SARA LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26261	N/A	N/A	N/A	N/A	N/A	104 S C ST	None	LOMPOC	CA	93436	6924	00	06000	34.638645	-120.4514709	Santa Barbara County
328191	Ordering, Referring, Prescribing	N/A	1316065006	0	0	GOETZ REGO, JENNIFER N LMFT	5/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48632	N/A	N/A	N/A	N/A	N/A	701 N MADISON ST	None	STOCKTON	CA	95202	1634	00	06000	37.95907454	-121.2956959	San Joaquin County
328200	Ordering, Referring, Prescribing	N/A	1316078165	0	0	GALDAMEZ, VIOLETA A MD	8/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A50144	N/A	N/A	N/A	N/A	N/A	6831 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4805	00	06000	33.97706276	-118.2225577	Los Angeles County
328216	Ordering, Referring, Prescribing	N/A	1316124662	0	0	GUEVARA, MARIA R	7/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102275	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
328238	Ordering, Referring, Prescribing	N/A	1316190572	0	0	GERSHMAN, LISA N MD	4/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112107	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
328244	Ordering, Referring, Prescribing	N/A	1316201346	0	0	GO, SHARON L	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92795	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
328304	Ordering, Referring, Prescribing	N/A	1316314032	0	0	GHADIA, RAJNISH H PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH73996	N/A	N/A	N/A	N/A	N/A	1241 W FOOTHILL BLVD.	None	UPLAND	CA	91786	3681	00	06000	34.10698077	-117.6713946	San Bernardino County
328322	Ordering, Referring, Prescribing	N/A	1316323736	0	0	GARCIA, ARTURO PA-C	8/10/2019	Taxonomy not applicable	NA	n/a	000	Unknown	52721	N/A	N/A	N/A	N/A	N/A	1665 S. IMPERIAL AVE	D	EL CENTRO	CA	92243	4247	00	06000	32.77860065	-115.5695241	Imperial County
328325	Ordering, Referring, Prescribing	N/A	1316326473	0	0	GUERRERO JIMENEZ, MARIA I LCSW	4/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101310	N/A	N/A	N/A	N/A	N/A	920 16TH ST	None	MODESTO	CA	95354	1119	00	06000	37.64452747	-120.9942327	Stanislaus County
328333	Ordering, Referring, Prescribing	N/A	1316332497	0	0	GHOSH, MOYUKH MD	11/21/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144868	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	STE M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
328336	Ordering, Referring, Prescribing	N/A	1316346075	0	0	GOODRIDGE, YVETTE L NP	8/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20859	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	# 170	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
328346	Ordering, Referring, Prescribing	N/A	1316357221	0	0	GOODFRIEND, GABRIELLA MD	11/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162998	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
328389	Ordering, Referring, Prescribing	N/A	1316424609	0	0	GALANDARYAN, SRBUI S	2/18/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128743	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
328409	Ordering, Referring, Prescribing	N/A	1316461130	0	0	GRAY, FRANCIS E LCSW	3/10/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121477	N/A	N/A	N/A	N/A	N/A	1255 ALLSTON WAY	None	BERKELEY	CA	94702	1893	00	06000	37.86702492	-122.2865918	Alameda County
328435	Ordering, Referring, Prescribing	N/A	1316491350	0	0	GEREGA, MARIA PSYD	6/15/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32678	N/A	N/A	N/A	N/A	N/A	3626 BALBOA STREET	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
328442	Ordering, Referring, Prescribing	N/A	1316499239	0	0	GALINATO, DENA L PSYD	11/16/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32221	N/A	N/A	N/A	N/A	N/A	31805 TEMECULA PKWY	D7-524	TEMECULA	CA	92592	8203	00	06000	33.47753395	-117.1015409	Riverside County
328467	Ordering, Referring, Prescribing	N/A	1316534951	0	0	GEZALIAN, TIGRAN PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83548	N/A	N/A	N/A	N/A	N/A	5001 W. AVENUE N	None	LANCASTER	CA	93536	2989	00	06000	34.63089147	-118.219455	Los Angeles County
328503	Ordering, Referring, Prescribing	N/A	1316614738	0	0	GRIFFITH, TAMMY	11/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	20344	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
328510	Ordering, Referring, Prescribing	N/A	1316611726	0	0	GREEN, SAUNDRA L LMFT	7/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52777	N/A	N/A	N/A	N/A	N/A	5776 STONERIDGE MALL RD	STE 300	PLEASANTON	CA	94588	4522	00	06000	37.69272221	-121.9305836	Alameda County
328513	Ordering, Referring, Prescribing	N/A	1316637770	0	0	GRYPARIS, EVANGELIA PA-C	3/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62566	N/A	N/A	N/A	N/A	N/A	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
328526	Ordering, Referring, Prescribing	N/A	1316701444	0	0	GONZALEZ, DENISSE NP	2/1/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028946	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
328527	Ordering, Referring, Prescribing	N/A	1316702814	0	0	GACHARNA, JANETH LMFT	3/13/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102527	N/A	N/A	N/A	N/A	N/A	13634 CORDARY AVE	None	HAWTHORNE	CA	90250	7409	00	06000	33.907257	-118.3416915	Los Angeles County
328565	Ordering, Referring, Prescribing	N/A	1326052457	0	0	GENORESE, KELLY K	4/11/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0415733	N/A	N/A	N/A	N/A	N/A	5400 RALSTON ST	None	VENTURA	CA	93003	6002	00	06000	34.25974984	-119.2179337	Ventura County
328582	Ordering, Referring, Prescribing	N/A	1326110156	0	0	GANPULE, NANDINI L MD	11/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A33030	N/A	N/A	N/A	N/A	N/A	2415 UNIVERSITY AVE	None	EAST PALO ALTO	CA	94303	1164	00	06000	37.47232529	-122.139568	San Mateo County
328638	Ordering, Referring, Prescribing	N/A	1326187758	0	0	GILREATH, SYLVAN J LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112158	N/A	N/A	N/A	N/A	N/A	8755 AERO DR	None	SAN DIEGO	CA	92123	1776	00	06000	32.80965252	-117.139383	San Diego County
328640	Ordering, Referring, Prescribing	N/A	1326172867	0	0	GONZALEZ, MIRIAM LMFT	4/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116948	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
328687	Ordering, Referring, Prescribing	N/A	1326294893	0	0	GANELES, ROBYN D LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT77689	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
328701	Ordering, Referring, Prescribing	N/A	1326307539	0	0	GORDON, KATHERINE A OT	2/11/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	11811	N/A	N/A	N/A	N/A	N/A	425 DIVISADERO ST	None	SAN FRANCISCO	CA	94117	2242	00	06000	37.77336026	-122.4375022	San Francisco County
328729	Ordering, Referring, Prescribing	N/A	1326338005	0	0	GRIMM, WENDY	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58113	N/A	N/A	N/A	N/A	N/A	2703 ORO DAM BLVD E	None	OROVILLE	CA	95966	5116	00	06000	39.50709449	-121.5453316	Butte County
328744	Ordering, Referring, Prescribing	N/A	1326355918	0	0	GARCIA, CHRISTINE PSYD	3/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26807	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
328767	Ordering, Referring, Prescribing	N/A	1326383738	0	0	GONZALEZ, JESSICA A LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100227	N/A	N/A	N/A	N/A	N/A	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	00	06000	36.777735	-119.7815105	Fresno County
328773	Ordering, Referring, Prescribing	N/A	1326399098	0	0	GIBSON, VICTORIA M LMFT	2/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124485	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
328793	Ordering, Referring, Prescribing	N/A	1326432873	0	0	GREENFIELD, ISABEL Q MD	7/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144104	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
328803	Ordering, Referring, Prescribing	N/A	1326443649	0	0	GRIGORIAN, TEODIK OD	5/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15169	N/A	N/A	N/A	N/A	N/A	14550 HAYNES ST	None	VAN NUYS	CA	91411	1613	00	06000	34.18967817	-118.4506446	Los Angeles County
328833	Ordering, Referring, Prescribing	N/A	1326489121	0	0	GUADARRAMA HERNANDEZ, ALMA E LCSW	6/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102281	N/A	N/A	N/A	N/A	N/A	49211 GRAPEFRUIT BOULEVA	STE 5	COACHELLA	CA	92236	1480	00	06000	33.69171437	-116.184351	Riverside County
328841	Ordering, Referring, Prescribing	N/A	1326495540	0	0	GAURA, PAUL E PHARMD	6/6/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80542	N/A	N/A	N/A	N/A	N/A	110 E CARSON ST	None	CARSON	CA	90745	2702	00	06000	33.83153455	-118.276704	Los Angeles County
328850	Ordering, Referring, Prescribing	N/A	1326520586	0	0	GALLAGHER, SHELBY L LCSW	8/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125337	N/A	N/A	N/A	N/A	N/A	855 N VERMONT AVE	STUDENT SERVICES BUILDIN	LOS ANGELES	CA	90029	3516	00	06000	34.086699	-118.2917585	Los Angeles County
328857	Ordering, Referring, Prescribing	N/A	1326539735	0	0	GARCIA, CHRISTINA LMFT	2/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT137935	N/A	N/A	N/A	N/A	N/A	1523 LONGBRANCH AVE	None	GROVER BEACH	CA	93433	2508	00	06000	35.11917729	-120.6126498	San Luis Obispo County
328868	Ordering, Referring, Prescribing	N/A	1326565490	0	0	GONZALEZ GUILLEN, MARIA C LCSW	6/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102310	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	405	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
328874	Ordering, Referring, Prescribing	N/A	1326573890	0	0	GARCIA, ELISA G NP	7/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021815	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
328897	Ordering, Referring, Prescribing	N/A	1326587833	0	0	GILL, REAGAN C DO	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18712	N/A	N/A	N/A	N/A	N/A	2100 NAPA-VALLEJO HIGHWA	None	NAPA	CA	94558	6293	00	06000	38.277846	-122.2678305	Napa County
328910	Ordering, Referring, Prescribing	N/A	1326620782	0	0	GOWDA, SANJIV	5/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21051	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
328917	Ordering, Referring, Prescribing	N/A	1326638099	0	0	GARCIA, ILIANA NP	1/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015899	N/A	N/A	N/A	N/A	N/A	1555 S GAREY AVE	None	POMONA	CA	91790	3001	00	06000	34.04317024	-117.7497127	Los Angeles County
328933	Ordering, Referring, Prescribing	N/A	1326691221	0	0	GO, TARYN L PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82654	N/A	N/A	N/A	N/A	N/A	3701 BROADWAY	None	OAKLAND	CA	94611	5613	00	06000	37.82533768	-122.258094	Alameda County
329014	Ordering, Referring, Prescribing	N/A	1336237833	0	0	GRAVES, KAREN L NP	12/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	844	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
329065	Ordering, Referring, Prescribing	N/A	1336347459	0	0	GRUNSTEIN, SARA LCSW	6/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16229	N/A	N/A	N/A	N/A	N/A	2887 COLLEGE AVE	1/360	BERKELEY	CA	94705	2154	00	06000	37.85881481	-122.2531941	Alameda County
329074	Ordering, Referring, Prescribing	N/A	1336359256	0	0	GRIGGS, DIANE R LCSW	2/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS11920	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
329082	Ordering, Referring, Prescribing	N/A	1336378116	0	0	GUTIERREZ, DIANE E LMFT	8/9/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT86992	N/A	N/A	N/A	N/A	N/A	1190 LINCOLN AVENUE	SUITE 6	SAN JOSE	CA	95125	3036	00	06000	37.30693766	-121.8999555	Santa Clara County
329093	Ordering, Referring, Prescribing	N/A	1336401041	0	0	GILL, AMANJOT K MD	12/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A142790	N/A	N/A	N/A	N/A	N/A	2180 HARVARD STREET	210	SACRAMENTO	CA	95815	3318	00	06000	38.60568	-121.4345385	Sacramento County
329094	Ordering, Referring, Prescribing	N/A	1336396548	0	0	GILLIAM-UDO, BRENITTA PA	9/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	15518	N/A	N/A	N/A	N/A	N/A	1414 NORTH CALIFORNIA ST	SUITE #A, B, C	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
329098	Ordering, Referring, Prescribing	N/A	1336408194	0	0	GOMEZ, EVEYLYN L MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132475	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
329131	Ordering, Referring, Prescribing	N/A	1336474055	0	0	GALEN, KENNETH D MD	9/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G85542	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
329151	Ordering, Referring, Prescribing	N/A	1336498849	0	0	GONZALEZ, ISABEL LMFT	11/21/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130981	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR.	STE 220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
329153	Ordering, Referring, Prescribing	N/A	1336500446	0	0	GOMEZ, KELSEY L	10/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116901	N/A	N/A	N/A	N/A	N/A	2275 S. MAIN ST.	STE. 201	CORONA	CA	92882	5303	00	06000	33.85511663	-117.5694892	Riverside County
329176	Ordering, Referring, Prescribing	N/A	1336529221	0	0	GUERRERO, AECHA LMFT	4/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113123	N/A	N/A	N/A	N/A	N/A	215 W. BEAMER STREET	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
329220	Ordering, Referring, Prescribing	N/A	1336591148	0	0	GENGLER, BILLIE L LCSW	1/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW12964	N/A	N/A	N/A	N/A	N/A	24275 JEFFERSON AVE	None	MURRIETA	CA	92562	0122	00	06000	33.5676365	-117.2174559	Riverside County
329238	Ordering, Referring, Prescribing	N/A	1336608132	0	0	GANDELMAN, JASON A MD	6/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	1455	N/A	N/A	N/A	N/A	N/A	401 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2211	00	06000	37.76376114	-122.4567626	San Francisco County
329271	Ordering, Referring, Prescribing	N/A	1336663681	0	0	GARDNER, KRISTA OD	6/21/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33947	N/A	N/A	N/A	N/A	N/A	2067 W VISTA WAY	120	VISTA	CA	92083	6032	00	06000	33.18505594	-117.285958	San Diego County
329281	Ordering, Referring, Prescribing	N/A	1336673730	0	0	GILBURD, ALEXANDER	2/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121902	N/A	N/A	N/A	N/A	N/A	1508 GREENFIELD AVE	302	LOS ANGELES	CA	90025	8018	00	06000	34.05153161	-118.4437181	Los Angeles County
329291	Ordering, Referring, Prescribing	N/A	1336694660	0	0	GODINEZ, MICHELLE A LCSW	6/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102283	N/A	N/A	N/A	N/A	N/A	10 DOUGLAS DR	140	MARTINEZ	CA	94553	4077	00	06000	37.99546221	-122.1222474	Contra Costa County
329292	Ordering, Referring, Prescribing	N/A	1336694157	0	0	GARCIA, DIANNE LMFT	10/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112943	N/A	N/A	N/A	N/A	N/A	2243 N MOUNTAIN AVE	None	CLAREMONT	CA	91711	1586	00	06000	34.124265	-117.729017	Los Angeles County
329351	Ordering, Referring, Prescribing	N/A	1336850387	0	0	GARRETT, NIKITA NP	12/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028529	N/A	N/A	N/A	N/A	N/A	1685 E MAIN STREET	SUITE 301	EL CAJON	CA	92021	0000	00	06000	32.81132509	-116.9192044	San Diego County
329380	Ordering, Referring, Prescribing	N/A	1346029436	0	0	GORECKI, SASHA D CNP	1/20/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95026331	N/A	N/A	N/A	N/A	N/A	3544 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
329400	Ordering, Referring, Prescribing	N/A	1346265873	0	0	GONZALEZ, LUIS DC	10/28/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	29860	N/A	N/A	N/A	N/A	N/A	1133 N PALM CANYON DR	SUITE A	PALM SPRINGS	CA	92262	4431	00	06000	33.838164	-116.546796	Riverside County
329404	Ordering, Referring, Prescribing	N/A	1346288024	0	0	GOKHMAN, IZABELLA MD	11/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84220	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWOTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
329406	Ordering, Referring, Prescribing	N/A	1346294725	0	0	GODDARD, ANDREW W MD	6/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C132659	N/A	N/A	N/A	N/A	N/A	299 TWELFTH ST	STE A	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
329454	Ordering, Referring, Prescribing	N/A	1346382587	0	0	GRIFFITH, DARLA LCSW	4/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25712	N/A	N/A	N/A	N/A	N/A	711 N COURT ST	STE B	VISALIA	CA	93291	3638	00	06000	36.336384	-119.292543	Tulare County
329463	Ordering, Referring, Prescribing	N/A	1346392552	0	0	GAMAYO, KRIS LMFT	2/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45027	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	SUITE 200	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
329466	Ordering, Referring, Prescribing	N/A	1346396645	0	0	GUERRA, JOSE J MD	7/22/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8135	N/A	N/A	N/A	N/A	N/A	2237 W BALL ROAD	None	ANAHEIM	CA	92804	5314	00	06000	33.817798	-117.9610599	Orange County
329470	Ordering, Referring, Prescribing	N/A	1346419298	0	0	GUTIERREZ-ESCALANTE, BEATRIZ LMFT	7/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120448	N/A	N/A	N/A	N/A	N/A	7601 CANBY AVE	None	RESEDA	CA	91335	2953	00	06000	34.20872085	-118.5347527	Los Angeles County
329504	Ordering, Referring, Prescribing	N/A	1346490968	0	0	GRELLO, LAURA M LCSW	4/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65028	N/A	N/A	N/A	N/A	N/A	1499 HUNTINGTON DR	SUITE 101	SOUTH PASADENA	CA	91030	5444	00	06000	34.10404853	-118.150551	Los Angeles County
329540	Ordering, Referring, Prescribing	N/A	1346544046	0	0	GALVAN, ROSALIA LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93724	N/A	N/A	N/A	N/A	N/A	8337 TELEGRAPH RD	None	PICO RIVERA	CA	90660	4909	00	06000	33.96454327	-118.1134473	Los Angeles County
329551	Ordering, Referring, Prescribing	N/A	1346558335	0	0	GARCIA, MATTHEW P LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76782	N/A	N/A	N/A	N/A	N/A	88 TABLE MOUNTAIN BLVD	None	OROVILLE	CA	95965	3578	00	06000	39.52148732	-121.5548586	Butte County
329572	Ordering, Referring, Prescribing	N/A	1346599677	0	0	GARCIA, LUIS L LMFT	4/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103981	N/A	N/A	N/A	N/A	N/A	42 N. SUTTER ST	500	STOCKTON	CA	95202	2913	00	06000	37.95413419	-121.286063	San Joaquin County
329599	Ordering, Referring, Prescribing	N/A	1346647021	0	0	GREGORY, CHRISTOPHER PHARMD	4/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	74559	N/A	N/A	N/A	N/A	N/A	1046 COAST VILLAGE ROAD	B	MONTECITO	CA	93108	2715	00	06000	34.42170279	-119.6507446	Santa Barbara County
329609	Ordering, Referring, Prescribing	N/A	1346654522	0	0	GEE, JANICE L MD	8/22/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140515	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
329631	Ordering, Referring, Prescribing	N/A	1346691680	0	0	GONZALEZ, BRENDA M MSW LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91971	N/A	N/A	N/A	N/A	N/A	10929 SOUTH ST	SUITE 208B	CERRITOS	CA	90703	5391	00	06000	33.85836353	-118.101204	Los Angeles County
329669	Ordering, Referring, Prescribing	N/A	1346752946	0	0	GILL, MANPREET K	11/3/2017	Taxonomy not applicable	NA	n/a	000	Unknown	55131	N/A	N/A	N/A	N/A	N/A	8120 TIMBERLAKE WY	STE 112	SACRAMENTO	CA	95823	5413	00	06000	38.461023	-121.41414	Sacramento County
329686	Ordering, Referring, Prescribing	N/A	1346776234	0	0	GALZOTE, ROSANNA M MD	7/24/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157347	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
329719	Ordering, Referring, Prescribing	N/A	1346835055	0	0	GERGES, MARIAN	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81912	N/A	N/A	N/A	N/A	N/A	9830 LONG BEACH BLVD	None	SOUTHGATE	CA	90280	4153	00	06000	33.94602965	-118.21634	Los Angeles County
329729	Ordering, Referring, Prescribing	N/A	1346865334	0	0	GUAJARDO, LAURA GABRIELLA PSYD	9/4/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35304	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
329732	Ordering, Referring, Prescribing	N/A	1346879095	0	0	GLUBOK GONZALEZ, ELISA MD	2/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184272	N/A	N/A	N/A	N/A	N/A	751 LOMBARDI CT	None	SANTA ROSA	CA	95407	6798	00	06000	38.427804	-122.7493035	Sonoma County
329739	Ordering, Referring, Prescribing	N/A	1346892874	0	0	GOMEZ, KEVIN I LMFT	8/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140795	N/A	N/A	N/A	N/A	N/A	26137 LA PAZ RD	230	MISSION VIEJO	CA	92691	5319	00	06000	33.60038172	-117.6735855	Orange County
329743	Ordering, Referring, Prescribing	N/A	1346891017	0	0	GARCIA, GENI	7/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA58298	N/A	N/A	N/A	N/A	N/A	2907 EL CAMINO ROAD	None	REDWOOD CITY	CA	94061	4003	00	06000	37.46906354	-122.2114417	San Mateo County
329759	Ordering, Referring, Prescribing	N/A	1346942612	0	0	GRITTEN, ROZALYNA DO	8/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23361	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
329790	Ordering, Referring, Prescribing	N/A	1356045462	0	0	GAULDEN, JULIE A NP	3/29/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024754	N/A	N/A	N/A	N/A	N/A	1519 S OREGON ST	None	YREKA	CA	96097	3425	00	06000	41.71676111	-122.6424895	Siskiyou County
329802	Ordering, Referring, Prescribing	N/A	1356120570	0	0	GRAMAJO ENZENSPERGER, AMANDA PA-C	4/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64405	N/A	N/A	N/A	N/A	N/A	49169 ROAD 426	None	OAKHURST	CA	93644	8702	00	06000	37.3300998	-119.650508	Madera County
329814	Ordering, Referring, Prescribing	N/A	1356331573	0	0	GABRIELSON, MARY JUDE NP	9/7/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	7083	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
329838	Ordering, Referring, Prescribing	N/A	1356417547	0	0	GLASSER, LAURENCE A MD MPH	11/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71383	N/A	N/A	N/A	N/A	N/A	19231 VICTORY BLVD	110	RESEDA	CA	91335	6308	00	06000	34.18659852	-118.552221	Los Angeles County
329887	Ordering, Referring, Prescribing	N/A	1356535231	0	0	GIMBEL, ERIKA L LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC48004	N/A	N/A	N/A	N/A	N/A	4117 PENNIMAN COURT	UNIT F	OAKLAND	CA	94619	1718	00	06000	37.78469556	-122.2025172	Alameda County
329953	Ordering, Referring, Prescribing	N/A	1356659809	0	0	GIBBS, DAMIEN M LCSW	1/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106439	N/A	N/A	N/A	N/A	N/A	592 RIO LINDO AVE	None	CHICO	CA	95926	1817	00	06000	39.75427022	-121.8482553	Butte County
329975	Ordering, Referring, Prescribing	N/A	1356693675	0	0	GARCIA, VERONICA M LCSW	4/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73772	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
329989	Ordering, Referring, Prescribing	N/A	1356710875	0	0	GONZALEZ, JODY M PHARMD	9/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	69343	N/A	N/A	N/A	N/A	N/A	11234 ANDERSON ST	6300	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
329991	Ordering, Referring, Prescribing	N/A	1356714612	0	0	GONZALEZ, KAITLYN N LCSW	1/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106667	N/A	N/A	N/A	N/A	N/A	380 ENCINAL ST.	STE 200	SANTA CRUZ	CA	95060	2178	00	06000	36.98747083	-122.0380148	Santa Cruz County
329992	Ordering, Referring, Prescribing	N/A	1356712228	0	0	GEORGE, KIRSTEN PA-C	12/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	52969	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL RD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
330006	Ordering, Referring, Prescribing	N/A	1356726509	0	0	GARCIA, MARIA N B NP	8/17/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	667711	N/A	N/A	N/A	N/A	N/A	11711 SAND CANYON RD	None	YUCAIPA	CA	92399	1742	00	06000	34.03910186	-117.1061254	San Bernardino County
330016	Ordering, Referring, Prescribing	N/A	1356755698	0	0	GHEBRENDRIAS, SARAH T MD	1/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138908	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
330018	Ordering, Referring, Prescribing	N/A	1356751333	0	0	GRIER, RYAN O	1/4/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65122	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	STE 225	VENTURA	CA	93004	1382	00	06000	34.29321532	-119.1597424	Ventura County
330032	Ordering, Referring, Prescribing	N/A	1356775993	0	0	GERGES, PAUL PHARMD	12/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	69008	N/A	N/A	N/A	N/A	N/A	8254 WHITE OAK AVE	UNIT 4	NORTHRIDGE	CA	91325	0000	00	06000	34.22053414	-118.5185976	Los Angeles County
330051	Ordering, Referring, Prescribing	N/A	1356801575	0	0	GUEVARA, BERNARDO MD	3/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176826	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
330072	Ordering, Referring, Prescribing	N/A	1356833578	0	0	GONZALEZ, MICHAEL J	6/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55680	N/A	N/A	N/A	N/A	N/A	1500 E CHEVY CHASE DR	401	GLENDALE	CA	91206	4139	00	06000	34.15201194	-118.2322051	Los Angeles County
330081	Ordering, Referring, Prescribing	N/A	1356852289	0	0	GOOD, WYATT PHARMD	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77609	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
330107	Ordering, Referring, Prescribing	N/A	1356900138	0	0	GUZMAN-HERNANDEZ, KRISTINE LCSW	6/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115831	N/A	N/A	N/A	N/A	N/A	9808 VENICE BLVD	None	CULVER CITY	CA	90232	2732	00	06000	34.0236396	-118.3980847	Los Angeles County
330136	Ordering, Referring, Prescribing	N/A	1356955207	0	0	GARCIA, VANESSA L LCSW	12/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127676	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
330200	Ordering, Referring, Prescribing	N/A	1366094336	0	0	GARCIA, JESSENIA N MSW LCSW	7/3/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123817	N/A	N/A	N/A	N/A	N/A	204 HAMPTON DR,	None	VENICE	CA	90921	8663	00	06000	33.99779632	-118.4781798	Los Angeles County
330237	Ordering, Referring, Prescribing	N/A	1366221327	0	0	GILANI, SAFIA NP	9/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027391	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
330276	Ordering, Referring, Prescribing	N/A	1366536369	0	0	GESS, SUSAN L PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	41970	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
330277	Ordering, Referring, Prescribing	N/A	1366560112	0	0	GRAFF, ROBERT S MD	3/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G70479	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
330298	Ordering, Referring, Prescribing	N/A	1366599367	0	0	GORMAN, JENNIFER A LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35787	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
330314	Ordering, Referring, Prescribing	N/A	1366636391	0	0	GONZALEZ, CELINA I LMFT	5/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84915	N/A	N/A	N/A	N/A	N/A	2001 JUNIPERO SERRA BLVD	650	DALY CITY	CA	94014	3220	00	06000	37.70124814	-122.4706974	San Mateo County
330317	Ordering, Referring, Prescribing	N/A	1366641813	0	0	GLEASON, SHEILA A PHD	2/6/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY13685	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
330326	Ordering, Referring, Prescribing	N/A	1366671596	0	0	GRACE, LARISSA A MD	6/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116676	N/A	N/A	N/A	N/A	N/A	1900 ROYALTY DR	180	POMONA	CA	91767	3032	00	06000	34.07754346	-117.7463466	Los Angeles County
330388	Ordering, Referring, Prescribing	N/A	1366793085	0	0	GONZALEZ, VICTORIA PHD	11/9/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28016	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST.	H	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
330396	Ordering, Referring, Prescribing	N/A	1366803397	0	0	GONZALEZ, BELEN LCSW	3/8/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114118	N/A	N/A	N/A	N/A	N/A	1105 E FLORIDA AVE, HEME	None	HEMET	CA	92543	1305	00	06000	33.74750951	-116.960463	Riverside County
330414	Ordering, Referring, Prescribing	N/A	1366831778	0	0	GOODRICK, SARAH F	12/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020787	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
330415	Ordering, Referring, Prescribing	N/A	1366816092	0	0	GARCIA, HELIUD S LCSW	7/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	116647	N/A	N/A	N/A	N/A	N/A	222 S HILL ST	600	LOS ANGELES	CA	90012	3506	00	06000	34.0525918	-118.2482081	Los Angeles County
330424	Ordering, Referring, Prescribing	N/A	1366829772	0	0	GURROLA, ANGELICA LCSW	2/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100228	N/A	N/A	N/A	N/A	N/A	4701 E. CESAR CHAVEZ AVE	None	LOS ANGELES	CA	90022	0431	00	06000	34.04062547	-118.1643975	Los Angeles County
330453	Ordering, Referring, Prescribing	N/A	1366875452	0	0	GREY, LAUREN P LMFT	6/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94707	N/A	N/A	N/A	N/A	N/A	452 S 1ST ST	None	SAN JOSE	CA	95113	2815	00	06000	37.32939426	-121.8854867	Santa Clara County
330464	Ordering, Referring, Prescribing	N/A	1366902199	0	0	GONIS, ANTIGONE MD	4/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177615	N/A	N/A	N/A	N/A	N/A	1014 N BROADWAY	None	SANTA ANA	CA	92701	3408	00	06000	33.75354748	-117.8697553	Orange County
330488	Ordering, Referring, Prescribing	N/A	1366942302	0	0	GONZALEZ-MCKENZIE, NANCY LCSW	4/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW103955	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
330528	Ordering, Referring, Prescribing	N/A	1376005868	0	0	GALVEZ, LIZBETH LMFT	1/13/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144365	N/A	N/A	N/A	N/A	N/A	23311 DRACAEA AVE	None	MORENO VALLEY	CA	92553	3201	00	06000	33.92807348	-117.258489	Riverside County
330589	Ordering, Referring, Prescribing	N/A	1376121343	0	0	GORJIKIA, NIYAYESH	3/6/2024	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E6027	N/A	N/A	N/A	N/A	N/A	4150 CLEMENT ST	None	SAN FRANCISCO	CA	94121	1545	00	06000	37.78109398	-122.5051321	San Francisco County
330590	Ordering, Referring, Prescribing	N/A	1376119933	0	0	GERAGA, DIANNE LISA D NP	3/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016851	N/A	N/A	N/A	N/A	N/A	5959 GREENBACK LN	STE 500	CITRUS HEIGHTS	CA	95621	4700	00	06000	38.681397	-121.322682	Sacramento County
330673	Ordering, Referring, Prescribing	N/A	1376610428	0	0	GECKELER, WILLIAM R MD	11/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G47868	N/A	N/A	N/A	N/A	N/A	631 MAPLE AVE	SUITE A	LOS ANGELES	CA	90014	1200	00	06000	34.04323075	-118.2485358	Los Angeles County
330714	Ordering, Referring, Prescribing	N/A	1376674937	0	0	GIRVETZ, JON E PHD	12/7/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY5503	N/A	N/A	N/A	N/A	N/A	550 WATER ST	F-3	SANTA CRUZ	CA	95060	4124	00	06000	36.98046158	-122.018718	Santa Cruz County
330719	Ordering, Referring, Prescribing	N/A	1376677765	0	0	GONZALES, ROCIO E LCSW	6/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85325	N/A	N/A	N/A	N/A	N/A	5000 W SUNSET BLVD	600	LOS ANGELES	CA	90027	5861	00	06000	34.0981066	-118.2986382	Los Angeles County
330726	Ordering, Referring, Prescribing	N/A	1376688531	0	0	GERACIMOS, RYAN MD	11/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C166869	N/A	N/A	N/A	N/A	N/A	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	00	06000	33.5580705	-117.1835458	Riverside County
330730	Ordering, Referring, Prescribing	N/A	1376718023	0	0	GOULD, DARIN MD	3/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C161437	N/A	N/A	N/A	N/A	N/A	6302 THIRTEENTH AVE	None	LUCERNE	CA	95458	1024	00	06000	39.08779639	-122.79255	Lake County
330756	Ordering, Referring, Prescribing	N/A	1376773184	0	0	GAMBOA, BEDA LCSW	12/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61555	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
330819	Ordering, Referring, Prescribing	N/A	1376894535	0	0	GARNER, JESSICA PA-C	2/28/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA22470	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	MB 20	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
330837	Ordering, Referring, Prescribing	N/A	1376921908	0	0	GALLANT, RACHEL MD	1/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155298	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
330839	Ordering, Referring, Prescribing	N/A	1376923102	0	0	GROSS, ALLISON A LCSW	5/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122686	N/A	N/A	N/A	N/A	N/A	964 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	00	06000	34.089372	-118.291723	Los Angeles County
330847	Ordering, Referring, Prescribing	N/A	1376942904	0	0	GUTTIKONDA, KRISHNAVENI T	3/16/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65299	N/A	N/A	N/A	N/A	N/A	1998 N MOTEL BLVD	None	LAS CRUCES	NM	88007	4100	00	06000	32.32478296	-106.8120224	Doña Ana County
330875	Ordering, Referring, Prescribing	N/A	1376978890	0	0	GUERRERO, MAYRA L LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80223	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
330889	Ordering, Referring, Prescribing	N/A	1376990390	0	0	GUTIERREZ, AMY LCSW	2/28/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110765	N/A	N/A	N/A	N/A	N/A	215 5TH ST	None	MARYSVILLE	CA	95901	0100	00	06000	39.14051769	-121.5868454	Yuba County
330912	Ordering, Referring, Prescribing	N/A	1386024156	0	0	GARCIA, SUZZETTE LPCC	6/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	5979	N/A	N/A	N/A	N/A	N/A	290 LOOF AVE	None	GILROY	CA	10509	5020	00	06000	0	0	None
330924	Ordering, Referring, Prescribing	N/A	1386044709	0	0	GARCIA, MAYRA E LCSW	6/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101998	N/A	N/A	N/A	N/A	N/A	1454 EAST 2ND STREET	None	SAN BERNARDINO	CA	92408	0118	00	06000	34.1035953	-117.2563723	San Bernardino County
330947	Ordering, Referring, Prescribing	N/A	1386080539	0	0	GRAY, JENNIFER E PHARMD	3/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH75263	N/A	N/A	N/A	N/A	N/A	33644 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2071	00	06000	34.03405949	-117.070083	San Bernardino County
330973	Ordering, Referring, Prescribing	N/A	1386121945	0	0	GUZMAN, LUZ A LMFT	3/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138921	N/A	N/A	N/A	N/A	N/A	2151 SALVIO ST STE 201	STE 301	CONCORD	CA	94520	2467	00	06000	37.97770065	-122.034159	Contra Costa County
330990	Ordering, Referring, Prescribing	N/A	1386149748	0	0	GUPTA, SHUCHI NP	11/5/2019	Taxonomy not applicable	NA	n/a	000	Unknown	NP95009623	N/A	N/A	N/A	N/A	N/A	1080 EMELINE AVENUE	None	SANTA CRUZ	CA	95060	1966	00	06000	36.99191102	-122.0176744	Santa Cruz County
331022	Ordering, Referring, Prescribing	N/A	1386180800	0	0	GILES, KESSA D PHARMD	4/12/2019	Taxonomy not applicable	NA	n/a	000	Unknown	80442	N/A	N/A	N/A	N/A	N/A	1799 MARLOW RD	None	SANTA ROSA	CA	95401	4474	00	06000	38.452095	-122.752836	Sonoma County
331048	Ordering, Referring, Prescribing	N/A	1386226272	0	0	GUTIERREZ, KARLA G NP	6/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017518	N/A	N/A	N/A	N/A	N/A	4151 MEXICALI DR	None	BAKERSFIELD	CA	93313	2065	00	06000	35.317233	-119.081649	Kern County
331054	Ordering, Referring, Prescribing	N/A	1386233492	0	0	GERITY, CAITLIN M NP	1/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016350	N/A	N/A	N/A	N/A	N/A	3741 S LA BREA AVE	None	LOS ANGELES	CA	90016	5309	00	06000	34.01991	-118.355626	Los Angeles County
331087	Ordering, Referring, Prescribing	N/A	1386311611	0	0	GROSS, AARION I PA-C	6/17/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64665	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
331097	Ordering, Referring, Prescribing	N/A	1386353761	0	0	GRANADA, MARK JASON R NP	3/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024681	N/A	N/A	N/A	N/A	N/A	857 W CHILDS AVENUE	None	MERCED	CA	95341	6805	00	06000	37.2882813	-120.497688	Merced County
331103	Ordering, Referring, Prescribing	N/A	1386379428	0	0	GONZALEZ-MORA, DEYANIRA LCSW	4/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107680	N/A	N/A	N/A	N/A	N/A	1022 CALLOWAY DR	None	BAKERSFIELD	CA	93312	6337	00	06000	35.36767613	-119.1111388	Kern County
331114	Ordering, Referring, Prescribing	N/A	1386393494	0	0	GETMAN, TATIANA J DO	9/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21671	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
331117	Ordering, Referring, Prescribing	N/A	1386399228	0	0	GARASS, MARYANA A	1/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85819	N/A	N/A	N/A	N/A	N/A	495 E HOLT AVE	None	POMONA	CA	91767	5539	00	06000	34.06259846	-117.7425045	Los Angeles County
331132	Ordering, Referring, Prescribing	N/A	1386617421	0	0	GANDOTRA, GAURAV MD	12/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C158794	N/A	N/A	N/A	N/A	N/A	5900 BROCKTON AVE	None	RIVERSIDE	CA	92506	1862	00	06000	33.96263615	-117.395639	Riverside County
331167	Ordering, Referring, Prescribing	N/A	1386755106	0	0	GODUN, JEFFREY T DC	8/19/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	26285	N/A	N/A	N/A	N/A	N/A	16200 AMBER VALLEY DR	None	WHITTIER	CA	90604	4051	00	06000	33.92458653	-117.9826605	Los Angeles County
331169	Ordering, Referring, Prescribing	N/A	1386747186	0	0	GIFFORD, KIMBERLY LMFT	12/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48900	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92018	4711	00	06000	32.77025942	-117.2017196	San Diego County
331220	Ordering, Referring, Prescribing	N/A	1386805521	0	0	GUIAHI, MARYAM	3/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C169723	N/A	N/A	N/A	N/A	N/A	2633 16TH ST	None	BAKERSFIELD	CA	93301	3348	00	06000	35.37232854	-119.0327985	Kern County
331248	Ordering, Referring, Prescribing	N/A	1386876712	0	0	GNAT, ROBERT P NP	10/4/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95005461	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
331258	Ordering, Referring, Prescribing	N/A	1386891117	0	0	GUERRA, KATHERINE LCSW	12/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW61164	N/A	N/A	N/A	N/A	N/A	1816 S FIGUEROA ST	6TH FLOOR	LOS ANGELES	CA	90015	3422	00	06000	34.03542929	-118.2713663	Los Angeles County
331259	Ordering, Referring, Prescribing	N/A	1386903094	0	0	GONZALES, ALEXIS A LMFT	1/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113870	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
331273	Ordering, Referring, Prescribing	N/A	1386931533	0	0	GARNIER, OLIVIA PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64025	N/A	N/A	N/A	N/A	N/A	2219 ROSEDALE AVE	None	OAKLAND	CA	94601	4325	00	06000	37.78082774	-122.2094372	Alameda County
331286	Ordering, Referring, Prescribing	N/A	1386951424	0	0	GUZMAN, NANCY LCSW	12/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70879	N/A	N/A	N/A	N/A	N/A	17660 LAKEWOOD BLVD	None	BELLFLOWER	CA	90706	6410	00	06000	33.87138705	-118.142548	Los Angeles County
331307	Ordering, Referring, Prescribing	N/A	1386998227	0	0	GONZALES, ROMMEL	6/18/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122760	N/A	N/A	N/A	N/A	N/A	508 S ALVARADO ST	None	LOS ANGELES	CA	90057	2904	00	06000	34.06017147	-118.2744308	Los Angeles County
331334	Ordering, Referring, Prescribing	N/A	1396016903	0	0	GRAY, KANDICE D LCSW	2/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90095	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
331389	Ordering, Referring, Prescribing	N/A	1396146486	0	0	GRINBERG, SVETLANA DO	7/18/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23147	N/A	N/A	N/A	N/A	N/A	704 LEBEC ROAD	None	LEBEC	CA	93243	0000	00	06000	34.82081411	-118.8844069	Kern County
331390	Ordering, Referring, Prescribing	N/A	1396152179	0	0	GALERA, ABDON F NP	4/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002811	N/A	N/A	N/A	N/A	N/A	1510 FLORIDA AVENUE	SUITE A	MODESTO	CA	95350	4437	00	06000	37.666053	-120.996222	Stanislaus County
331395	Ordering, Referring, Prescribing	N/A	1396155578	0	0	GAMBLE, GWENDOLYN LCSW	10/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60747	N/A	N/A	N/A	N/A	N/A	8850 AUBURN FOLSOM RD	None	GRANITE BAY	CA	95746	6525	00	06000	38.73846656	-121.1705399	Placer County
331413	Ordering, Referring, Prescribing	N/A	1396176202	0	0	GLASS, BRIAN N NP	10/19/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95085178	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
331429	Ordering, Referring, Prescribing	N/A	1396188033	0	0	GRUSZYNSKI, MARK MD	7/29/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A136759	N/A	N/A	N/A	N/A	N/A	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
331437	Ordering, Referring, Prescribing	N/A	1396206082	0	0	GOMES, SALLY A LCSW	3/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107155	N/A	N/A	N/A	N/A	N/A	6924 HYDE PARK DRIVE	UNIT 220	SAN DIEGO	CA	92119	2264	00	06000	32.80139318	-117.046579	San Diego County
331445	Ordering, Referring, Prescribing	N/A	1396211645	0	0	GARDNER, LAKEYLA NP	10/17/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017057	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
331452	Ordering, Referring, Prescribing	N/A	1396212395	0	0	GRIGORE, AMY Y PA	10/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56222	N/A	N/A	N/A	N/A	N/A	329 W 8TH ST	STE 109	HANFORD	CA	93230	4533	00	06000	36.32698307	-119.6503466	Kings County
331455	Ordering, Referring, Prescribing	N/A	1396239810	0	0	GOMEZ, ELIZABETH A LMFT	1/5/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124626	N/A	N/A	N/A	N/A	N/A	8876 MISSION BLVD	None	JURUPA VALLEY	CA	92509	2811	00	06000	34.01176954	-117.476118	Riverside County
331456	Ordering, Referring, Prescribing	N/A	1396234068	0	0	GLASSMAKER, JULIE A PHARMD	6/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	42608	N/A	N/A	N/A	N/A	N/A	939 LAKEVILLE ST	None	PETALUMA	CA	94952	3329	00	06000	38.23544819	-122.6240777	Sonoma County
331473	Ordering, Referring, Prescribing	N/A	1396227898	0	0	GARCIA, HELENA LMFT	1/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130875	N/A	N/A	N/A	N/A	N/A	6043 HOLLYWOOD BLVD	LOS ANGELES CA 90028	LOS ANGELES	CA	90048	3401	00	06000	34.1016835	-118.321569	Los Angeles County
331480	Ordering, Referring, Prescribing	N/A	1396278180	0	0	GOODRICH, DYLAN MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171045	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
331518	Ordering, Referring, Prescribing	N/A	1396342879	0	0	GEORGE, ALEXIA LCSW	10/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126832	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
331540	Ordering, Referring, Prescribing	N/A	1396375374	0	0	GERBERDING, ELIZABETH LMFT	11/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47287	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
331551	Ordering, Referring, Prescribing	N/A	1396386355	0	0	GUARDADO, MARISA MSW LCSW	5/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27817	N/A	N/A	N/A	N/A	N/A	1640 VALENCIA ST	SUITE 2A	SAN FRANCISCO	CA	94110	5047	00	06000	37.74627855	-122.4201634	San Francisco County
331579	Ordering, Referring, Prescribing	N/A	1396485942	0	0	GIANG, ANTHONY	2/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH85925	N/A	N/A	N/A	N/A	N/A	15500 WASHINGTON AVE	None	SAN LEANDRO	CA	94579	1839	00	06000	37.68575579	-122.1388804	Alameda County
331598	Ordering, Referring, Prescribing	N/A	1396710307	0	0	GROB, CHARLES MD	11/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G43029	N/A	N/A	N/A	N/A	N/A	1000 W. CARSON ST.	None	TORRANCE	CA	90509	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
331624	Ordering, Referring, Prescribing	N/A	1396818712	0	0	GILBERT, MARTA L LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25054	N/A	N/A	N/A	N/A	N/A	982 MISSION STREET	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
331646	Ordering, Referring, Prescribing	N/A	1396861977	0	0	GONZALEZ, JILL OT	5/11/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	7588	N/A	N/A	N/A	N/A	N/A	11080 W. OLYMPIC BLVD.	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
331658	Ordering, Referring, Prescribing	N/A	1396875530	0	0	GARCIA, DANIEL LMFT	5/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113947	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	None	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
331672	Ordering, Referring, Prescribing	N/A	1396885588	0	0	GUTIERREZ, PATRICIA NP	7/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14614	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
331674	Ordering, Referring, Prescribing	N/A	1396888129	0	0	GARDNER, SHARON	4/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84533	N/A	N/A	N/A	N/A	N/A	43300 LITTLE RIVER AIRPO	82	LITTLE RIVER	CA	95456	9613	00	06000	39.26775605	-123.7554809	Mendocino County
331676	Ordering, Referring, Prescribing	N/A	1396886982	0	0	GROVER, JUDY E LMFT	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46681	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
331683	Ordering, Referring, Prescribing	N/A	1396913265	0	0	GRANDE, RACHEL E PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59854	N/A	N/A	N/A	N/A	N/A	51 INNES CT	209	SAN FRANCISCO	CA	94124	4440	00	06000	37.72719397	-122.3676111	San Francisco County
331691	Ordering, Referring, Prescribing	N/A	1396936647	0	0	GRAY, BRIAN K LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29414	N/A	N/A	N/A	N/A	N/A	1227 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2871	00	06000	34.27181352	-118.7762625	Ventura County
331701	Ordering, Referring, Prescribing	N/A	1396948345	0	0	GONZALEZ, GRACIELA LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88599	N/A	N/A	N/A	N/A	N/A	840 GUADALUPE PARKWAY	238	SAN JOSE	CA	95110	1714	00	06000	37.34957284	-121.9080687	Santa Clara County
331720	Ordering, Referring, Prescribing	N/A	1396987624	0	0	GONZALEZ, ROSA A LMFT	6/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126393	N/A	N/A	N/A	N/A	N/A	6711 ARLINGTON AVE	STE D	RIVERSIDE	CA	92504	1955	00	06000	33.9459035	-117.442989	Riverside County
331756	Ordering, Referring, Prescribing	N/A	1407089014	0	0	GRAHAM, ANNE B NP	10/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	416806	N/A	N/A	N/A	N/A	N/A	2633 16TH STREET	None	BAKERSFIELD	CA	93301	3417	00	06000	35.37232854	-119.0327985	Kern County
331780	Ordering, Referring, Prescribing	N/A	1407129687	0	0	GREEN-RUSSELL, KIMBERLY N LMFT	8/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT80853	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
331781	Ordering, Referring, Prescribing	N/A	1407132541	0	0	GUNGAP, JILL	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH53062	N/A	N/A	N/A	N/A	N/A	4009 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	5613	00	06000	33.99022878	-118.4476363	Los Angeles County
331795	Ordering, Referring, Prescribing	N/A	1407168545	0	0	GONZALEZ-JOLY, LILIA LMFT	4/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106107	N/A	N/A	N/A	N/A	N/A	26081 MOCINE AVE,	None	HAYWARD	CA	94544	1001	00	06000	37.64800936	-122.0758633	Alameda County
331796	Ordering, Referring, Prescribing	N/A	1407171291	0	0	GALBUSERA, LUDMILLA M LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52900	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR	628	LOS ANGELES	CA	90008	3606	00	06000	34.00888336	-118.3389334	Los Angeles County
331798	Ordering, Referring, Prescribing	N/A	1407173107	0	0	GORIN, SHLOMIT PSYD	5/14/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32599	N/A	N/A	N/A	N/A	N/A	3626 BALBOA ST	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
331807	Ordering, Referring, Prescribing	N/A	1407200710	0	0	GOMEZ, LUZ CORONA MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150429	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
331824	Ordering, Referring, Prescribing	N/A	1407231657	0	0	GREEN, TINA L LMFT	11/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122864	N/A	N/A	N/A	N/A	N/A	2821 H ST	None	BAKERSFIELD	CA	93301	1913	00	06000	35.38560771	-119.0211608	Kern County
331861	Ordering, Referring, Prescribing	N/A	1407297377	0	0	GOITEIN, ALEXANDER LCSW	11/6/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82400	N/A	N/A	N/A	N/A	N/A	1028 PRINCE AVE	None	HEALDSBURG	CA	95448	3449	00	06000	38.62287049	-122.8680553	Sonoma County
331899	Ordering, Referring, Prescribing	N/A	1407341126	0	0	GARCIA, JESSICA M LMFT	4/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125295	N/A	N/A	N/A	N/A	N/A	6635 FLORENCE AVE	None	BELL	CA	90201	4909	00	06000	33.96212715	-118.1462995	Los Angeles County
331921	Ordering, Referring, Prescribing	N/A	1407365992	0	0	GALLEGOS, MONICA C LCSW	11/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98616	N/A	N/A	N/A	N/A	N/A	17291 IRVINE BLVD	STE 263	TUSTIN	CA	92780	2941	00	06000	33.74830852	-117.830817	Orange County
331957	Ordering, Referring, Prescribing	N/A	1407434244	0	0	GIL, PHILIP E MD	7/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181134	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
331964	Ordering, Referring, Prescribing	N/A	1407465461	0	0	GOMEZ, EMMA E LCSW	1/3/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73048	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
331996	Ordering, Referring, Prescribing	N/A	1407583933	0	0	GERKMAN, DAMIAN A PA-C	6/1/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64311	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
331998	Ordering, Referring, Prescribing	N/A	1407584543	0	0	GREWAL, HARJOT K DC	7/27/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36408	N/A	N/A	N/A	N/A	N/A	40924 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53353137	-121.9601832	Alameda County
332003	Ordering, Referring, Prescribing	N/A	1407605819	0	0	GILMORE, TAMISHA P NP	3/12/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029418	N/A	N/A	N/A	N/A	N/A	12640 HESPERIA RD STE D	STE D	VICTORVILLE	CA	92395	7753	00	06000	34.48056876	-117.2907887	San Bernardino County
332019	Ordering, Referring, Prescribing	N/A	1407849243	0	0	GONZALEZ, FRANCISCO J DDS	9/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	34335	N/A	N/A	N/A	N/A	N/A	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	00	06000	34.11150069	-118.1888319	Los Angeles County
332024	Ordering, Referring, Prescribing	N/A	1407866288	0	0	GREENBERG, ADAM MD	1/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G145782	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
332026	Ordering, Referring, Prescribing	N/A	1407871817	0	0	GOMEZ, DENISE MD	11/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66289	N/A	N/A	N/A	N/A	N/A	605 CROUCH ST	BLDG C	OCEANSIDE	CA	92054	4415	00	06000	33.19619156	-117.3537219	San Diego County
332043	Ordering, Referring, Prescribing	N/A	1407927601	0	0	GRAHAM, THOMAS M	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	14840	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
332074	Ordering, Referring, Prescribing	N/A	1407985948	0	0	GUTIERREZ-HUNT, IMELDA LCSW	10/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83200	N/A	N/A	N/A	N/A	N/A	570 SOUTH MT. VERNON AVE	#G	SAN BERNARDINO	CA	92410	2737	00	06000	34.090776	-117.3138565	San Bernardino County
332096	Ordering, Referring, Prescribing	N/A	1417034612	0	0	GRAJEDA, AMERICA M	9/10/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49510	N/A	N/A	N/A	N/A	N/A	1801 VICENTE STREET	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
332101	Ordering, Referring, Prescribing	N/A	1417043985	0	0	GROVET, JENNIFER L LMFT	1/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46596	N/A	N/A	N/A	N/A	N/A	855 CANYON RD.	None	REDDING	CA	96001	5544	00	06000	40.48978049	-122.3926387	Shasta County
332130	Ordering, Referring, Prescribing	N/A	1417088055	0	0	GLASS, CRAIG W LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91261	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	100	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
332141	Ordering, Referring, Prescribing	N/A	1417106063	0	0	GELTMAN, ELISE LCSW	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27710	N/A	N/A	N/A	N/A	N/A	3301 EAST 12TH STREET	SUITE	OAKLAND	CA	94601	3424	00	06000	37.77617499	-122.2247899	Alameda County
332180	Ordering, Referring, Prescribing	N/A	1417187956	0	0	GIROUARD, MICHAEL J PHD	3/3/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29094	N/A	N/A	N/A	N/A	N/A	65 N HOCKETT ST	None	PORTERVILLE	CA	93257	0000	00	06000	36.0663928	-119.01714	Tulare County
332187	Ordering, Referring, Prescribing	N/A	1417206749	0	0	GOLDEN, JAYNEE LCSW	12/11/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80497	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
332198	Ordering, Referring, Prescribing	N/A	1417225442	0	0	GOH, YOKE	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55539	N/A	N/A	N/A	N/A	N/A	1775 EUREKA WAY	None	REDDING	CA	96001	0456	00	06000	40.58654561	-122.3967104	Shasta County
332226	Ordering, Referring, Prescribing	N/A	1417292210	0	0	GONZALEZ, EDITH L LCSW	1/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74807	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	FLOOR 6	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
332276	Ordering, Referring, Prescribing	N/A	1417345695	0	0	GREENBERG, HEATHER LPCC	4/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC10525	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
332285	Ordering, Referring, Prescribing	N/A	1417372186	0	0	GORA, KELLI C NP	10/6/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	659920	N/A	N/A	N/A	N/A	N/A	41820 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	1649	00	06000	34.24651473	-116.8897879	San Bernardino County
332290	Ordering, Referring, Prescribing	N/A	1417378654	0	0	GONZALEZ, NATALIE	4/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69561	N/A	N/A	N/A	N/A	N/A	2609 SPACE CT	None	LANCASTER	CA	93536	6049	00	06000	34.68319154	-118.1779197	Los Angeles County
332305	Ordering, Referring, Prescribing	N/A	1417398546	0	0	GARCIA, VIOLETA LCSW	7/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95492	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
332316	Ordering, Referring, Prescribing	N/A	1417418179	0	0	GONZALEZ PEREZ, ALEJANDRO MD	2/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL157	N/A	N/A	N/A	N/A	N/A	7800 NILES ST	None	BAKERSFIELD	CA	93306	4922	00	06000	35.37628052	-118.9179	Kern County
332350	Ordering, Referring, Prescribing	N/A	1417476276	0	0	GRIJALVA, JENNIFER	8/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112719	N/A	N/A	N/A	N/A	N/A	1005 E WASHINGTON BLVD	None	LOS ANGELES	CA	90021	3068	00	06000	34.02578238	-118.2530622	Los Angeles County
332354	Ordering, Referring, Prescribing	N/A	1417482464	0	0	GUY, TIFFANIE P PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75632	N/A	N/A	N/A	N/A	N/A	2020 W CLEVELAND AVE	None	MADERA	CA	93637	8759	00	06000	36.97450854	-120.0811275	Madera County
332362	Ordering, Referring, Prescribing	N/A	1417487901	0	0	GOMEZ, LILIANA LCSW	10/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97820	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
332372	Ordering, Referring, Prescribing	N/A	1417509878	0	0	GRANT, BRANDON J NP	12/8/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012207	N/A	N/A	N/A	N/A	N/A	12440 FIRESTONE BLVD	3020	NORWALK	CA	90650	4340	00	06000	33.90523023	-118.0681168	Los Angeles County
332377	Ordering, Referring, Prescribing	N/A	1417519778	0	0	GARCIA, KARINA LCSW	4/18/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW122059	N/A	N/A	N/A	N/A	N/A	8019 COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
332383	Ordering, Referring, Prescribing	N/A	1417527128	0	0	GILL, KULBIR K CNP	10/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017372	N/A	N/A	N/A	N/A	N/A	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	00	06000	35.20895551	-118.839294	Kern County
332385	Ordering, Referring, Prescribing	N/A	1417534348	0	0	GARCIA PAZ, CAMILA MD	2/6/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193723	N/A	N/A	N/A	N/A	N/A	501 S IDAHO ST	190	LA HABRA	CA	90631	6047	00	06000	33.927525	-117.959216	Orange County
332409	Ordering, Referring, Prescribing	N/A	1417579319	0	0	GRUBISIC, CARRIE A LMFT	4/11/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132250	N/A	N/A	N/A	N/A	N/A	1801 PARK COURT PL, UNIT	None	SANTA ANA	CA	92701	5028	00	06000	33.74986153	-117.8429355	Orange County
332414	Ordering, Referring, Prescribing	N/A	1417591207	0	0	GARDNER, CRYSTAL L RN PHN	6/25/2019	Taxonomy not applicable	NA	n/a	000	Unknown	531420	N/A	N/A	N/A	N/A	N/A	1644 MAGNOLIA AVE	None	REDDING	CA	96001	1513	00	06000	40.5803004	-122.400834	Shasta County
332429	Ordering, Referring, Prescribing	N/A	1417618117	0	0	GALLIRASMUSSEN, LIVIA S OD	10/30/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35195	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
332438	Ordering, Referring, Prescribing	N/A	1417654914	0	0	GUTHRIE, TIFFANY N	2/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024250	N/A	N/A	N/A	N/A	N/A	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	00	06000	34.05260995	-118.3015825	Los Angeles County
332476	Ordering, Referring, Prescribing	N/A	1417967480	0	0	GOSCH, CHRISTINE E	2/27/2018	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	4475	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
332521	Ordering, Referring, Prescribing	N/A	1427134824	0	0	GILLIAN, LARA PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57415	N/A	N/A	N/A	N/A	N/A	5110 LEE ST.	None	TORRANCE	CA	90503	5329	00	06000	33.83597807	-118.3673573	Los Angeles County
332532	Ordering, Referring, Prescribing	N/A	1427177682	0	0	GARCIA, STARLIGHT M LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29501	N/A	N/A	N/A	N/A	N/A	8300 S VERMONT AVE	None	LOS ANGELES	CA	90044	3493	00	06000	33.963021	-118.291474	Los Angeles County
332534	Ordering, Referring, Prescribing	N/A	1427180504	0	0	GARZA, ROXANNE M LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86698	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
332541	Ordering, Referring, Prescribing	N/A	1427190487	0	0	GAREWAL, JAGDEEP S MD	6/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64095	N/A	N/A	N/A	N/A	N/A	6700 EUCALYPTUS DR	A	BAKERSFIELD	CA	93306	6075	00	06000	35.36520975	-118.9297178	Kern County
332549	Ordering, Referring, Prescribing	N/A	1427205319	0	0	GRIERSON, ERIN E	6/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51344	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
332550	Ordering, Referring, Prescribing	N/A	1427202373	0	0	GASSER, TYLER G MD	4/16/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C155432	N/A	N/A	N/A	N/A	N/A	1303 E HERNDON AVE	None	FRESNO	CA	93710	6092	00	06000	36.83626596	-119.7674879	Fresno County
332564	Ordering, Referring, Prescribing	N/A	1427241835	0	0	GIALANELLA, ANDREA L LCSW	8/29/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22826	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
332567	Ordering, Referring, Prescribing	N/A	1427246651	0	0	GARCIA, ALFONSO LMFT	1/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97275	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
332595	Ordering, Referring, Prescribing	N/A	1427314368	0	0	GANCHINGCO, BARBARA J DO	6/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14212	N/A	N/A	N/A	N/A	N/A	308 E SAN JACINTO AVE	None	PERRIS	CA	92570	2878	00	06000	33.78658073	-117.2226438	Riverside County
332612	Ordering, Referring, Prescribing	N/A	1427338409	0	0	GORSI, SHAMAILA MD	3/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173684	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
332616	Ordering, Referring, Prescribing	N/A	1427352632	0	0	GRAVES, SUSANNAH J K MD	6/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A120500	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS ST	None	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
332629	Ordering, Referring, Prescribing	N/A	1427368190	0	0	GHAZARIAN, ANNASHE	8/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65656	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
332662	Ordering, Referring, Prescribing	N/A	1427407089	0	0	GIBBS, BRIANNA LCSW	8/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117582	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
332664	Ordering, Referring, Prescribing	N/A	1427441872	0	0	GUEVARA, MA G LCSW	3/31/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107499	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
332699	Ordering, Referring, Prescribing	N/A	1427489095	0	0	GARCIA, NANCY LCSW	8/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93462	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
332715	Ordering, Referring, Prescribing	N/A	1427507797	0	0	GULLEY, MEGAN PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75067	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
332750	Ordering, Referring, Prescribing	N/A	1427574409	0	0	GERACI, ADRIENNE F LCSW	2/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113942	N/A	N/A	N/A	N/A	N/A	2136 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1102	00	06000	32.75537928	-117.1416551	San Diego County
332816	Ordering, Referring, Prescribing	N/A	1427706449	0	0	GOLDSBERRY, EMILY G PHARMD	2/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85917	N/A	N/A	N/A	N/A	N/A	1101 W TEHACHAPI BLVD	None	TEHACHAPI	CA	93561	2559	00	06000	35.1318273	-118.4672295	Kern County
332820	Ordering, Referring, Prescribing	N/A	1427720929	0	0	GEORGY, SHADY G	9/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85277	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
332833	Ordering, Referring, Prescribing	N/A	1427773621	0	0	GALLO, LINDA C PHD	12/1/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27375	N/A	N/A	N/A	N/A	N/A	780 BAY BLVD	SUITE 200	CHULA VISTA	CA	91910	5259	00	06000	32.61954307	-117.0927222	San Diego County
332916	Ordering, Referring, Prescribing	N/A	1437287331	0	0	GREER-BREWER, GEORGETTE LMFT	7/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99722	N/A	N/A	N/A	N/A	N/A	12715 PIONEER BLVD.	None	NORWALK	CA	90650	2873	00	06000	33.91524469	-118.081899	Los Angeles County
332919	Ordering, Referring, Prescribing	N/A	1437287273	0	0	GIDDINGS II, CHARLES M	8/16/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D21253	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
332935	Ordering, Referring, Prescribing	N/A	1437315637	0	0	GALUSTIAN, AZAD LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW77648	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
332938	Ordering, Referring, Prescribing	N/A	1437326170	0	0	GROVER, AMELIA LCSW	9/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29838	N/A	N/A	N/A	N/A	N/A	220 S PALISADE DR	STE 203	SANTA MARIA	CA	93454	8903	00	06000	34.95143521	-120.412098	Santa Barbara County
332962	Ordering, Referring, Prescribing	N/A	1437372455	0	0	GARCIA, HEATHER L LMFT	7/6/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45219	N/A	N/A	N/A	N/A	N/A	6707 EMBARCADERO DR	None	STOCKTON	CA	95219	3382	00	06000	38.0025944	-121.3672861	San Joaquin County
332977	Ordering, Referring, Prescribing	N/A	1437399748	0	0	GARRETT, MICHAEL J LMFT	1/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102866	N/A	N/A	N/A	N/A	N/A	6160 MISSION GORGE RD	100	SAN DIEGO	CA	92120	3410	00	06000	32.7868143	-117.0977635	San Diego County
332995	Ordering, Referring, Prescribing	N/A	1437427978	0	0	GILROY, LAURA L	12/27/2016	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27123	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8506	00	06000	33.91695337	-117.2672536	Riverside County
333007	Ordering, Referring, Prescribing	N/A	1437434081	0	0	GUANDIQUE, MARTA V LMFT	4/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102434	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
333011	Ordering, Referring, Prescribing	N/A	1437442555	0	0	GONZAGA, VICENTE M MD	5/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	C164167	N/A	N/A	N/A	N/A	N/A	707 N MICHIGAN ST	STE 400	SOUTH BEND	IN	46601	1071	00	06000	41.68454727	-86.25059572	St. Joseph County
333101	Ordering, Referring, Prescribing	N/A	1437584513	0	0	GUTIERREZ, MELISSA LCSW	3/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91257	N/A	N/A	N/A	N/A	N/A	6305 WOODMAN AVE	None	VAN NUYS	CA	91401	2346	00	06000	34.185132	-118.4312985	Los Angeles County
333111	Ordering, Referring, Prescribing	N/A	1437592623	0	0	GRUNWALD, DAVID MD	5/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143305	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
333131	Ordering, Referring, Prescribing	N/A	1437611571	0	0	GOMEZ, JESSE MD	2/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179973	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
333170	Ordering, Referring, Prescribing	N/A	1437676053	0	0	GOMEZ, JENNIFER LMFT	1/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130368	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
333171	Ordering, Referring, Prescribing	N/A	1437674819	0	0	GARZA, INDIA O LCSW	10/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104589	N/A	N/A	N/A	N/A	N/A	310 3RD STREET	SUITE C	EUREKA	CA	95501	0587	00	06000	40.8033152	-124.1683129	Humboldt County
333214	Ordering, Referring, Prescribing	N/A	1437757242	0	0	GILL, TESSA K	4/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014396	N/A	N/A	N/A	N/A	N/A	2633 16TH STREET	None	BAKERSFIELD	CA	93301	3348	00	06000	35.37232854	-119.0327985	Kern County
333252	Ordering, Referring, Prescribing	N/A	1437824836	0	0	GRICE, CEDAR M NP	3/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032786	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
333253	Ordering, Referring, Prescribing	N/A	1437829256	0	0	GARCIA, YESENIA M NP	8/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018041	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
333275	Ordering, Referring, Prescribing	N/A	1437897998	0	0	GAMPONG, MEGAN NICOLE C MD	5/8/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189386	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVE	SUITE #300	MORENO VALLEY	CA	92555	3901	00	06000	33.91013953	-117.193383	Riverside County
333286	Ordering, Referring, Prescribing	N/A	1437928736	0	0	GADOR, MARICAR NP	8/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95026420	N/A	N/A	N/A	N/A	N/A	4240 KEARNY MESA RD	None	SAN DIEGO	CA	92111	3777	00	06000	32.81857281	-117.1491983	San Diego County
333318	Ordering, Referring, Prescribing	N/A	1447313796	0	0	GREEN, HENRY J MD	3/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	G56683	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
333328	Ordering, Referring, Prescribing	N/A	1447329917	0	0	GIBBS, MARCIE LCSW	12/14/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27056	N/A	N/A	N/A	N/A	N/A	631 MAPLE AVE.	SUITE C	LOS ANGELES	CA	90014	1200	00	06000	34.04323075	-118.2485358	Los Angeles County
333331	Ordering, Referring, Prescribing	N/A	1447331699	0	0	GULINO, JOSEPH L MD	4/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A117442	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
333333	Ordering, Referring, Prescribing	N/A	1447337894	0	0	GRAVES, DONNA M LCSW	12/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	11916	N/A	N/A	N/A	N/A	N/A	11017 PLAINVIEW AVE	None	TUJUNGA	CA	91042	1217	00	06000	34.26879742	-118.2984135	Los Angeles County
333338	Ordering, Referring, Prescribing	N/A	1447354618	0	0	GARCIA LORETT, YOLANDA DDS	8/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	44879	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
333375	Ordering, Referring, Prescribing	N/A	1447422241	0	0	GUNVILLE, CHAD A LMFT	4/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108745	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE,	None	OAKLAND	CA	94602	0000	00	06000	37.8007257	-122.2064578	Alameda County
333381	Ordering, Referring, Prescribing	N/A	1447451539	0	0	GOSWAMI, AMITABH U DO	10/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9044	N/A	N/A	N/A	N/A	N/A	7255 N CEDAR AVE	SUITE 101	FRESNO	CA	93720	3831	00	06000	36.84176021	-119.7568158	Fresno County
333416	Ordering, Referring, Prescribing	N/A	1447524194	0	0	GILLETTE, REBECCA LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92641	N/A	N/A	N/A	N/A	N/A	101 WEST COAST RD	None	REDWAY	CA	95560	0769	00	06000	40.11704433	-123.8133408	Humboldt County
333430	Ordering, Referring, Prescribing	N/A	1447549696	0	0	GONZALEZ, MARCOS M LMFT	4/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116847	N/A	N/A	N/A	N/A	N/A	3400 MCCALL AVE	104	SELMA	CA	93662	4165	00	06000	36.58383	-119.6106525	Fresno County
333431	Ordering, Referring, Prescribing	N/A	1447546932	0	0	GOES, CARLEY PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65219	N/A	N/A	N/A	N/A	N/A	2345 FAIR OAKS BLVD	None	SACRAMENTO, CA	CA	95825	0000	00	06000	38.57535	-121.407633	Sacramento County
333436	Ordering, Referring, Prescribing	N/A	1447558986	0	0	GRAVES, JAIME	3/28/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28611	N/A	N/A	N/A	N/A	N/A	1001 NEEDHAM ST	None	MODESTO	CA	95354	0730	00	06000	37.64594353	-121.005729	Stanislaus County
333457	Ordering, Referring, Prescribing	N/A	1447604426	0	0	GARCIA, DIEGO R LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118699	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
333465	Ordering, Referring, Prescribing	N/A	1447630256	0	0	GUERRA MANALO, MARIA M PHARMD	10/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	70973	N/A	N/A	N/A	N/A	N/A	4618 FOUNTAIN AVE	None	LOS ANGELES	CA	90029	1830	00	06000	34.095582	-118.290195	Los Angeles County
333480	Ordering, Referring, Prescribing	N/A	1447647771	0	0	GOULD, BRIAN S DO	9/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18479	N/A	N/A	N/A	N/A	N/A	260 HOSPITAL DRIVE	SUITE 107	UKIAH	CA	95482	4568	00	06000	39.15349918	-123.2039443	Mendocino County
333490	Ordering, Referring, Prescribing	N/A	1447652680	0	0	GRYN, JOANNE M LCSW	10/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104517	N/A	N/A	N/A	N/A	N/A	1955 LONG BEACH BLVD SUI	None	LONG BEACH	CA	90802	9080	00	06000	33.79290697	-118.1895017	Los Angeles County
333509	Ordering, Referring, Prescribing	N/A	1447685573	0	0	GARCIA, ENID LMFT	3/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125030	N/A	N/A	N/A	N/A	N/A	265 S ANITA DR	201	ORANGE	CA	92868	3355	00	06000	33.78499409	-117.8811837	Orange County
333585	Ordering, Referring, Prescribing	N/A	1447799804	0	0	GUTIERREZ, LORENA LCSW	6/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101898	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
333602	Ordering, Referring, Prescribing	N/A	1447851647	0	0	GANOTISI, MELANIE NP	8/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015691	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
333736	Ordering, Referring, Prescribing	N/A	1457490617	0	0	GOODWIN, LISA M LCSW	3/8/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22609	N/A	N/A	N/A	N/A	N/A	1650 E OLD BADILLO ST	None	COVINA	CA	91724	3163	00	06000	34.08615236	-117.8550927	Los Angeles County
333766	Ordering, Referring, Prescribing	N/A	1457542797	0	0	GAMBETTI, ROBERTA M PHD	6/9/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19853	N/A	N/A	N/A	N/A	N/A	2425 BISSO LANE	200	CONCORD	CA	94520	4204	00	06000	37.98393807	-122.0466953	Contra Costa County
333774	Ordering, Referring, Prescribing	N/A	1457549693	0	0	GAVEL, DAVID A MD	10/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97054	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
333775	Ordering, Referring, Prescribing	N/A	1457562688	0	0	GARCIA, ELIZABETH LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103008	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
333779	Ordering, Referring, Prescribing	N/A	1457552002	0	0	GAMBOA, VERONICA M	2/6/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46320	N/A	N/A	N/A	N/A	N/A	777 N. FIRST ST	SUITE 444	SAN JOSE	CA	95112	6339	00	06000	37.35064564	-121.9015633	Santa Clara County
333792	Ordering, Referring, Prescribing	N/A	1457600439	0	0	GOMEZ, MONTSERRAT G LCSW	10/1/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75056	N/A	N/A	N/A	N/A	N/A	4161 W 147TH ST	None	LAWNDALE	CA	90260	1709	00	06000	33.8983413	-118.3479126	Los Angeles County
333793	Ordering, Referring, Prescribing	N/A	1457601676	0	0	GARZA, HEATHER L	12/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005736	N/A	N/A	N/A	N/A	N/A	1510 CAPITOLA RD	None	SANTA CRUZ	CA	95062	2912	00	06000	36.97627773	-121.9846375	Santa Cruz County
333808	Ordering, Referring, Prescribing	N/A	1457635237	0	0	GRAGNANI, VANESSA R PHARMD	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61783	N/A	N/A	N/A	N/A	N/A	988 SIERRA STREET	None	KINGSBURG	CA	93631	1554	00	06000	36.51781851	-119.5567515	Fresno County
333845	Ordering, Referring, Prescribing	N/A	1457694945	0	0	GONZALES, MONIQUE R LMFT	12/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122859	N/A	N/A	N/A	N/A	N/A	10400 FRICOT CITY RD	None	SAN ANDREAS	CA	95249	9642	00	06000	38.17354088	-120.5345257	Calaveras County
333899	Ordering, Referring, Prescribing	N/A	1457782047	0	0	GEROSA, JOSEPH PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	39494	N/A	N/A	N/A	N/A	N/A	5401 KATELLA AVE	None	CYPRESS	CA	90720	2809	00	06000	33.8030835	-118.039581	Orange County
333900	Ordering, Referring, Prescribing	N/A	1457784563	0	0	GARCIA PISANI, LAURA	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118205	N/A	N/A	N/A	N/A	N/A	26081 MOCINE AVE	None	HAYWARD	CA	94544	2923	00	06000	37.64800936	-122.0758633	Alameda County
333902	Ordering, Referring, Prescribing	N/A	1457786121	0	0	GOULD, MADELINE S	10/24/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA23151	N/A	N/A	N/A	N/A	N/A	12900 FREDERICK ST	STE C	MORENO VALLEY	CA	92553	5266	00	06000	33.932655	-117.261383	Riverside County
333911	Ordering, Referring, Prescribing	N/A	1457794109	0	0	GERGES, MICKEL A	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D62273	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD RD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
333919	Ordering, Referring, Prescribing	N/A	1457813081	0	0	GONZALEZ, JENNIFER MD	2/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194039	N/A	N/A	N/A	N/A	N/A	1277 E. LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2871	00	06000	34.2718503	-118.7750363	Ventura County
333970	Ordering, Referring, Prescribing	N/A	1457870826	0	0	GONGCHUN, SHERRI E PHARMD	3/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77022	N/A	N/A	N/A	N/A	N/A	1650 HERNDON AVE	None	CLOVIS	CA	93611	0505	00	06000	36.83737407	-119.6849821	Fresno County
333972	Ordering, Referring, Prescribing	N/A	1457870735	0	0	GIROD, CANDACE P PSYD	10/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122560	N/A	N/A	N/A	N/A	N/A	850 E WARDLOW RD	None	LONG BEACH	CA	90807	4628	00	06000	33.81888054	-118.182069	Los Angeles County
333996	Ordering, Referring, Prescribing	N/A	1457905127	0	0	GOODALL, ANDREW R PHARMD	9/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	82588	N/A	N/A	N/A	N/A	N/A	3940 FOURTH AVE	150	SAN DIEGO	CA	92103	7913	00	06000	32.74912549	-117.161641	San Diego County
334062	Ordering, Referring, Prescribing	N/A	1467053488	0	0	GOMEZ NARANJO, SOL LCSW	2/3/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125253	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
334068	Ordering, Referring, Prescribing	N/A	1467075689	0	0	GUTHRIE, CATHERINE A NP	5/26/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014560	N/A	N/A	N/A	N/A	N/A	2160 APPIAN WAY	200	PINOLE	CA	94564	2524	00	06000	37.99585174	-122.3021549	Contra Costa County
334100	Ordering, Referring, Prescribing	N/A	1467129056	0	0	GALLEGOS, GENEVIEVE A LCSW	6/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123056	N/A	N/A	N/A	N/A	N/A	8019 COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
334122	Ordering, Referring, Prescribing	N/A	1467274902	0	0	GUTIN, MARK A PHARMD	10/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	90428	N/A	N/A	N/A	N/A	N/A	37323 FREMONT BLVD	None	FREMONT	CA	94536	3702	00	06000	37.55820562	-122.0070406	Alameda County
334146	Ordering, Referring, Prescribing	N/A	1467485383	0	0	GAUVIN, WALI MD	10/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C156631	N/A	N/A	N/A	N/A	N/A	500 OLD RIVER ROAD	105	BAKERSFIELD	CA	93311	9505	00	06000	35.35127492	-119.1142991	Kern County
334151	Ordering, Referring, Prescribing	N/A	1467516583	0	0	GILBERT, JOEL	1/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23401	N/A	N/A	N/A	N/A	N/A	3164 CONDO CT	None	SANTA ROSA	CA	95403	2557	00	06000	38.468709	-122.7425085	Sonoma County
334174	Ordering, Referring, Prescribing	N/A	1467584003	0	0	GOLDSTEIN, ALISON LMFT	10/26/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41237	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	CULVER CITY	CA	90034	0000	00	06000	34.03321301	-118.4109122	Los Angeles County
334175	Ordering, Referring, Prescribing	N/A	1467584268	0	0	GONZALEZ, SAMUEL G LMFT	7/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45661	N/A	N/A	N/A	N/A	N/A	840 N AVENUE 66	None	LOS ANGELES	CA	90042	1508	00	06000	34.12110842	-118.1725545	Los Angeles County
334200	Ordering, Referring, Prescribing	N/A	1467639310	0	0	GARCIA SANDOVAL, MARIA LCSW	11/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85689	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
334211	Ordering, Referring, Prescribing	N/A	1467656769	0	0	GUNDOLFF, ANGELA H LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51191	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
334228	Ordering, Referring, Prescribing	N/A	1467700104	0	0	GONZALEZ, JOSE A LCSW	2/4/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80281	N/A	N/A	N/A	N/A	N/A	975 W MORGAN	None	PERRIS	CA	92571	3103	00	06000	33.83764414	-117.2475905	Riverside County
334276	Ordering, Referring, Prescribing	N/A	1467778001	0	0	GALVEZ-STRINGHAM, MARCY LMFT	7/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86779	N/A	N/A	N/A	N/A	N/A	7365 CARNELIAN ST	SUITE 222D	RANCHO CUCAMONGA	CA	91730	1157	00	06000	34.12038413	-117.6160525	San Bernardino County
334284	Ordering, Referring, Prescribing	N/A	1467787846	0	0	GLOECKNER, ROBIN RDH	6/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RDH24336	N/A	N/A	N/A	N/A	N/A	1304 S MILLER ST	None	SANTA MARIA	CA	93454	6904	00	06000	34.93828125	-120.4315875	Santa Barbara County
334317	Ordering, Referring, Prescribing	N/A	1467834812	0	0	GUTIERREZ-RIVERA, NANCY MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155276	N/A	N/A	N/A	N/A	N/A	1939 ACADEMY AVE	None	SANGER	CA	93657	3737	00	06000	36.68936951	-119.5550306	Fresno County
334331	Ordering, Referring, Prescribing	N/A	1467855379	0	0	GRANT, TRUITT LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98967	N/A	N/A	N/A	N/A	N/A	339 PAJARO ST	STE. D	SALINAS	CA	93901	3400	00	06000	36.6725294	-121.6522021	Monterey County
334350	Ordering, Referring, Prescribing	N/A	1467883082	0	0	GONZALEZ, ELENA P LMFT	4/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104665	N/A	N/A	N/A	N/A	N/A	3605 VISTA WAY	258	OCEANSIDE	CA	92056	4565	00	06000	33.1818929	-117.3104591	San Diego County
334400	Ordering, Referring, Prescribing	N/A	1467946301	0	0	GUERRERO, MELISSA LMFT	1/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	81226	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
334430	Ordering, Referring, Prescribing	N/A	1467975987	0	0	GONZALEZ, VICTORIA M LMFT	7/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126848	N/A	N/A	N/A	N/A	N/A	777 N. 1ST ST	STE 444	SAN JOSE	CA	95112	6339	00	06000	37.35064564	-121.9015633	Santa Clara County
334445	Ordering, Referring, Prescribing	N/A	1477008019	0	0	GODINEZ, BLANCA L LCSW	10/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97587	N/A	N/A	N/A	N/A	N/A	3845 N. CLARK ST. SUITE	None	FRESNO	CA	93726	4842	00	06000	36.788364	-119.785209	Fresno County
334448	Ordering, Referring, Prescribing	N/A	1477016897	0	0	GRADO, LAUREN G CRNA	8/18/2022	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	95001843	N/A	N/A	N/A	N/A	N/A	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
334481	Ordering, Referring, Prescribing	N/A	1477080992	0	0	GAERTNER, MARK L MD	4/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163132	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
334483	Ordering, Referring, Prescribing	N/A	1477086163	0	0	GARCIA, ROCIO LMFT	10/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122704	N/A	N/A	N/A	N/A	N/A	4001 MISSION OAKS BLVD S	None	CAMARILLO	CA	93012	5121	00	06000	34.21641579	-119.0166203	Ventura County
334493	Ordering, Referring, Prescribing	N/A	1477097103	0	0	GRAVES, NATALIE E LMFT	2/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121870	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
334570	Ordering, Referring, Prescribing	N/A	1477328896	0	0	GENAGRITIS, ELENI F NP	11/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95027989	N/A	N/A	N/A	N/A	N/A	1919 W 7TH ST	None	LOS ANGELES	CA	90057	4103	00	06000	34.05575686	-118.2751751	Los Angeles County
334575	Ordering, Referring, Prescribing	N/A	1477370724	0	0	GILLETTE, DINA E RDH	10/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RDH11229	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
334586	Ordering, Referring, Prescribing	N/A	1477539252	0	0	GRAY, SHARMANE M MD	11/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C132774	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
334634	Ordering, Referring, Prescribing	N/A	1477654747	0	0	GILL, JEFFRY MD	1/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G77828	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
334637	Ordering, Referring, Prescribing	N/A	1477663953	0	0	GONZALEZ, BRIAN M	4/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58677	N/A	N/A	N/A	N/A	N/A	17284 SLOVER AVE	204	FONTANA	CA	92337	7584	00	06000	34.065396	-117.4277475	San Bernardino County
334641	Ordering, Referring, Prescribing	N/A	1477674034	0	0	GRUSKA, JANIS K	4/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	ND-99	N/A	N/A	N/A	N/A	N/A	4110 SORRENTO VALLEY BLV	None	SAN DIEGO	CA	92121	1429	00	06000	32.90375674	-117.2170258	San Diego County
334654	Ordering, Referring, Prescribing	N/A	1477698389	0	0	GALANG-FEATHER, NERISSA V MD	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44676	N/A	N/A	N/A	N/A	N/A	303 E VANDERBILT WAY	None	SAN BERNARDINO	CA	92415	0026	00	06000	34.06872265	-117.2775832	San Bernardino County
334692	Ordering, Referring, Prescribing	N/A	1477786267	0	0	GONZALES, DAVID H LCSW	5/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106417	N/A	N/A	N/A	N/A	N/A	6520 S MOONEY BLVD	None	VISALIA	CA	93277	9529	00	06000	36.271125	-119.3119785	Tulare County
334698	Ordering, Referring, Prescribing	N/A	1477792299	0	0	GARCIA, LOURDES M LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76677	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
334699	Ordering, Referring, Prescribing	N/A	1477802171	0	0	GARCIA-CAMBRON, RICARDO LMFT	5/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132596	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
334705	Ordering, Referring, Prescribing	N/A	1477804110	0	0	GRIGGS, TOBIAS R LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89176	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
334721	Ordering, Referring, Prescribing	N/A	1477824043	0	0	GARCIA, LAUREN M LCSW	11/19/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80639	N/A	N/A	N/A	N/A	N/A	8550 BALBOA BLVD	SUITE 150	NORTHRIDGE	CA	91325	3562	00	06000	34.225713	-118.5026045	Los Angeles County
334724	Ordering, Referring, Prescribing	N/A	1477835130	0	0	GOYAL, ANU PHARMD	1/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54622	N/A	N/A	N/A	N/A	N/A	470 PLUMAS BLVD	SUITE 103	YUBA CITY	CA	95991	5077	00	06000	39.13270038	-121.6141985	Sutter County
334768	Ordering, Referring, Prescribing	N/A	1477909323	0	0	GRICE, CHRISTINA PHD	2/13/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30531	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
334769	Ordering, Referring, Prescribing	N/A	1477908549	0	0	GOHEL, SURAGBHAI B MD MPH	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157821	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
334834	Ordering, Referring, Prescribing	N/A	1487007480	0	0	GONZALEZ TAPIA, YESENIA LCSW	12/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103801	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
334838	Ordering, Referring, Prescribing	N/A	1487012811	0	0	GARCIA, MICHELLE NP	6/20/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012820	N/A	N/A	N/A	N/A	N/A	2292 FARADAY AVE	None	CARLSBAD	CA	92008	7238	00	06000	33.13490794	-117.2765569	San Diego County
334844	Ordering, Referring, Prescribing	N/A	1487019469	0	0	GERGES, BESHOY PHARMD	12/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	73225	N/A	N/A	N/A	N/A	N/A	8254 WHITE OAK AVE	UNIT 4	NORTHRIDGE	CA	91325	0000	00	06000	34.22053414	-118.5185976	Los Angeles County
334849	Ordering, Referring, Prescribing	N/A	1487029153	0	0	GRAY, NAIDERA D LCSW	12/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99108	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	6TH FL	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
334855	Ordering, Referring, Prescribing	N/A	1487034864	0	0	GHADIA, CHINTAL	3/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	62088	N/A	N/A	N/A	N/A	N/A	7070 ARCHIBALD AVE	None	EASTVALE	CA	92880	8718	00	06000	33.959394	-117.593014	Riverside County
334864	Ordering, Referring, Prescribing	N/A	1487048070	0	0	GEORGE, DOUGLAS U LCSW	1/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93830	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
334875	Ordering, Referring, Prescribing	N/A	1487056495	0	0	GARCIA, MARYSA LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78665	N/A	N/A	N/A	N/A	N/A	2008 N GAREY AVE	None	POMONA	CA	91767	2722	00	06000	34.08295003	-117.7528173	Los Angeles County
334925	Ordering, Referring, Prescribing	N/A	1487127015	0	0	GONZALEZ, ALBERTO J	3/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124828	N/A	N/A	N/A	N/A	N/A	500 W FOSTER RD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
334929	Ordering, Referring, Prescribing	N/A	1487128914	0	0	GAMBLIN, STEPHANIE A LMFT	1/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137458	N/A	N/A	N/A	N/A	N/A	238 S FLOWER ST	None	ORANGE	CA	92868	3415	00	06000	33.78532688	-117.877301	Orange County
334935	Ordering, Referring, Prescribing	N/A	1487146197	0	0	GUAN, JACKY LMFT	4/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138984	N/A	N/A	N/A	N/A	N/A	310 HARBOR BLVD	BUILDING E	BELMONT	CA	94002	4018	00	06000	37.52045283	-122.2680405	San Mateo County
334940	Ordering, Referring, Prescribing	N/A	1487148698	0	0	GRANT, CARMEN LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98952	N/A	N/A	N/A	N/A	N/A	1012 MAIN ST	None	RAMONA	CA	92065	2170	00	06000	33.04181722	-116.8689096	San Diego County
334989	Ordering, Referring, Prescribing	N/A	1487217568	0	0	GHONASGI, TANVI M MD	11/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179081	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	STE 180	WEST SACRAMENTO	CA	95616	9701	00	06000	38.58811316	-121.5270471	Yolo County
334998	Ordering, Referring, Prescribing	N/A	1487233938	0	0	GHANIM, ALANA MD	1/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192893	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	SUITE 100	EL CAJON	CA	92020	3315	00	06000	32.79492453	-116.9627861	San Diego County
335035	Ordering, Referring, Prescribing	N/A	1487318929	0	0	GUNSOLUS, KARINA O RN BS	11/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	95045848	N/A	N/A	N/A	N/A	N/A	9333 LOCH LOMOND DR	None	PICO RIVERA	CA	90660	2913	00	06000	33.99484196	-118.0815839	Los Angeles County
335039	Ordering, Referring, Prescribing	N/A	1487336327	0	0	GARCIA, JESSICA M PA-C	7/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63035	N/A	N/A	N/A	N/A	N/A	1430 FREEDOM BLVD	None	WATSONVILLE	CA	95076	2780	00	06000	36.92713051	-121.7652145	Santa Cruz County
335052	Ordering, Referring, Prescribing	N/A	1487369799	0	0	GRAY, CULLEN PA-C	2/7/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64044	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
335060	Ordering, Referring, Prescribing	N/A	1487394581	0	0	GUNNINGHAM, NOAH MD	1/31/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187646	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
335071	Ordering, Referring, Prescribing	N/A	1487432340	0	0	GIZ, ANETA M CNP	8/4/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026489	N/A	N/A	N/A	N/A	N/A	661 W. 1ST STREET	None	TUSTIN	CA	92780	2939	00	06000	33.74578153	-117.831231	Orange County
335072	Ordering, Referring, Prescribing	N/A	1487491718	0	0	GILL, GURVEEN DDS	7/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	0401418532	N/A	N/A	N/A	N/A	N/A	207 N BUTTE ST	None	WILLOWS	CA	95988	2803	00	06000	39.52212468	-122.195408	Glenn County
335090	Ordering, Referring, Prescribing	N/A	1487483368	0	0	GHADER, MISHA NP	4/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029732	N/A	N/A	N/A	N/A	N/A	400 WEST 30TH AVE	None	LOS ANGELES	CA	90007	0000	00	06000	34.0239409	-118.2755606	Los Angeles County
335101	Ordering, Referring, Prescribing	N/A	1487720991	0	0	GRADY, MICHELLE	6/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25904	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
335108	Ordering, Referring, Prescribing	N/A	1487732046	0	0	GURVIS, RAFAEL L	11/23/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D37426	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
335121	Ordering, Referring, Prescribing	N/A	1487766622	0	0	GOMBERG, LEE M PHD	1/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY14226	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	THIRD FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
335122	Ordering, Referring, Prescribing	N/A	1487770160	0	0	GUILIN, HEATHER M LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28919	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	150	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
335124	Ordering, Referring, Prescribing	N/A	1487740619	0	0	GARCIA GOMEZ, GORETTI MD	3/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79620	N/A	N/A	N/A	N/A	N/A	4816 EAST 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
335134	Ordering, Referring, Prescribing	N/A	1487773222	0	0	GONZALEZ, ELIDA NP	4/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	288491	N/A	N/A	N/A	N/A	N/A	119 S SIXTH ST	None	FOWLER	CA	93625	2439	00	06000	36.62995919	-119.678276	Fresno County
335176	Ordering, Referring, Prescribing	N/A	1487862710	0	0	GRIFFITH, NANCY A NP	5/28/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	450746	N/A	N/A	N/A	N/A	N/A	729 N SUNRISE AVE	SUITE 900	ROSEVILLE	CA	95661	4525	00	06000	38.73444822	-121.2720033	Placer County
335184	Ordering, Referring, Prescribing	N/A	1487898250	0	0	GILLS, JACK L MD	3/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123202	N/A	N/A	N/A	N/A	N/A	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	00	06000	38.642832	-121.3649325	Sacramento County
335189	Ordering, Referring, Prescribing	N/A	1487905543	0	0	GUERRERO, ESMERALDA NP	4/23/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	792210	N/A	N/A	N/A	N/A	N/A	1400 NORTH MAIN ST	None	SANTA ANA	CA	92701	2304	00	06000	33.75688822	-117.8676134	Orange County
335190	Ordering, Referring, Prescribing	N/A	1487917118	0	0	GARCIA, NICOLE A LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT89903	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	None	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
335210	Ordering, Referring, Prescribing	N/A	1487942488	0	0	GATTEY, JOEL A LMFT	10/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112422	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
335262	Ordering, Referring, Prescribing	N/A	1497030951	0	0	GLADWILL, JESS E LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118460	N/A	N/A	N/A	N/A	N/A	1255 KENDALL ROAD	None	SAN LUIS OBISPO	CA	93401	8750	00	06000	35.2372881	-120.6292313	San Luis Obispo County
335313	Ordering, Referring, Prescribing	N/A	1497108351	0	0	GARCIA, STEPHANIE LMFT	1/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130844	N/A	N/A	N/A	N/A	N/A	4900 SERRENIA AVE	None	WOODLAND HILLS	CA	91364	3301	00	06000	34.15843077	-118.5882436	Los Angeles County
335335	Ordering, Referring, Prescribing	N/A	1497141865	0	0	GIESSMANN, KRISTINA	2/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6555	N/A	N/A	N/A	N/A	N/A	2275 S. MAIN ST.	SUITE 201	CORONA	CA	92882	5303	00	06000	33.85511663	-117.5694892	Riverside County
335353	Ordering, Referring, Prescribing	N/A	1497153688	0	0	GALAVIZ, MARIA G NP	11/8/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001483	N/A	N/A	N/A	N/A	N/A	7821 S. AVALON BLVD	None	LOS ANGELES	CA	90003	2358	00	06000	33.969393	-118.265197	Los Angeles County
335364	Ordering, Referring, Prescribing	N/A	1497191233	0	0	GELDRES-BECCERA, TERRY M	11/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	86911	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
335388	Ordering, Referring, Prescribing	N/A	1497218812	0	0	GOHIL, RAJIT R MD	3/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176689	N/A	N/A	N/A	N/A	N/A	651 N STATE STREET	5	SAN JACINTO	CA	92583	6573	00	06000	33.79510156	-116.9715082	Riverside County
335407	Ordering, Referring, Prescribing	N/A	1497252308	0	0	GILBERT, MAURA E NP	10/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008780	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	0000	00	06000	34.42887662	-119.7237878	Santa Barbara County
335427	Ordering, Referring, Prescribing	N/A	1497294177	0	0	GUIDO, CARYN NP	5/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95022637	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
335436	Ordering, Referring, Prescribing	N/A	1497312045	0	0	GHALCHI, JASMINE PA-C	5/24/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56815	N/A	N/A	N/A	N/A	N/A	11888 BARTLETT AVE	None	ADELANTO	CA	92301	1709	00	06000	34.57927736	-117.4068692	San Bernardino County
335437	Ordering, Referring, Prescribing	N/A	1497305213	0	0	GONZALEZ, MARIA DEL CARMEN LMFT	7/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134042	N/A	N/A	N/A	N/A	N/A	4000 WEST METROPOLITAN D	None	ORANGE	CA	92868	3503	00	06000	33.78016046	-117.8956101	Orange County
335450	Ordering, Referring, Prescribing	N/A	1497328686	0	0	GRIFFITH, REBIE NP	9/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95027206	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
335454	Ordering, Referring, Prescribing	N/A	1497360440	0	0	GONZALEZ, CRISTIAN MSW LCSW	10/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126624	N/A	N/A	N/A	N/A	N/A	16580 HARBOR BLVD	UNIT M	FOUNTAIN VALLEY	CA	92708	4241	00	06000	33.72282	-117.9197845	Orange County
335459	Ordering, Referring, Prescribing	N/A	1497371835	0	0	GUIMOND, SAVANNAH W LCSW	8/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117737	N/A	N/A	N/A	N/A	N/A	2201 MISSION AVE	#100	OCEANSIDE	CA	92058	2313	00	06000	33.20742226	-117.3612486	San Diego County
335467	Ordering, Referring, Prescribing	N/A	1497381875	0	0	GARCIA-SHELTON, DORA A LMFT	10/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135548	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	801	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
335485	Ordering, Referring, Prescribing	N/A	1497417000	0	0	GARCIA, MONICA F OD	10/6/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT35029	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	CHOWCHILLA	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
335524	Ordering, Referring, Prescribing	N/A	1497716567	0	0	GHIDE, EPHRAIM MD	7/24/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	43654	N/A	N/A	N/A	N/A	N/A	4050 COON RAPIDS BLVD NW	None	COON RAPIDS	MN	55433	2522	00	06000	45.18395809	-93.36860464	Anoka County
335526	Ordering, Referring, Prescribing	N/A	1497730758	0	0	GATES, GRACE E MD	3/31/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54094	N/A	N/A	N/A	N/A	N/A	4501 MISSION BAY DR	None	SAN DIEGO	CA	92109	4924	00	06000	32.80307971	-117.2166446	San Diego County
335528	Ordering, Referring, Prescribing	N/A	1497721260	0	0	GREEN, ALAN C	11/28/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G76287	N/A	N/A	N/A	N/A	N/A	370 S CRENSHAW BLVD	E100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
335531	Ordering, Referring, Prescribing	N/A	1497758304	0	0	GUIJON, JOHN DDS	9/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS42730	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	None	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
335562	Ordering, Referring, Prescribing	N/A	1497859433	0	0	GREENBERG, JAMES Y MD	10/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A55519	N/A	N/A	N/A	N/A	N/A	2299 POST ST STE 205	None	SAN FRANCISCO	CA	94115	3473	00	06000	37.78434298	-122.4392033	San Francisco County
335587	Ordering, Referring, Prescribing	N/A	1497897656	0	0	GEANTA-THOMAS, ALICE C LMFT	12/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80297	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	GOLETA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
335590	Ordering, Referring, Prescribing	N/A	1497899561	0	0	GALBREATH, KIMBERLY V	5/8/2017	Taxonomy not applicable	NA	n/a	000	Unknown	13667	N/A	N/A	N/A	N/A	N/A	275 S MADERA AVE	STE 201	KERMAN	CA	93630	1401	00	06000	36.73165922	-120.0602617	Fresno County
335612	Ordering, Referring, Prescribing	N/A	1497961585	0	0	GARGURI, TAHANI M DDS	11/17/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	49319	N/A	N/A	N/A	N/A	N/A	3590 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2655	00	06000	33.93042906	-118.2056035	Los Angeles County
335662	Ordering, Referring, Prescribing	N/A	1508106600	0	0	GORDON, KALI MD	7/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	GA72733	N/A	N/A	N/A	N/A	N/A	36977 PARK AVE	None	BURNEY	CA	96013	4067	00	06000	40.87640189	-121.6730441	Shasta County
335675	Ordering, Referring, Prescribing	N/A	1508124132	0	0	GILDE, JASON E MD	11/10/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131061	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
335746	Ordering, Referring, Prescribing	N/A	1508235193	0	0	GONZALEZ, ROSARIO LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88681	N/A	N/A	N/A	N/A	N/A	21081 S WESTERN AVE	295	TORRANCE	CA	90501	1703	00	06000	33.83886841	-118.3093605	Los Angeles County
335769	Ordering, Referring, Prescribing	N/A	1508269812	0	0	GAINES, KENTARA LCSW	3/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121425	N/A	N/A	N/A	N/A	N/A	100 PHILLIPS DRIVE	None	SAUSALITO	CA	94965	1126	00	06000	37.87309986	-122.5132921	Marin County
335845	Ordering, Referring, Prescribing	N/A	1508394644	0	0	GOLCHERT, KORY J	11/18/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102387	N/A	N/A	N/A	N/A	N/A	1807 BAY RD	None	EAST PALO ALTO	CA	94303	1312	00	06000	37.47199121	-122.1344629	San Mateo County
335851	Ordering, Referring, Prescribing	N/A	1508398702	0	0	GARCIA, EDUARDO MD	2/11/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159799	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
335855	Ordering, Referring, Prescribing	N/A	1508411588	0	0	GUO, YUJING NP	12/17/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012125	N/A	N/A	N/A	N/A	N/A	1020 S ARROYO PKWY	None	PASADENA	CA	91105	3911	00	06000	34.128351	-118.1471735	Los Angeles County
335858	Ordering, Referring, Prescribing	N/A	1508414715	0	0	GRIFFITHS, RUSSELL S PSYD	1/29/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	LEP2541	N/A	N/A	N/A	N/A	N/A	200 KALMUS DR	None	COSTA MESA	CA	92626	5922	00	06000	33.67250829	-117.8813768	Orange County
335870	Ordering, Referring, Prescribing	N/A	1508433400	0	0	GRANESE, JULIA E	1/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015682	N/A	N/A	N/A	N/A	N/A	42220 10TH ST WEST	109	LANCASTER	CA	93534	7075	00	06000	34.65072	-118.1475825	Los Angeles County
335917	Ordering, Referring, Prescribing	N/A	1508564964	0	0	GUTIERREZ, MARISOL	1/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024070	N/A	N/A	N/A	N/A	N/A	1093 11TH ST	None	REEDLEY	CA	93654	2950	00	06000	36.60074456	-119.4445203	Fresno County
335920	Ordering, Referring, Prescribing	N/A	1508540311	0	0	GONZALES, SHANNA LMFT	6/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139947	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
335974	Ordering, Referring, Prescribing	N/A	1508909276	0	0	GARCIA, JOANA M LMFT	12/31/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41873	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
336003	Ordering, Referring, Prescribing	N/A	1508983453	0	0	GRAHAM, TESSA LMFT	10/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39945	N/A	N/A	N/A	N/A	N/A	18050 VANOWEN ST.	None	RESEDA	CA	91355	9998	00	06000	34.19384052	-118.526904	Los Angeles County
336039	Ordering, Referring, Prescribing	N/A	1518050178	0	0	GONA, SUMA F MD	3/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A96360	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
336055	Ordering, Referring, Prescribing	N/A	1518083294	0	0	GENZEL-DERMAN, BRETTE PSYD	1/6/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PSY17779	N/A	N/A	N/A	N/A	N/A	8550 BALBOA BLVD	None	NORTHRIDGE	CA	91325	3562	00	06000	34.225713	-118.5026045	Los Angeles County
336058	Ordering, Referring, Prescribing	N/A	1518084268	0	0	GORDON, LORETTA N LMFT	3/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50459	N/A	N/A	N/A	N/A	N/A	2712 MISSION ST	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
336092	Ordering, Referring, Prescribing	N/A	1518152339	0	0	GALLOWAY-BROWN, EVA G LMFT	7/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT88041	N/A	N/A	N/A	N/A	N/A	820 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0928	00	06000	34.1268333	-117.2687417	San Bernardino County
336093	Ordering, Referring, Prescribing	N/A	1518152644	0	0	GIBSON-WEINBERGER, DANNY R LMFT	2/9/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43948	N/A	N/A	N/A	N/A	N/A	510 SO. VERMONT AVENUE	None	LOS ANGELES	CA	90020	1912	00	06000	34.065	-118.291631	Los Angeles County
336096	Ordering, Referring, Prescribing	N/A	1518153485	0	0	GILBERTS, SARAH L LCSW	7/11/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60068	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
336104	Ordering, Referring, Prescribing	N/A	1518169739	0	0	GOLDMAN, HILDA R LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT21428	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY STREET,	SUITE E 500	FREMONT	CA	94537	5006	00	06000	37.55123907	-121.9828956	Alameda County
336153	Ordering, Referring, Prescribing	N/A	1518265396	0	0	GIFFARD, JASON M	1/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85907	N/A	N/A	N/A	N/A	N/A	2525 N CHESTER AVE	None	BAKERSFIELD	CA	93308	1770	00	06000	35.429463	-119.0213795	Kern County
336176	Ordering, Referring, Prescribing	N/A	1518314921	0	0	GAMBLE, THOMAS A PHARMD	6/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	35577	N/A	N/A	N/A	N/A	N/A	12199 HESPERIA RD	None	VICTORVILLE	CA	92395	4756	00	06000	34.47228373	-117.291759	San Bernardino County
336200	Ordering, Referring, Prescribing	N/A	1518354349	0	0	GALBRAITH, SUZY LMFT	3/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121966	N/A	N/A	N/A	N/A	N/A	5276 HOLLISTER AVE	458	GOLETA	CA	93111	2073	00	06000	34.43504438	-119.8083695	Santa Barbara County
336203	Ordering, Referring, Prescribing	N/A	1518357821	0	0	GARCIA, JAVIER E LCSW	4/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88764	N/A	N/A	N/A	N/A	N/A	4164 BROCKTON AVE	None	RIVERSIDE	CA	92501	3400	00	06000	33.98077024	-117.3813862	Riverside County
336206	Ordering, Referring, Prescribing	N/A	1518361666	0	0	GARCIA, FRANK I LCSW	6/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94664	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
336218	Ordering, Referring, Prescribing	N/A	1518373539	0	0	GALLEGOS, STEPHANIE M LCSW	6/24/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90466	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
336219	Ordering, Referring, Prescribing	N/A	1518378991	0	0	GUERRERO GONZALES, ISABELA A LCSW	3/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110995	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3195	00	06000	36.696987	-121.633164	Monterey County
336230	Ordering, Referring, Prescribing	N/A	1518389659	0	0	GONZALEZ, VERONICA Y LMFT	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99735	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2308	00	06000	34.54007429	-117.2744761	San Bernardino County
336265	Ordering, Referring, Prescribing	N/A	1518450337	0	0	GOMEZ, HOLLY L LMFT	3/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138391	N/A	N/A	N/A	N/A	N/A	1401 L ST	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37071435	-119.0164657	Kern County
336272	Ordering, Referring, Prescribing	N/A	1518470921	0	0	GONZALEZ, CARLA I NP	12/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008047	N/A	N/A	N/A	N/A	N/A	16465 SIERRA LAKES PKWY	300	FONTANA	CA	92336	1242	00	06000	34.13805177	-117.4457839	San Bernardino County
336302	Ordering, Referring, Prescribing	N/A	1518524107	0	0	GALLEGOS-KNIGHT, NIKKELLE NP	1/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011257	N/A	N/A	N/A	N/A	N/A	7677 CENTER AVE	None	HUNTINGTON BEACH	CA	92647	3074	00	06000	33.736257	-117.995535	Orange County
336332	Ordering, Referring, Prescribing	N/A	1518609635	0	0	GIORGI, KENNETH NP	5/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95020616	N/A	N/A	N/A	N/A	N/A	2810 CAMINO DEL RIO S	SUITE# 106	SAN DIEGO	CA	92108	3818	00	06000	32.77081335	-117.1316557	San Diego County
336335	Ordering, Referring, Prescribing	N/A	1518631555	0	0	GARCIA, DHARSHINI NP	6/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017651	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
336381	Ordering, Referring, Prescribing	N/A	1528041654	0	0	GORDON, ROBERT B MD	1/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C34624	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
336393	Ordering, Referring, Prescribing	N/A	1528067030	0	0	GREEN, STANLEY A	1/27/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	27519	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
336409	Ordering, Referring, Prescribing	N/A	1528127198	0	0	GWEON, PAUL Y MD	1/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G73207	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
336420	Ordering, Referring, Prescribing	N/A	1528146289	0	0	GARCIA, NANCY LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51536	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
336426	Ordering, Referring, Prescribing	N/A	1528181898	0	0	GUERRERO, CHARITO LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27159	N/A	N/A	N/A	N/A	N/A	5628 E SLAUSON AVE	None	COMMERCE	CA	90040	2922	00	06000	33.98593459	-118.163681	Los Angeles County
336445	Ordering, Referring, Prescribing	N/A	1528217999	0	0	GOULD, PAMELA L	6/8/2015	Taxonomy not applicable	NA	n/a	000	Unknown	64	N/A	N/A	N/A	N/A	N/A	7385 HEALDSBURG AVE	SUITE 203	SEBASTOPOL	CA	95472	3223	00	06000	38.40523147	-122.830461	Sonoma County
336459	Ordering, Referring, Prescribing	N/A	1528249208	0	0	GHOBRIAL, NAZEM MD	1/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102124	N/A	N/A	N/A	N/A	N/A	6172 LAUREL BLOSSOM PL	None	RANCHO CUCAMONGA	CA	91739	9431	00	06000	34.14189349	-117.5249728	San Bernardino County
336468	Ordering, Referring, Prescribing	N/A	1528273943	0	0	GALLARDO, KATHY MD	7/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A98636	N/A	N/A	N/A	N/A	N/A	120 N 8TH ST	None	EL CENTRO	CA	92243	2328	00	06000	32.793282	-115.5614685	Imperial County
336475	Ordering, Referring, Prescribing	N/A	1528291838	0	0	GARRETT, JANA R LCSW	2/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70969	N/A	N/A	N/A	N/A	N/A	13800 HEACOCK ST	C220	MORENO VALLEY	CA	92553	3339	00	06000	33.91968997	-117.2437139	Riverside County
336476	Ordering, Referring, Prescribing	N/A	1528295243	0	0	GORDON, BONNIE G LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21271	N/A	N/A	N/A	N/A	N/A	2275 MARKET ST.	SUITE 7	SAN FRANCISCO	CA	94114	1652	00	06000	37.76473469	-122.4322875	San Francisco County
336485	Ordering, Referring, Prescribing	N/A	1528297637	0	0	GRAFF, LEA CCC-SLP	8/5/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	10435	N/A	N/A	N/A	N/A	N/A	294 GREEN VALLEY ROAD	None	WATSONVILLE	CA	95076	1300	00	06000	36.93991665	-121.7699818	Santa Cruz County
336489	Ordering, Referring, Prescribing	N/A	1528309382	0	0	GOBRIAL, NANCY LMFT	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106654	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
336496	Ordering, Referring, Prescribing	N/A	1528320165	0	0	GARCIA, RUMALDA C LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113765	N/A	N/A	N/A	N/A	N/A	123 WEST GUTIERREZ STREE	None	SANTA BARBARA	CA	93101	0400	00	06000	34.41387023	-119.6962788	Santa Barbara County
336532	Ordering, Referring, Prescribing	N/A	1528368750	0	0	GASPARYAN, ELIZABETH LCSW	4/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88286	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
336550	Ordering, Referring, Prescribing	N/A	1528420163	0	0	GUTIERREZ, MAYRA R LCSW	3/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114182	N/A	N/A	N/A	N/A	N/A	2417 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3040	00	06000	34.01413253	-118.1278906	Los Angeles County
336555	Ordering, Referring, Prescribing	N/A	1528420817	0	0	GREENE, AARON MD	10/30/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150561	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
336562	Ordering, Referring, Prescribing	N/A	1528429206	0	0	GARDNER, GABRIELLE LMFT	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113453	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
336584	Ordering, Referring, Prescribing	N/A	1528454972	0	0	GARZON, MELISSA MD MPH	3/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	155958	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
336592	Ordering, Referring, Prescribing	N/A	1528464534	0	0	GRAY, EMILY LMFT	5/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105795	N/A	N/A	N/A	N/A	N/A	652 FOREST AVE	None	PALO ALTO	CA	94301	2622	00	06000	37.44868402	-122.1547101	Santa Clara County
336611	Ordering, Referring, Prescribing	N/A	1528507183	0	0	GIULLIAN, BRANDON PA-C	8/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	54219	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
336631	Ordering, Referring, Prescribing	N/A	1528535515	0	0	GUTIERREZ, JENNIE M DDS	10/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	103330	N/A	N/A	N/A	N/A	N/A	3590 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2655	00	06000	33.93042906	-118.2056035	Los Angeles County
336644	Ordering, Referring, Prescribing	N/A	1528557378	0	0	GARRISON, LUCAS M LCSW	10/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111073	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
336645	Ordering, Referring, Prescribing	N/A	1528562204	0	0	GIBBONS, GERALD R MD	11/20/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174627	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
336655	Ordering, Referring, Prescribing	N/A	1528581246	0	0	GARCIA HERRERA, CESAR LMFT	8/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121093	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
336669	Ordering, Referring, Prescribing	N/A	1528597192	0	0	GONZALEZ, EVETTE A LMFT	8/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127794	N/A	N/A	N/A	N/A	N/A	3741 STOCKER ST	None	LOS ANGELES	CA	90008	5109	00	06000	34.00623019	-118.3384304	Los Angeles County
336713	Ordering, Referring, Prescribing	N/A	1528683315	0	0	GALLEGOS, GONZALO LCSW	1/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	113217	N/A	N/A	N/A	N/A	N/A	1743 RECHE RD	None	FALLBROOK	CA	92028	3624	00	06000	33.36917448	-117.221877	San Diego County
336722	Ordering, Referring, Prescribing	N/A	1528670387	0	0	GOMEZ, ADAN LCSW	7/3/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123828	N/A	N/A	N/A	N/A	N/A	1455 EAST 3RD ST.	None	SAN BERNARDINO	CA	92408	0118	00	06000	34.10449624	-117.2555619	San Bernardino County
336746	Ordering, Referring, Prescribing	N/A	1528781218	0	0	GERAGOSIAN, MARET PHARMD	7/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86267	N/A	N/A	N/A	N/A	N/A	44840 MONTEREY AVE	None	PALM DESSERT	CA	92260	3325	00	06000	33.722667	-116.391222	Riverside County
336754	Ordering, Referring, Prescribing	N/A	1528845633	0	0	GOMEZ, KARLA J DMD	4/2/2025	Taxonomy not applicable	NA	n/a	000	Unknown	109355	N/A	N/A	N/A	N/A	N/A	200 E ANAHEIM ST	None	WILMINGTON	CA	90744	4516	00	06000	33.78003976	-118.2608958	Los Angeles County
336757	Ordering, Referring, Prescribing	N/A	1538108097	0	0	GONZALEZ, ALEJANDRO L DO	9/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A6453	N/A	N/A	N/A	N/A	N/A	4225 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6217	00	06000	33.94330446	-118.1970199	Los Angeles County
336806	Ordering, Referring, Prescribing	N/A	1538248091	0	0	GEORGULAS, ANNE MD	9/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C181717	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
336812	Ordering, Referring, Prescribing	N/A	1538265269	0	0	GUILLERMO, MARIA-CECILIA LMFT	8/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT22935	N/A	N/A	N/A	N/A	N/A	3270 KERNER BLVD	SUITE B	SAN RAFAEL	CA	94901	4840	00	06000	37.96108677	-122.5017451	Marin County
336823	Ordering, Referring, Prescribing	N/A	1538285234	0	0	GREENLAND, SANDRA J LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38319	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
336855	Ordering, Referring, Prescribing	N/A	1538340088	0	0	GROSS, DANIEL E LCSW	2/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82064	N/A	N/A	N/A	N/A	N/A	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4558	00	06000	35.27488974	-120.6468257	San Luis Obispo County
336865	Ordering, Referring, Prescribing	N/A	1538350293	0	0	GOMEZ GONZALEZ, ALEXIS NP	2/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP17373	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
336872	Ordering, Referring, Prescribing	N/A	1538381645	0	0	GRIFFITH, KEN C	2/18/1999	Taxonomy not applicable	NA	n/a	099	DENTIST	D44316	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
336899	Ordering, Referring, Prescribing	N/A	1538436670	0	0	GORDON, CLARA PA-C	11/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA52487	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
336935	Ordering, Referring, Prescribing	N/A	1538486204	0	0	GUZMAN, ROCIO D	3/13/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D47480	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
336963	Ordering, Referring, Prescribing	N/A	1538538004	0	0	GIN, MATTHEW R PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73561	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	B23	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
336997	Ordering, Referring, Prescribing	N/A	1538572805	0	0	GRAVA, TOFANI LMFT	2/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104702	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	LARKSPUR	CA	94939	0000	00	06000	37.9469952	-122.5373892	Marin County
337012	Ordering, Referring, Prescribing	N/A	1538599774	0	0	GHEISAR-SHAHABIAN, JZEELA LMFT	8/5/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98994	N/A	N/A	N/A	N/A	N/A	6518 LONETREE BLVD STE 1	166	ROCKLIN	CA	95765	5874	00	06000	38.8041476	-121.2936557	Placer County
337013	Ordering, Referring, Prescribing	N/A	1538595137	0	0	GALLEGOS, LAUREL E CCC-SLP	4/5/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	28682	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
337018	Ordering, Referring, Prescribing	N/A	1538610639	0	0	GUILLEN-GARCIA, DULCE JEANETTE LCSW	9/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110460	N/A	N/A	N/A	N/A	N/A	1904 RICHLAND AVE	None	CERES	CA	95307	4562	00	06000	37.60031128	-120.9658226	Stanislaus County
337053	Ordering, Referring, Prescribing	N/A	1538666748	0	0	GOLD, KELLYANNE R	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164250	N/A	N/A	N/A	N/A	N/A	7515 VAN NUYS BLVD	None	VAN NUYS	CA	91405	1949	00	06000	34.207344	-118.4487995	Los Angeles County
337058	Ordering, Referring, Prescribing	N/A	1538678008	0	0	GAUDIOSO, LINDSEY LCSW	9/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97274	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
337063	Ordering, Referring, Prescribing	N/A	1538685953	0	0	GARBANI, SHANNAN LMFT	3/11/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129896	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
337099	Ordering, Referring, Prescribing	N/A	1538770722	0	0	GALLMEYER, JENNIFER LCSW	1/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112972	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LANE	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
337106	Ordering, Referring, Prescribing	N/A	1538796107	0	0	GOMEZ-MUSTAFA, CARLOS E MD	6/17/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179745	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
337129	Ordering, Referring, Prescribing	N/A	1538875059	0	0	GUZMAN, MARTHA NP	1/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024049	N/A	N/A	N/A	N/A	N/A	833 SEQUOIA AVE	None	LINDSAY	CA	93247	1424	00	06000	36.212967	-119.0961185	Tulare County
337137	Ordering, Referring, Prescribing	N/A	1538883293	0	0	GUDINO, JEANETTE PA	2/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62417	N/A	N/A	N/A	N/A	N/A	5075 S BRADLEY RD	STE 131	SANTA MARIA	CA	93455	5077	00	06000	34.864155	-120.4187955	Santa Barbara County
337169	Ordering, Referring, Prescribing	N/A	1548047657	0	0	GREWAL, PARWINDER NP	7/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95025157	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
337188	Ordering, Referring, Prescribing	N/A	1548283187	0	0	GARNER, STEVEN L MD	7/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G68153	N/A	N/A	N/A	N/A	N/A	3311 MISSION DR	None	SANTA CRUZ	CA	95065	1827	00	06000	36.99102829	-121.9802419	Santa Cruz County
337196	Ordering, Referring, Prescribing	N/A	1548248065	0	0	GORDON, LOWELL MD	1/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44724	N/A	N/A	N/A	N/A	N/A	661 W 1ST STREET	G	TUSTIN	CA	92780	2939	00	06000	33.74578153	-117.831231	Orange County
337199	Ordering, Referring, Prescribing	N/A	1548309594	0	0	GUERRERO-URBANSKI, CAROL L LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17449	N/A	N/A	N/A	N/A	N/A	840 GUADALUPE PKWY	None	SAN JOSE	CA	95110	1714	00	06000	37.34957284	-121.9080687	Santa Clara County
337243	Ordering, Referring, Prescribing	N/A	1548425242	0	0	GIBBS, ELIZABETH LMFT	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50844	N/A	N/A	N/A	N/A	N/A	1617 CRAVENS AVE	None	TORRANCE	CA	90501	3203	00	06000	33.83269486	-118.3158222	Los Angeles County
337244	Ordering, Referring, Prescribing	N/A	1548412075	0	0	GAYTAN, JENNIFER L LCSW	2/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	69673	N/A	N/A	N/A	N/A	N/A	1908 BUSINESS CENTER DRI	220	SAN BERNARDINO	CA	92408	3436	00	06000	34.06732096	-117.2801085	San Bernardino County
337275	Ordering, Referring, Prescribing	N/A	1548500259	0	0	GARG, ANU MD	4/7/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139624	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
337279	Ordering, Referring, Prescribing	N/A	1548504251	0	0	GREEN, TONYA K PHARMD	7/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66709	N/A	N/A	N/A	N/A	N/A	265 W FOREST AVE	None	COALINGA	CA	93210	1929	00	06000	36.13725472	-120.3608121	Fresno County
337291	Ordering, Referring, Prescribing	N/A	1548525595	0	0	GUZMAN, MARIA NP	1/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028796	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVENUE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
337301	Ordering, Referring, Prescribing	N/A	1548542905	0	0	GUARDADO MCDOUGALL, NANCY E PSYD	6/8/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31740	N/A	N/A	N/A	N/A	N/A	3551 CAMINO MIRA COSTA	300	SAN CLEMENTE	CA	92672	3508	00	06000	33.45549271	-117.6566925	Orange County
337317	Ordering, Referring, Prescribing	N/A	1548572613	0	0	GOMEZ, PRISCILA LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104634	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
337318	Ordering, Referring, Prescribing	N/A	1548561368	0	0	GALVAN, JULISSA LMFT	12/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126298	N/A	N/A	N/A	N/A	N/A	1830 S CENTRAL ST	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
337322	Ordering, Referring, Prescribing	N/A	1548579055	0	0	GUZMAN, JAZMIN LMFT	7/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127065	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
337327	Ordering, Referring, Prescribing	N/A	1548598956	0	0	GRAY, ERIN D LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84691	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
337329	Ordering, Referring, Prescribing	N/A	1548602568	0	0	GOMEZ, JANAY P CNP	1/12/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008244	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
337341	Ordering, Referring, Prescribing	N/A	1548628068	0	0	GRAHAM, CAITLIN C LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102092	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
337354	Ordering, Referring, Prescribing	N/A	1548637168	0	0	GRIFFITH, WILLIAM E LMFT	3/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125236	N/A	N/A	N/A	N/A	N/A	1727 MARTIN LUTHER KING	109	OAKLAND	CA	94612	1327	00	06000	37.80868384	-122.2744362	Alameda County
337365	Ordering, Referring, Prescribing	N/A	1548667306	0	0	GARCIA, DULCE M	10/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	118453	N/A	N/A	N/A	N/A	N/A	200 KALMUS DR	None	COSTA MESA	CA	92626	5922	00	06000	33.67250829	-117.8813768	Orange County
337390	Ordering, Referring, Prescribing	N/A	1548714652	0	0	GONZALES, MICHELLE K PT	2/22/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT291706	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
337419	Ordering, Referring, Prescribing	N/A	1548739295	0	0	GABAY, RUTH NP	1/8/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010819	N/A	N/A	N/A	N/A	N/A	5255 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5716	00	06000	34.09815646	-118.304595	Los Angeles County
337440	Ordering, Referring, Prescribing	N/A	1548786403	0	0	GUDINO-GUTIERREZ, KAREN LCSW	6/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108785	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE	None	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
337506	Ordering, Referring, Prescribing	N/A	1548997968	0	0	GOSSAL, MOEMI	7/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021962	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
337513	Ordering, Referring, Prescribing	N/A	1548993058	0	0	GONZALEZ, YESENIA C PA-C	6/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64592	N/A	N/A	N/A	N/A	N/A	3727 W 6TH ST	200	LOS ANGELES	CA	90020	5105	00	06000	34.06358655	-118.3037656	Los Angeles County
337514	Ordering, Referring, Prescribing	N/A	1558029694	0	0	GOMEZ, KAREN NP	7/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017947	N/A	N/A	N/A	N/A	N/A	2651 SOUTH C ST	100	OXNARD	CA	93033	0000	00	06000	34.17497898	-119.1811966	Ventura County
337560	Ordering, Referring, Prescribing	N/A	1558347138	0	0	GOGO, ALBINA L S MD	8/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G48957	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	STE 2100	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
337586	Ordering, Referring, Prescribing	N/A	1558461095	0	0	GRIMLEY, MARGARET	12/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C50335	N/A	N/A	N/A	N/A	N/A	2400 BISSO LN	None	CONCORD	CA	94520	4832	00	06000	37.98411857	-122.0466636	Contra Costa County
337599	Ordering, Referring, Prescribing	N/A	1558483107	0	0	GONZALES, CHONN L	6/24/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0573908	N/A	N/A	N/A	N/A	N/A	918 W. FOOTHILL BLVD #A	None	UPLAND	CA	91786	3772	00	06000	34.10676594	-117.6636152	San Bernardino County
337600	Ordering, Referring, Prescribing	N/A	1558487561	0	0	GILMAN, ELENA MD	2/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	A84495	N/A	N/A	N/A	N/A	N/A	7451 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2803	00	06000	34.20616081	-118.3878161	Los Angeles County
337603	Ordering, Referring, Prescribing	N/A	1558492553	0	0	GONZALEZ, RUBENIA LCSW	12/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81029	N/A	N/A	N/A	N/A	N/A	901 W VICTORIA ST.	STE. G	COMPTON	CA	90220	5820	00	06000	33.86784006	-118.2368928	Los Angeles County
337607	Ordering, Referring, Prescribing	N/A	1558496406	0	0	GRISWOLD, LINKA	7/3/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35149	N/A	N/A	N/A	N/A	N/A	2629 TOWNSGATE ROAD,	235	WESTLAKE VILLAGE	CA	91361	2987	00	06000	34.15794856	-118.8297275	Ventura County
337637	Ordering, Referring, Prescribing	N/A	1558595421	0	0	GORSKY, OLENA MD	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126292	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3RD FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
337685	Ordering, Referring, Prescribing	N/A	1558657361	0	0	GILES, ERIN DO	1/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12661	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
337686	Ordering, Referring, Prescribing	N/A	1558673327	0	0	GONZALEZ, CORINA L MD	11/19/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C146092	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
337690	Ordering, Referring, Prescribing	N/A	1558678466	0	0	GAYOWSKI, WILLIAM LMFT	1/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83696	N/A	N/A	N/A	N/A	N/A	2400 COUNTY CENTER DR	A	SANTA ROSA	CA	95403	3004	00	06000	38.46366	-122.7255255	Sonoma County
337706	Ordering, Referring, Prescribing	N/A	1558710632	0	0	GARIBAY MALANOWSKI, ERIKA LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99293	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	3RD FL	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
337727	Ordering, Referring, Prescribing	N/A	1558747584	0	0	GONZALEZ, GREGORY J LMFT	8/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127824	N/A	N/A	N/A	N/A	N/A	1401 L ST	None	BAKERSFIELD	CA	93301	4522	00	06000	35.37071435	-119.0164657	Kern County
337730	Ordering, Referring, Prescribing	N/A	1558762351	0	0	GOMEZ, MAYRA R LCSW	4/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87570	N/A	N/A	N/A	N/A	N/A	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
337771	Ordering, Referring, Prescribing	N/A	1558822684	0	0	GONZALEZ, EVELIN R	9/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182396	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
337791	Ordering, Referring, Prescribing	N/A	1558852962	0	0	GREEN, MARGARET IJEOMA NP	11/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008501	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVENUE	SUITE 300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
337795	Ordering, Referring, Prescribing	N/A	1558858183	0	0	GUZIK, PAUL DO	6/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19162	N/A	N/A	N/A	N/A	N/A	1551 BISHOP ST	STE 230	SAN LUIS OBISPO	CA	93401	0001	00	06000	35.27475609	-120.6454494	San Luis Obispo County
337807	Ordering, Referring, Prescribing	N/A	1558872846	0	0	GONZALES, LYNNIS LMFT	7/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120301	N/A	N/A	N/A	N/A	N/A	520 W PALMDALE BLVD	D	PALMDALE	CA	93551	4229	00	06000	34.58407117	-118.1400842	Los Angeles County
337814	Ordering, Referring, Prescribing	N/A	1558885848	0	0	GUTIERREZ BEJAR, FERNANDO LMFT	12/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123708	N/A	N/A	N/A	N/A	N/A	310 HARBOR BLVD	BUILDING E	BELMONT	CA	94002	4018	00	06000	37.52045283	-122.2680405	San Mateo County
337816	Ordering, Referring, Prescribing	N/A	1558881862	0	0	GOODWIN, DIANNA LCSW	10/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77394	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92142	4711	00	06000	32.77025942	-117.2017196	San Diego County
337831	Ordering, Referring, Prescribing	N/A	1558918680	0	0	GREENO, JENNIFER LCSW	5/31/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108273	N/A	N/A	N/A	N/A	N/A	12625 HESPERIA ROAD	None	VICTORVILLE	CA	92395	7720	00	06000	34.48058899	-117.2907353	San Bernardino County
337878	Ordering, Referring, Prescribing	N/A	1568028124	0	0	GABRIEL, RYAN DO	2/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20444	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
337915	Ordering, Referring, Prescribing	N/A	1568131738	0	0	GOV, KENNETH T	2/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84996	N/A	N/A	N/A	N/A	N/A	1755 HACIENDA DR	None	VISTA	CA	92081	4546	00	06000	33.18744941	-117.2759225	San Diego County
337929	Ordering, Referring, Prescribing	N/A	1568166973	0	0	GUTIERREZ, BRENDA MD	5/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196527	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST.	None	LOS ANGELES	CA	90033	3135	00	06000	34.05627579	-118.2064774	Los Angeles County
337937	Ordering, Referring, Prescribing	N/A	1568190700	0	0	GARCIA, VALENTINA M NP	5/25/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95021062	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	STE 180	DAVIS	CA	95605	2394	00	06000	38.58811316	-121.5270471	Yolo County
337970	Ordering, Referring, Prescribing	N/A	1568490563	0	0	GARRITY, KELLY LMFT	8/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102944	N/A	N/A	N/A	N/A	N/A	3 CORPORATE PARK	STE 170	IRVINE	CA	92606	5162	00	06000	33.69055394	-117.8260389	Orange County
337984	Ordering, Referring, Prescribing	N/A	1568519221	0	0	GINIGER, HAYLEY N LMFT	12/12/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38599	N/A	N/A	N/A	N/A	N/A	589 W FREMONT AVE	None	SUNNYVALE	CA	94087	2556	00	06000	37.35222904	-122.0350225	Santa Clara County
338016	Ordering, Referring, Prescribing	N/A	1568588325	0	0	GILLIS, RUTH A LMFT	6/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50313	N/A	N/A	N/A	N/A	N/A	1250 6TH AVE	100	SAN DIEGO	CA	92101	4300	00	06000	32.71854144	-117.1593008	San Diego County
338047	Ordering, Referring, Prescribing	N/A	1568660629	0	0	GUILLORY, VANESSA A LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50496	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
338066	Ordering, Referring, Prescribing	N/A	1568711232	0	0	GONZALEZ, MAYRA LCSW	10/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100826	N/A	N/A	N/A	N/A	N/A	320 N MIDWAY DR	None	ESCONDIDO	CA	92027	2708	00	06000	33.13635398	-117.0510038	San Diego County
338077	Ordering, Referring, Prescribing	N/A	1568718120	0	0	GUTIERREZ, EVELYN LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71102	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	600	LOS ANGELES	CA	90015	2881	00	06000	34.03692236	-118.2655238	Los Angeles County
338095	Ordering, Referring, Prescribing	N/A	1568749471	0	0	GOLDSTEIN, ALLISON R	1/22/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0798009	N/A	N/A	N/A	N/A	N/A	5525 E DEL AMO BLVD	None	LAKEWOOD	CA	90713	2307	00	06000	33.8471395	-118.1244195	Los Angeles County
338099	Ordering, Referring, Prescribing	N/A	1568760940	0	0	GONZALEZ, LETICIA LMFT	3/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114677	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
338124	Ordering, Referring, Prescribing	N/A	1568794550	0	0	GARCIA, JACQUELINE L	12/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93184	N/A	N/A	N/A	N/A	N/A	12756 VAN NUYS BLVD	None	PACOIMA	CA	91331	1626	00	06000	34.27415381	-118.4110145	Los Angeles County
338126	Ordering, Referring, Prescribing	N/A	1568795060	0	0	GOMEZ, NOEMI LCSW	6/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73901	N/A	N/A	N/A	N/A	N/A	299 12TH ST	None	MARINA	CA	93933	6003	00	06000	36.66784472	-121.8011077	Monterey County
338147	Ordering, Referring, Prescribing	N/A	1568821684	0	0	GOECKERMANN, CELIA LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT33318	N/A	N/A	N/A	N/A	N/A	380 ENCINAL ST	SUITE 200	SANTA CRUZ	CA	95060	2178	00	06000	36.98747083	-122.0380148	Santa Cruz County
338162	Ordering, Referring, Prescribing	N/A	1568845774	0	0	GUTIERREZ, BRENDA LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98957	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD	A	SANTA FE SPRINGS	CA	90670	3691	00	06000	33.94629336	-118.0832752	Los Angeles County
338205	Ordering, Referring, Prescribing	N/A	1568893956	0	0	GONZALES, GISELA J LMFT	12/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123782	N/A	N/A	N/A	N/A	N/A	820 34TH ST	None	BAKERSFIELD	CA	93301	2283	00	06000	35.39053308	-119.0117133	Kern County
338245	Ordering, Referring, Prescribing	N/A	1568929982	0	0	GARCIA LEIVA, MARILE NP	12/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011158	N/A	N/A	N/A	N/A	N/A	808 W. 58TH	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
338246	Ordering, Referring, Prescribing	N/A	1568953487	0	0	GILL, TRENIESE I NP	5/25/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009170	N/A	N/A	N/A	N/A	N/A	750 E MAIN ST	None	BARSTOW	CA	92311	2354	00	06000	34.8986565	-117.017658	San Bernardino County
338271	Ordering, Referring, Prescribing	N/A	1578003463	0	0	GAGGI, DINA S	11/5/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	102932	N/A	N/A	N/A	N/A	N/A	7967 BROADWAY	None	LEMON GROVE	CA	91945	1809	00	06000	32.74269062	-117.0268984	San Diego County
338282	Ordering, Referring, Prescribing	N/A	1578024519	0	0	GUO, YING	2/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176604	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2282	00	06000	38.555181	-121.4566785	Sacramento County
338299	Ordering, Referring, Prescribing	N/A	1578052411	0	0	GONZALES, MARI A LMFT	11/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129375	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
338317	Ordering, Referring, Prescribing	N/A	1578081063	0	0	GRIEST, SARAH PSYD	7/24/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33926	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
338329	Ordering, Referring, Prescribing	N/A	1578086245	0	0	GREENE, EVAN A LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116777	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2205	00	06000	37.81022696	-122.2887619	Alameda County
338341	Ordering, Referring, Prescribing	N/A	1578103800	0	0	GARCIA, GRYANEROLL R NP	2/5/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013893	N/A	N/A	N/A	N/A	N/A	18077 HIGHWAY 18	SUITE 100	APPLE VALLEY	CA	92307	2197	00	06000	34.54021616	-117.2696677	San Bernardino County
338347	Ordering, Referring, Prescribing	N/A	1578126595	0	0	GRIFFIN, STEPHANIE A NP	6/6/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95006062	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
338359	Ordering, Referring, Prescribing	N/A	1578158580	0	0	GUERRERO, TAWNY A NP	1/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95016579	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	CHOWCHILLA	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
338373	Ordering, Referring, Prescribing	N/A	1578195707	0	0	GUION, BRADLEY PA	9/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA58536	N/A	N/A	N/A	N/A	N/A	502 EUCLID AVE	204	NATIONAL CITY	CA	91950	2931	00	06000	32.68505421	-117.0832793	San Diego County
338409	Ordering, Referring, Prescribing	N/A	1578300547	0	0	GARCIA, NOAH LCSW	10/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29023	N/A	N/A	N/A	N/A	N/A	1649 VAN NESS AVE	None	FRESNO	CA	93721	1128	00	06000	36.74134612	-119.796548	Fresno County
338412	Ordering, Referring, Prescribing	N/A	1578235149	0	0	GUZMAN, FRANK A NP	8/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022289	N/A	N/A	N/A	N/A	N/A	4425 S. CENTRAL AVE	None	LOS ANGELES	CA	90001	9002	00	06000	34.003116	-118.2565185	Los Angeles County
338430	Ordering, Referring, Prescribing	N/A	1578554150	0	0	GUZMAN, RAMONA L NP	5/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	318531	N/A	N/A	N/A	N/A	N/A	48677 VICTORIA LN	None	OAKHURST	CA	93644	9216	00	06000	37.32772782	-119.6601883	Madera County
338455	Ordering, Referring, Prescribing	N/A	1578619839	0	0	GUTIERREZ, EDITH M LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76827	N/A	N/A	N/A	N/A	N/A	659 S CENTRAL VALLEY HWY	None	SHAFTER	CA	93263	2790	00	06000	35.49514829	-119.264618	Kern County
338472	Ordering, Referring, Prescribing	N/A	1578681839	0	0	GUTIERREZ, MONICA J	5/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52429	N/A	N/A	N/A	N/A	N/A	649 E ALBERTONI ST	100	CARSON	CA	90746	1538	00	06000	33.87194399	-118.2643054	Los Angeles County
338483	Ordering, Referring, Prescribing	N/A	1578695870	0	0	GOMEZ, ALEJANDRA LMFT	10/26/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51450	N/A	N/A	N/A	N/A	N/A	1721 E 120TH ST	None	LOS ANGELES	CA	90059	3051	00	06000	33.92464172	-118.2429544	Los Angeles County
338498	Ordering, Referring, Prescribing	N/A	1578708384	0	0	GOSK, JENNIFER A LMFT	9/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53747	N/A	N/A	N/A	N/A	N/A	303 POTRERO ST, #42	102	SANTA CRUZ	CA	95060	2741	00	06000	36.982078	-122.0297837	Santa Cruz County
338514	Ordering, Referring, Prescribing	N/A	1578745352	0	0	GARCIA, KRISTEN D LMFT	2/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96307	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
338529	Ordering, Referring, Prescribing	N/A	1578762001	0	0	GRANT, RACHELLE R	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53444	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
338539	Ordering, Referring, Prescribing	N/A	1578779260	0	0	GARRETT, BRIAN P MD	11/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144630	N/A	N/A	N/A	N/A	N/A	950 GLENN DR	None	FOLSOM	CA	95630	3193	00	06000	38.664684	-121.177917	Sacramento County
338557	Ordering, Referring, Prescribing	N/A	1578814042	0	0	GUTOMAN, JON CHRISTOPHER LMFT	2/2/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130945	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
338595	Ordering, Referring, Prescribing	N/A	1578871760	0	0	GALVEZ, JACQUELINE	2/28/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW72688	N/A	N/A	N/A	N/A	N/A	10200 SEPULVEDA BLVD	300	MISSION HILLS	CA	91345	2649	00	06000	34.25572562	-118.4673156	Los Angeles County
338606	Ordering, Referring, Prescribing	N/A	1578883252	0	0	GREER, ROCKY S MD	6/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122249	N/A	N/A	N/A	N/A	N/A	1000 TRANCAS ST	None	NAPA	CA	94588	2906	00	06000	38.32349768	-122.2963137	Napa County
338612	Ordering, Referring, Prescribing	N/A	1578896791	0	0	GUTIERREZ, ALFONSO MSW LCSW	6/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74659	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
338619	Ordering, Referring, Prescribing	N/A	1578905907	0	0	GOPAL, POOJA PSYD	6/3/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33383	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
338644	Ordering, Referring, Prescribing	N/A	1578926325	0	0	GRACER, MIRA S MD	6/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A148239	N/A	N/A	N/A	N/A	N/A	10605 BALBOA BLVD	None	GRANADA HILLS	CA	91344	6342	00	06000	34.263378	-118.5022965	Los Angeles County
338646	Ordering, Referring, Prescribing	N/A	1578925814	0	0	GORDON, ALEXIS J MD	1/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152357	N/A	N/A	N/A	N/A	N/A	2512 ALTA ST	None	LOS ANGELES	CA	90031	2457	00	06000	34.07602223	-118.203989	Los Angeles County
338674	Ordering, Referring, Prescribing	N/A	1578967253	0	0	GRANT, JENNIFER M LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96406	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
338680	Ordering, Referring, Prescribing	N/A	1578951513	0	0	GRANT, GRETCHEN G LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117214	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	94043	3049	00	06000	37.36411044	-121.9052075	Santa Clara County
338686	Ordering, Referring, Prescribing	N/A	1578989091	0	0	GARCIA, RICHARD PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69276	N/A	N/A	N/A	N/A	N/A	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	00	06000	33.904782	-117.469323	Riverside County
338689	Ordering, Referring, Prescribing	N/A	1578990750	0	0	GOGOBERIDZE, SALOME DO	6/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16523	N/A	N/A	N/A	N/A	N/A	7601 HOSPITAL WAY	STE 220	SACRAMENTO	CA	95823	5408	00	06000	38.464794	-121.415571	Sacramento County
338710	Ordering, Referring, Prescribing	N/A	1588007009	0	0	GREGORY, BRITTANY J LMFT	9/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121310	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
338711	Ordering, Referring, Prescribing	N/A	1588014971	0	0	GRIGSBY, MELISSA MD	3/19/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150912	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2315	00	06000	38.555181	-121.4566785	Sacramento County
338712	Ordering, Referring, Prescribing	N/A	1588014500	0	0	GONZALEZ BOBADILLA, CARLOS R LMFT	7/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112467	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
338730	Ordering, Referring, Prescribing	N/A	1588038244	0	0	GUILLEN, JESSICA M NP	12/18/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	828219	N/A	N/A	N/A	N/A	N/A	1057 KINGSTON AVE	None	LOS ANGELES	CA	90033	1310	00	06000	34.05708747	-118.209555	Los Angeles County
338762	Ordering, Referring, Prescribing	N/A	1588066955	0	0	GORFU, MELISSA W LCSW	2/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99946	N/A	N/A	N/A	N/A	N/A	801 E. CHAPMAN AVE.	#203	FULLERTON	CA	92836	0919	00	06000	33.87407517	-117.9110814	Orange County
338771	Ordering, Referring, Prescribing	N/A	1588079255	0	0	GIRI, ADITI MD	4/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162034	N/A	N/A	N/A	N/A	N/A	1510 FLORIDA AVE STE B	STE B	MODESTO	CA	95350	4437	00	06000	37.666053	-120.996222	Stanislaus County
338787	Ordering, Referring, Prescribing	N/A	1588102255	0	0	GONZALEZ REZNICHEK, MARIKA G LMFT	10/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122808	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	None	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
338789	Ordering, Referring, Prescribing	N/A	1588109375	0	0	GRAJO, ANA MARIE A NP	11/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005722	N/A	N/A	N/A	N/A	N/A	329 WEST 8TH STREET	SUITE 101	HANFORD	CA	93230	8823	00	06000	36.32698307	-119.6503466	Kings County
338802	Ordering, Referring, Prescribing	N/A	1588134209	0	0	GEMENTERA, JALESSA LMFT	12/16/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT152060	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA STREET	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
338817	Ordering, Referring, Prescribing	N/A	1588147029	0	0	GARCIA, RON D LCSW	3/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114563	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
338825	Ordering, Referring, Prescribing	N/A	1588168108	0	0	GRUSHCHAK, SOLOMIYA MD	7/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177233	N/A	N/A	N/A	N/A	N/A	285 N EL CAMINO REAL	STE 117	ENCINITAS	CA	92024	5384	00	06000	33.05317488	-117.2611779	San Diego County
338836	Ordering, Referring, Prescribing	N/A	1588184055	0	0	GOMEZ RINCON, MARIANELA MD FAAP	2/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169505	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
338858	Ordering, Referring, Prescribing	N/A	1588225460	0	0	GAYED, MARIAN A LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112359	N/A	N/A	N/A	N/A	N/A	954 W FOOTHILL BLVD	200	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
338876	Ordering, Referring, Prescribing	N/A	1588284350	0	0	GARCIA, CLAUDIA DDS	6/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107069	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
338892	Ordering, Referring, Prescribing	N/A	1588336804	0	0	GHERSI, PABLO NP	6/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95025536	N/A	N/A	N/A	N/A	N/A	1910 MAGNOLIA AVE	None	LOS ANGELES	CA	90007	1220	00	06000	34.039638	-118.2864045	Los Angeles County
338919	Ordering, Referring, Prescribing	N/A	1588442412	0	0	GUZMAN, MELODY E NP	11/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025633	N/A	N/A	N/A	N/A	N/A	1760 TERMINO AVE	STE .100	LONG BEACH	CA	90804	9998	00	06000	33.78889871	-118.1458784	Los Angeles County
338924	Ordering, Referring, Prescribing	N/A	1588614770	0	0	GRUZENSKY, DENISE M NP	4/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	11188	N/A	N/A	N/A	N/A	N/A	1524 WEST LACEY BLVD	SUITE 103	HANFORD	CA	93230	5967	00	06000	36.32816338	-119.6690189	Kings County
338943	Ordering, Referring, Prescribing	N/A	1588701353	0	0	GARIBAY, SHAVONNE LMFT	1/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51000	N/A	N/A	N/A	N/A	N/A	1393 BAILEY ST	None	HANFORD	CA	93230	5922	00	06000	36.32728474	-119.665912	Kings County
338955	Ordering, Referring, Prescribing	N/A	1588728364	0	0	GEORGE, ROBERT S LCSW	11/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24133	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	None	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
338974	Ordering, Referring, Prescribing	N/A	1588769764	0	0	GOLDSHTEIN, GRETA PHARMD	1/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	49705	N/A	N/A	N/A	N/A	N/A	23693 CALABASAS RD	B	CALABASAS	CA	91302	3431	00	06000	34.15608673	-118.6429399	Los Angeles County
338976	Ordering, Referring, Prescribing	N/A	1588781546	0	0	GONZALEZ, CARLOS N LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	64561	N/A	N/A	N/A	N/A	N/A	2600 REDONDO AVE	6TH FLOOR	LONG BEACH	CA	90806	2325	00	06000	33.806097	-118.151378	Los Angeles County
338982	Ordering, Referring, Prescribing	N/A	1588785158	0	0	GABRIEL, RUBEN A LCSW	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70162	N/A	N/A	N/A	N/A	N/A	1870 N MAIN ST	None	SALINAS	CA	93906	2042	00	06000	36.71784314	-121.6554107	Monterey County
339014	Ordering, Referring, Prescribing	N/A	1588846471	0	0	GOMEZ, MARIA O LCSW	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75820	N/A	N/A	N/A	N/A	N/A	242 N VILLA AVE	None	WILLOWS	CA	95928	2641	00	06000	39.52243848	-122.208844	Glenn County
339041	Ordering, Referring, Prescribing	N/A	1588863088	0	0	GHARIBIAN, NINETTE LMFT	12/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53755	N/A	N/A	N/A	N/A	N/A	6957 NORTH FIGUEROA STRE	None	LOS ANGELES	CA	90042	1245	00	06000	34.12873587	-118.18774	Los Angeles County
339048	Ordering, Referring, Prescribing	N/A	1588932271	0	0	GOODEN, TONI R LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107336	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	None	OXNARD	CA	93036	0617	00	06000	34.219566	-119.1539365	Ventura County
339049	Ordering, Referring, Prescribing	N/A	1588925507	0	0	GARZA, ERMELINDA G LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114812	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
339081	Ordering, Referring, Prescribing	N/A	1588971493	0	0	GUTIERREZ, LEAH A PSYD	6/2/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28476	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
339086	Ordering, Referring, Prescribing	N/A	1588976385	0	0	GREEN, SHULAMITE A PHD	3/9/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27502	N/A	N/A	N/A	N/A	N/A	1000 VETERAN AVE.	None	LOS ANGELES	CA	90024	2704	00	06000	34.0605595	-118.4499527	Los Angeles County
339112	Ordering, Referring, Prescribing	N/A	1598017139	0	0	GUADALUPE, BRENDA L LMFT	2/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109520	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
339114	Ordering, Referring, Prescribing	N/A	1598012791	0	0	GLAZER, DANIELLE M NP	8/29/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22158	N/A	N/A	N/A	N/A	N/A	46896 HIGHWAY 1	None	BIG SUR	CA	93920	9693	00	06000	36.26867238	-121.8064797	Monterey County
339121	Ordering, Referring, Prescribing	N/A	1598020844	0	0	GUPTA, SHUBHRA MD	5/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156150	N/A	N/A	N/A	N/A	N/A	533 PARNASSUS AVE	U101	SAN FRANCISCO	CA	94143	2208	00	06000	37.76304484	-122.4592904	San Francisco County
339169	Ordering, Referring, Prescribing	N/A	1598102154	0	0	GAUTHIER, SHARAH C LMFT	8/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109991	N/A	N/A	N/A	N/A	N/A	11716 ENTERPRISE DR	None	AUBURN	CA	95603	3732	00	06000	38.90720197	-121.0838099	Placer County
339186	Ordering, Referring, Prescribing	N/A	1598123143	0	0	GRAY, KIMBERLY LCSW	6/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79378	N/A	N/A	N/A	N/A	N/A	1611 BUNKER HILL WAY	SUITE 120	SALINAS	CA	93901	6006	00	06000	36.69971964	-121.6172769	Monterey County
339210	Ordering, Referring, Prescribing	N/A	1598148595	0	0	GARCIA, DANNY J MD	2/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184237	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
339227	Ordering, Referring, Prescribing	N/A	1598177412	0	0	GITLIN, REBECCA S PHD	11/9/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28752	N/A	N/A	N/A	N/A	N/A	5000 W SUNSET BLVD	600	LOS ANGELES	CA	90027	5861	00	06000	34.0981066	-118.2986382	Los Angeles County
339237	Ordering, Referring, Prescribing	N/A	1598194128	0	0	GALVAN, VICTORIA LMFT	10/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107675	N/A	N/A	N/A	N/A	N/A	251 E HACKETT RD	None	MODESTO	CA	95358	9800	00	06000	37.58764784	-120.9907809	Stanislaus County
339243	Ordering, Referring, Prescribing	N/A	1598198210	0	0	GONZALEZ, LILIANA LCSW	1/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92664	N/A	N/A	N/A	N/A	N/A	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
339262	Ordering, Referring, Prescribing	N/A	1598242141	0	0	GAMBOA, JAMIE PSYD	9/24/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32955	N/A	N/A	N/A	N/A	N/A	4605 LANKERSHIM BLVD	STE 545	NORTH HOLLYWOOD	CA	91602	1892	00	06000	34.15389329	-118.3679999	Los Angeles County
339282	Ordering, Referring, Prescribing	N/A	1598283665	0	0	GARCIA, YVETTE LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75544	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
339311	Ordering, Referring, Prescribing	N/A	1598323735	0	0	GROVES, DONNA LMFT	7/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111523	N/A	N/A	N/A	N/A	N/A	2001 S BARRINGTON AVE.	None	LOS ANGELES	CA	90025	5363	00	06000	34.03672191	-118.4500156	Los Angeles County
339319	Ordering, Referring, Prescribing	N/A	1598351967	0	0	GOETZ, RACHELLE E LMFT	2/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131312	N/A	N/A	N/A	N/A	N/A	225 W BROADWAY	155	GLENDALE	CA	91204	1331	00	06000	34.14673469	-118.257145	Los Angeles County
339320	Ordering, Referring, Prescribing	N/A	1598360794	0	0	GONZALEZ-CORREA, JOSE MD	7/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188139	N/A	N/A	N/A	N/A	N/A	14427 CHASE ST.	SUITE 100	PANORAMA CITY	CA	91402	3020	00	06000	34.22477664	-118.4478733	Los Angeles County
339331	Ordering, Referring, Prescribing	N/A	1598367831	0	0	GILL, KARANDEEP PT	12/5/2021	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	299396	N/A	N/A	N/A	N/A	N/A	2156 W GRANT LINE RD	None	TRACY	CA	95377	7336	00	06000	37.75400147	-121.4554725	San Joaquin County
339368	Ordering, Referring, Prescribing	N/A	1598500027	0	0	GAROFALO, ETHAN PA-C	8/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64968	N/A	N/A	N/A	N/A	N/A	706 PEACH ST	None	CORNING	CA	96021	3355	00	06000	39.928689	-122.174397	Tehama County
339371	Ordering, Referring, Prescribing	N/A	1598490906	0	0	GARCIA-PEREZ, NELLY A LCSW	1/20/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW128211	N/A	N/A	N/A	N/A	N/A	4441 E CESAR CHAVEZ BLVD	None	FRESNO	CA	93702	3604	00	06000	36.7358051	-119.7545078	Fresno County
339392	Ordering, Referring, Prescribing	N/A	1598769846	0	0	GUGGA, JARNAIL S MD	3/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A31418	N/A	N/A	N/A	N/A	N/A	1532 SAN BERNARDINO AVE	SUITE B7	POMONA	CA	91767	3559	00	06000	34.0758525	-117.7200855	Los Angeles County
339393	Ordering, Referring, Prescribing	N/A	1598763179	0	0	GASPER, JAMES J	7/21/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	56540	N/A	N/A	N/A	N/A	N/A	4327 GOLDEN CENTER DR	None	PLACERVILLE	CA	95667	6287	00	06000	38.70662835	-120.8276613	El Dorado County
339400	Ordering, Referring, Prescribing	N/A	1598781239	0	0	GOOD, KRISTIN B PSYD	8/7/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20854	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
339409	Ordering, Referring, Prescribing	N/A	1598808602	0	0	GUTIERREZ, GAIL LCSW	10/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24840	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
339432	Ordering, Referring, Prescribing	N/A	1598883860	0	0	GARCIA, JANET LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80700	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	SUITE 300	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
339459	Ordering, Referring, Prescribing	N/A	1598939258	0	0	GRACIA, CHRISTINA LCSW	5/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79288	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
339496	Ordering, Referring, Prescribing	N/A	1609023845	0	0	GARCIA, ROSEMARY	1/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A107622	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS ST	SUITE S	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
339518	Ordering, Referring, Prescribing	N/A	1609067610	0	0	GASPAR, SANDRA LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52795	N/A	N/A	N/A	N/A	N/A	3312 E 12TH STREET	259	OAKLAND	CA	94601	2940	00	06000	37.77626277	-122.2248748	Alameda County
339524	Ordering, Referring, Prescribing	N/A	1609089416	0	0	GODINEZ, MARIO DDS	4/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS48807	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
339537	Ordering, Referring, Prescribing	N/A	1609121631	0	0	GROSS, HEATHER M LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107940	N/A	N/A	N/A	N/A	N/A	99 S. HUMBOLDT ST	None	WILLITS	CA	95490	3509	00	06000	39.41147147	-123.3533082	Mendocino County
339546	Ordering, Referring, Prescribing	N/A	1609143239	0	0	GOULD, LINDA A PHARMD	9/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	42613	N/A	N/A	N/A	N/A	N/A	1055 FREMONT BLVD	None	SEASIDE	CA	93955	5712	00	06000	36.59960815	-121.8503464	Monterey County
339595	Ordering, Referring, Prescribing	N/A	1609206523	0	0	GUILLEN, STACIA	12/4/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0788745	N/A	N/A	N/A	N/A	N/A	3772 TIBBETTS ST	None	RIVERSIDE	CA	92506	2640	00	06000	33.94720849	-117.399204	Riverside County
339646	Ordering, Referring, Prescribing	N/A	1609298397	0	0	GROSS, HERBERT C LMFT	7/13/2017	Taxonomy not applicable	NA	n/a	000	Unknown	LMFT20076	N/A	N/A	N/A	N/A	N/A	5762 BOLSA AVE	None	HUNTINGTON BEACH	CA	92649	1172	00	06000	33.74435559	-118.0280994	Orange County
339655	Ordering, Referring, Prescribing	N/A	1609305770	0	0	GARZA DE LA GARZA, OZIEL MD	9/13/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165441	N/A	N/A	N/A	N/A	N/A	12586 AVENUE 408	None	OROSI	CA	93647	9454	00	06000	36.53030229	-119.2915122	Tulare County
339656	Ordering, Referring, Prescribing	N/A	1609305168	0	0	GIST, MICHAELA L NP	6/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	95014727	N/A	N/A	N/A	N/A	N/A	3701 J ST	201	SACRAMENTO	CA	95816	5562	00	06000	38.571237	-121.4566245	Sacramento County
339733	Ordering, Referring, Prescribing	N/A	1609434224	0	0	GARCIA, LISA C LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78432	N/A	N/A	N/A	N/A	N/A	1000 SUNSET BLVD	None	ROCKLIN	CA	95765	3791	00	06000	38.81665958	-121.2884287	Placer County
339737	Ordering, Referring, Prescribing	N/A	1609430008	0	0	GOLDEN, CHRISTINA A PA-C	12/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58980	N/A	N/A	N/A	N/A	N/A	1710 PRAIRIE CITY RD	STE 125	FOLSOM	CA	95661	2335	00	06000	38.652453	-121.1675715	Sacramento County
339746	Ordering, Referring, Prescribing	N/A	1609466606	0	0	GANJINEH, SABA PHARMD	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84060	N/A	N/A	N/A	N/A	N/A	931 LOMAS SANTA FE DR	None	SOLANA BEACH	CA	92075	1502	00	06000	32.99565254	-117.2544159	San Diego County
339751	Ordering, Referring, Prescribing	N/A	1609484229	0	0	GLASHEEN, MEGAN E PHARMD	9/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79986	N/A	N/A	N/A	N/A	N/A	44840 MONTEREY AVE	None	PALM DESERT	CA	92260	3225	00	06000	33.722667	-116.391222	Riverside County
339771	Ordering, Referring, Prescribing	N/A	1609523745	0	0	GISLER, HEATHER L LMFT	10/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129694	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	SUITE 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
339836	Ordering, Referring, Prescribing	N/A	1609932847	0	0	GADD, GUY V LMFT	10/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50711	N/A	N/A	N/A	N/A	N/A	18880 CHERRY VALLEY BLVD	None	TUOLUMNE	CA	95379	9506	00	06000	37.96511668	-120.2399015	Tuolumne County
339850	Ordering, Referring, Prescribing	N/A	1609960020	0	0	GOMEZ, GABRIEL G LMFT	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41688	N/A	N/A	N/A	N/A	N/A	1925 E DAKOTA AVE	None	FRESNO	CA	93726	4821	00	06000	36.78683208	-119.7876584	Fresno County
339859	Ordering, Referring, Prescribing	N/A	1609980580	0	0	GUERRERO, GABRIELA D NP	1/18/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15549	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
339881	Ordering, Referring, Prescribing	N/A	1619021433	0	0	GOLDBERG, MOSES D	3/27/2015	Taxonomy not applicable	NA	n/a	000	Unknown	85	N/A	N/A	N/A	N/A	N/A	175 CONCOURSE BLVD	None	SANTA ROSA	CA	95403	8217	00	06000	38.51157204	-122.7885509	Sonoma County
339888	Ordering, Referring, Prescribing	N/A	1619031556	0	0	GERTSIK, LEV MD	6/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A54951	N/A	N/A	N/A	N/A	N/A	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	00	06000	34.133598	-118.1534895	Los Angeles County
339904	Ordering, Referring, Prescribing	N/A	1619062122	0	0	GOLDSTEIN, DIANE B PHD	6/9/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16307	N/A	N/A	N/A	N/A	N/A	2045 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1088	00	06000	37.709892	-122.118966	Alameda County
339925	Ordering, Referring, Prescribing	N/A	1619109014	0	0	GETHERS, YAGUANG	6/7/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26916	N/A	N/A	N/A	N/A	N/A	3626 BALBOA STREET	None	SAN FRANCISCO	CA	94121	2604	00	06000	37.77571711	-122.4980286	San Francisco County
339964	Ordering, Referring, Prescribing	N/A	1619178704	0	0	GREENBERG, JAMES P LCSW	4/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21395	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH ST.	STE. 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
339973	Ordering, Referring, Prescribing	N/A	1619200219	0	0	GALLAUGHER, KELLY LCSW	11/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96751	N/A	N/A	N/A	N/A	N/A	3257 PROFESSIONAL DRIVE	C	AUBURN	CA	95602	2460	00	06000	38.943405	-121.1008195	Placer County
339986	Ordering, Referring, Prescribing	N/A	1619225737	0	0	GARCIA, ERIKA LCSW	12/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98902	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	SUITE D	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
339988	Ordering, Referring, Prescribing	N/A	1619229341	0	0	GALVAN, LILIANA LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93620	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
339995	Ordering, Referring, Prescribing	N/A	1619246154	0	0	GERMANOVICH, OLGA PHARMD	8/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55880	N/A	N/A	N/A	N/A	N/A	7787 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	1528	00	06000	38.706741	-121.2724305	Sacramento County
340052	Ordering, Referring, Prescribing	N/A	1619344348	0	0	GAMAD, MARICELLE L NP	3/4/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002958	N/A	N/A	N/A	N/A	N/A	2501 MCHENRY AVE	SUITE F	MODESTO	CA	95350	1102	00	06000	37.677753	-120.9941595	Stanislaus County
340063	Ordering, Referring, Prescribing	N/A	1619358272	0	0	GORJI, RYAN MD	1/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165855	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
340104	Ordering, Referring, Prescribing	N/A	1619415874	0	0	GRAYSON-THOMAS, ROSHANDA NP	8/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022140	N/A	N/A	N/A	N/A	N/A	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	00	06000	39.68781544	-123.4842982	Mendocino County
340108	Ordering, Referring, Prescribing	N/A	1619418381	0	0	GOZUM, AYLMER G NP	11/20/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006214	N/A	N/A	N/A	N/A	N/A	1039 W. FLORENCE AVE	None	LOS ANGELES	CA	90044	2441	00	06000	33.97463885	-118.2933327	Los Angeles County
340112	Ordering, Referring, Prescribing	N/A	1619424199	0	0	GOLDBERG, HANNAH L NP	2/3/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004415	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	300	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
340130	Ordering, Referring, Prescribing	N/A	1619451754	0	0	GARCIA, MICHELLE LMFT	10/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132236	N/A	N/A	N/A	N/A	N/A	5700 WILSHIRE BLVD.	560	LOS ANGELES	CA	90036	5418	00	06000	34.06238949	-118.3535325	Los Angeles County
340139	Ordering, Referring, Prescribing	N/A	1619468295	0	0	GWIN, CHRISTINE J LCSW	11/23/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	90561	N/A	N/A	N/A	N/A	N/A	10400 FRICOT CITY RD	None	SAN ANDREAS	CA	95249	9642	00	06000	38.17354088	-120.5345257	Calaveras County
340142	Ordering, Referring, Prescribing	N/A	1619482155	0	0	GUTIERREZ, LISA LCSW	9/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118274	N/A	N/A	N/A	N/A	N/A	155 N. OCCIDENTAL BLVD	None	LOS ANGELES	CA	90026	4601	00	06000	34.07178779	-118.2787879	Los Angeles County
340151	Ordering, Referring, Prescribing	N/A	1619498656	0	0	GONG, CELIA OD FAAO	9/22/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33697	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
340163	Ordering, Referring, Prescribing	N/A	1619510591	0	0	GREENFIELD, MIRANDA PA-C	9/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61594	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
340195	Ordering, Referring, Prescribing	N/A	1619584232	0	0	GRABOWSKI, FELICIA NP	9/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018462	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE STE 30	STE 300	SAN JOSE	CA	95128	2680	00	06000	37.3160785	-121.937121	Santa Clara County
340212	Ordering, Referring, Prescribing	N/A	1619640653	0	0	GUTIERREZ, LUZ C DDS	11/15/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106571	N/A	N/A	N/A	N/A	N/A	6336 FLORENCE AVE	None	BELL GARDENS	CA	90201	4732	00	06000	33.96537744	-118.1518201	Los Angeles County
340248	Ordering, Referring, Prescribing	N/A	1619986965	0	0	GROOMER, JASON	10/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8134	N/A	N/A	N/A	N/A	N/A	12626 RIVERSIDE DR	STE 301	VALLEY VILLAGE	CA	91607	3473	00	06000	34.15758449	-118.408131	Los Angeles County
340280	Ordering, Referring, Prescribing	N/A	1629109830	0	0	GUERRERO, IVANIA LMFT	11/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45911	N/A	N/A	N/A	N/A	N/A	5800 S EASTERN AVE	270	COMMERCE	CA	90040	4016	00	06000	33.98534547	-118.1620372	Los Angeles County
340282	Ordering, Referring, Prescribing	N/A	1629114202	0	0	GRASSKA, MERRY A NP	7/11/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	293967	N/A	N/A	N/A	N/A	N/A	2985 BEAR ST	None	COSTA MESA	CA	92626	4300	00	06000	33.67929841	-117.8938955	Orange County
340287	Ordering, Referring, Prescribing	N/A	1629126289	0	0	GOEI, RAYMOND H DO	1/30/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A6848	N/A	N/A	N/A	N/A	N/A	9960 BALDWIN PLACE	None	EL MONTE	CA	91731	2204	00	06000	34.07140294	-118.0516061	Los Angeles County
340299	Ordering, Referring, Prescribing	N/A	1629147285	0	0	GABLER, JERALYN M LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38534	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	600	THOUSAND OAKS	CA	91360	4402	00	06000	34.17854676	-118.8805015	Ventura County
340332	Ordering, Referring, Prescribing	N/A	1629232533	0	0	GARZA, DIONNA P LMFT	11/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80429	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
340345	Ordering, Referring, Prescribing	N/A	1629263512	0	0	GUIROY, DON C MD	6/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A63231	N/A	N/A	N/A	N/A	N/A	2280 DIAMOND BLVD	500	CONCORD	CA	94520	5719	00	06000	37.97715317	-122.0605709	Contra Costa County
340382	Ordering, Referring, Prescribing	N/A	1629339528	0	0	GREN, RACHEL M LMFT	7/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110765	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
340390	Ordering, Referring, Prescribing	N/A	1629346705	0	0	GILBERT, BRADLEY M LMFT	9/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95079	N/A	N/A	N/A	N/A	N/A	13405 FOLSOM BLVD	BLDG. 200, SUITE 220	FOLSOM	CA	95630	4737	00	06000	38.657493	-121.1840775	Sacramento County
340424	Ordering, Referring, Prescribing	N/A	1629392014	0	0	GROVE, ERIC W	5/23/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D58930	N/A	N/A	N/A	N/A	N/A	57019 YUCCA TRL	None	TWENTYNINE PALMS	CA	92277	2459	00	06000	34.21999181	-116.0443736	San Bernardino County
340428	Ordering, Referring, Prescribing	N/A	1629400536	0	0	GRACE, LEAH D LMFT	5/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112334	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
340459	Ordering, Referring, Prescribing	N/A	1629461744	0	0	GILBERT, LAURIE A NP	4/3/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	825935	N/A	N/A	N/A	N/A	N/A	12900 FREDERICK ST	STE C	MORENO VALLEY	CA	92553	5266	00	06000	33.932655	-117.261383	Riverside County
340484	Ordering, Referring, Prescribing	N/A	1629498639	0	0	GADDIS, AMANDA N LMFT	2/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137781	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
340485	Ordering, Referring, Prescribing	N/A	1629508460	0	0	GIANG, BEVERLY	6/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159986	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVE	SUITE 300	MORENO VALLEY	CA	92555	3901	00	06000	33.91013953	-117.193383	Riverside County
340549	Ordering, Referring, Prescribing	N/A	1629602768	0	0	GAJOWSKI, CARRIE LMFT	5/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129824	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
340556	Ordering, Referring, Prescribing	N/A	1629614292	0	0	GREWAL, NAMDEEP MD	10/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182872	N/A	N/A	N/A	N/A	N/A	7800 NILES ST	None	BAKERSFIELD	CA	93306	4922	00	06000	35.37628052	-118.9179	Kern County
340583	Ordering, Referring, Prescribing	N/A	1629648621	0	0	GARG, RUCHITA OT	10/14/2024	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	27033	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
340622	Ordering, Referring, Prescribing	N/A	1629748652	0	0	GUZMAN NOLASCO, BLANCA F PHARMD	9/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85167	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
340684	Ordering, Referring, Prescribing	N/A	1639260292	0	0	GILL, TIRATH S MD	4/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51319	N/A	N/A	N/A	N/A	N/A	1470 W HERNDON AVE	None	FRESNO	CA	93711	0552	00	06000	36.83746879	-119.8186401	Fresno County
340693	Ordering, Referring, Prescribing	N/A	1639283674	0	0	GUPTA, PARUL	12/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67050	N/A	N/A	N/A	N/A	N/A	858 N CHERRY ST	STE F	TULARE	CA	93274	2243	00	06000	36.22014749	-119.337642	Tulare County
340743	Ordering, Referring, Prescribing	N/A	1639410046	0	0	GOMEZ, STEPHANIE	5/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108286	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
340820	Ordering, Referring, Prescribing	N/A	1639520182	0	0	GARCIA, LESLIE LCSW	7/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102804	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE	100	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County
340823	Ordering, Referring, Prescribing	N/A	1639522006	0	0	GYIMAH, SILAS MD	10/20/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157731	N/A	N/A	N/A	N/A	N/A	66675 PIERSON BLVD	None	DESERT HOT SPRING	CA	92240	0000	00	06000	33.96138951	-116.498223	Riverside County
340825	Ordering, Referring, Prescribing	N/A	1639522113	0	0	GIANG, MATTHEW L	10/21/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100435	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
340829	Ordering, Referring, Prescribing	N/A	1639528706	0	0	GARCIA NAVA, FLOR Y LMFT	12/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123714	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
340865	Ordering, Referring, Prescribing	N/A	1639575707	0	0	GOMEZ, CHLOE A LCSW	12/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80803	N/A	N/A	N/A	N/A	N/A	522 S. SAN PEDRO ST.	None	LOS ANGELES	CA	90013	2101	00	06000	34.0436196	-118.2442541	Los Angeles County
340866	Ordering, Referring, Prescribing	N/A	1639580319	0	0	GONG, SHERYL PHARMD	3/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69164	N/A	N/A	N/A	N/A	N/A	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
340869	Ordering, Referring, Prescribing	N/A	1639584758	0	0	GOULD, JENNIFER L DO	10/12/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14504	N/A	N/A	N/A	N/A	N/A	1328 SOUTH MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
340872	Ordering, Referring, Prescribing	N/A	1639580525	0	0	GALAN, STEPHANIE M LMFT	7/9/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT133659	N/A	N/A	N/A	N/A	N/A	2621 OSWELL ST	119	BAKERSFIELD	CA	93306	3172	00	06000	35.393283	-118.9496505	Kern County
340873	Ordering, Referring, Prescribing	N/A	1639593205	0	0	GREWAL, MANDIP K PHD	1/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	29804	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
340933	Ordering, Referring, Prescribing	N/A	1639673858	0	0	GARCIA, REGINA NP	2/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95007731	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
340944	Ordering, Referring, Prescribing	N/A	1639693211	0	0	GIESE-GARDNER, BRYAN LMFT	4/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116141	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
340952	Ordering, Referring, Prescribing	N/A	1639709520	0	0	GANDHI, RAVI PHARMD	1/8/2020	Taxonomy not applicable	NA	n/a	000	Unknown	81815	N/A	N/A	N/A	N/A	N/A	12648 BENTLEY STREET	A	WATERFORD	CA	95386	0121	00	06000	37.64105958	-120.7606132	Stanislaus County
340955	Ordering, Referring, Prescribing	N/A	1639717481	0	0	GEVORKIAN, NARINE B PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53397	N/A	N/A	N/A	N/A	N/A	550 S GRAND AVE	None	GLENDORA	CA	91741	4211	00	06000	34.129584	-117.872534	Los Angeles County
340956	Ordering, Referring, Prescribing	N/A	1639718133	0	0	GALINDO, CHRISTOPHER NP	6/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95021450	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	401	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
340960	Ordering, Referring, Prescribing	N/A	1639730872	0	0	GOLDSTEIN, BARRY PSYD	4/3/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17020	N/A	N/A	N/A	N/A	N/A	741 S ALVARADO STREET	None	LOS ANGELES	CA	90057	4021	00	06000	34.05538113	-118.2775582	Los Angeles County
340961	Ordering, Referring, Prescribing	N/A	1639732845	0	0	GOLD, IAN MD	4/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195875	N/A	N/A	N/A	N/A	N/A	345 SAN PEDRO ST	None	LOS ANGELES	CA	90013	1633	00	06000	34.04602976	-118.2429461	Los Angeles County
340964	Ordering, Referring, Prescribing	N/A	1639742620	0	0	GALSTYAN, HENRIETA LMFT	4/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125564	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
340965	Ordering, Referring, Prescribing	N/A	1639736812	0	0	GOMEZ, MERCEDES L LMFT	8/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141070	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
341026	Ordering, Referring, Prescribing	N/A	1639957996	0	0	GARCIA NEGRETE, VANESSA NP	7/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026092	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
341063	Ordering, Referring, Prescribing	N/A	1649303215	0	0	GORDON, JANE LMFT	7/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	27199	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
341106	Ordering, Referring, Prescribing	N/A	1649381641	0	0	GOLDSTONE, ALAN M OD	10/7/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT12297	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
341126	Ordering, Referring, Prescribing	N/A	1649437930	0	0	GRAVES, AMY LMFT	7/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100024	N/A	N/A	N/A	N/A	N/A	25910 ACERO	SUITE160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
341143	Ordering, Referring, Prescribing	N/A	1649472176	0	0	GHASRI, PONEH DDS	4/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	CA50058	N/A	N/A	N/A	N/A	N/A	16055 VENTURA BLVD.	SUITE 1035	ENCINO	CA	91436	2629	00	06000	34.15632563	-118.4832351	Los Angeles County
341151	Ordering, Referring, Prescribing	N/A	1649490319	0	0	GLEASON, HELEN LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36104	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	500	THOUSAND OAKS	CA	91360	4402	00	06000	34.17854676	-118.8805015	Ventura County
341172	Ordering, Referring, Prescribing	N/A	1649537671	0	0	GEIGER, ANNA-MARCELLE	4/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60687	N/A	N/A	N/A	N/A	N/A	79795 HIGHWAY 111	None	LA QUINTA	CA	92253	4756	00	06000	33.704217	-116.2730745	Riverside County
341175	Ordering, Referring, Prescribing	N/A	1649537762	0	0	GUERRERO, EDWARD V PHARMD	4/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	42605	N/A	N/A	N/A	N/A	N/A	1099 E. HOSPITALITY	None	SAN BERNARDINO	CA	92408	2813	00	06000	34.06887134	-117.2625206	San Bernardino County
341194	Ordering, Referring, Prescribing	N/A	1649568627	0	0	GONZALEZ, DIANA LCSW	1/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	73846	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
341233	Ordering, Referring, Prescribing	N/A	1649628512	0	0	GOODWIN, KELSEY Q DO	9/21/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15873	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
341260	Ordering, Referring, Prescribing	N/A	1649653072	0	0	GARCIA, CHRISTIANE N MSW LCSW	4/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107620	N/A	N/A	N/A	N/A	N/A	566 S. BRAND BLVD.	None	SAN FERNANDO	CA	91340	4002	00	06000	34.27861303	-118.4437412	Los Angeles County
341290	Ordering, Referring, Prescribing	N/A	1649705682	0	0	GUILLAUME, GINA MD	3/31/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158488	N/A	N/A	N/A	N/A	N/A	1403 W LOMITA BLVD	103	HARBOR CITY	CA	90710	2084	00	06000	33.79785936	-118.3016552	Los Angeles County
341311	Ordering, Referring, Prescribing	N/A	1649718750	0	0	GARRETT, KEITH L NP	2/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006156	N/A	N/A	N/A	N/A	N/A	1001 S STATE ST	None	HEMET	CA	92543	7186	00	06000	33.731505	-116.971599	Riverside County
341316	Ordering, Referring, Prescribing	N/A	1649768060	0	0	GONZALEZ, ALEXANDER W LMFT	6/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126483	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
341348	Ordering, Referring, Prescribing	N/A	1649822214	0	0	GUZMAN, ELIDA M LMFT	2/13/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT145002	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
341350	Ordering, Referring, Prescribing	N/A	1649826694	0	0	GONZALEZ, STEPHANIE G LMFT	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104836	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
341359	Ordering, Referring, Prescribing	N/A	1649835471	0	0	GAINES-GLYNN, STARR S NP	12/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004595	N/A	N/A	N/A	N/A	N/A	6107 N 1ST ST	None	FRESNO	CA	93710	5460	00	06000	36.8252391	-119.7723926	Fresno County
341397	Ordering, Referring, Prescribing	N/A	1649928219	0	0	GRANT, LAURA D NP	12/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019373	N/A	N/A	N/A	N/A	N/A	4011 N MARKS AVE	None	FRESNO	CA	93722	4555	00	06000	36.794691	-119.8443365	Fresno County
341420	Ordering, Referring, Prescribing	N/A	1649986357	0	0	GATES, LA QUISHA CNP	7/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95026120	N/A	N/A	N/A	N/A	N/A	403 S LONG BEACH BLVD.	SUITE B	COMPTON	CA	90221	3491	00	06000	33.89318091	-118.2078742	Los Angeles County
341428	Ordering, Referring, Prescribing	N/A	1659004133	0	0	GUSTAFSON, MELISSA NP	10/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95027646	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD GRAS	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
341435	Ordering, Referring, Prescribing	N/A	1659041416	0	0	GOLDAMMER, EMILY CRNA	12/22/2023	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	95002257	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
341457	Ordering, Referring, Prescribing	N/A	1659131167	0	0	GILLETTE, CHARISA MD	8/20/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL15679	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
341458	Ordering, Referring, Prescribing	N/A	1659148104	0	0	GARCIA, CATALINA NP	10/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95027525	N/A	N/A	N/A	N/A	N/A	855 E MADISON AVE	None	EL CAJON	CA	92020	3819	00	06000	32.80046744	-116.9522315	San Diego County
341528	Ordering, Referring, Prescribing	N/A	1659497204	0	0	GARDUNO, MARISOL LCSW	12/7/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64748	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	400	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
341582	Ordering, Referring, Prescribing	N/A	1659613156	0	0	GREENE, AMY R NP	9/10/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	124014	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
341735	Ordering, Referring, Prescribing	N/A	1659833473	0	0	GIPSON, CHELSEA S DO	9/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21976	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
341736	Ordering, Referring, Prescribing	N/A	1659835296	0	0	GASTELUM-HERNANDEZ, REBECCA C LCSW	2/10/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106646	N/A	N/A	N/A	N/A	N/A	200 W SANTA ANA BLVD	None	SANTA ANA	CA	92701	4134	00	06000	33.74970951	-117.8691975	Orange County
341739	Ordering, Referring, Prescribing	N/A	1659837912	0	0	GRONLEY, ERIC W LMFT	12/17/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT136041	N/A	N/A	N/A	N/A	N/A	991 10TH ST	None	ARCATA	CA	95521	6114	00	06000	40.87025254	-124.0884044	Humboldt County
341750	Ordering, Referring, Prescribing	N/A	1659856912	0	0	GILES, TIA LMFT	11/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142878	N/A	N/A	N/A	N/A	N/A	7300 LINCOLNSHIRE DR	None	SACRAMENTO	CA	95823	2002	00	06000	38.497347	-121.4577	Sacramento County
341776	Ordering, Referring, Prescribing	N/A	1659911519	0	0	GOLAHI, STEPHANIE PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80693	N/A	N/A	N/A	N/A	N/A	1011 SNEATH LN	None	SAN BRUNO	CA	94066	2311	00	06000	37.63437084	-122.4264474	San Mateo County
341804	Ordering, Referring, Prescribing	N/A	1659974947	0	0	GRIFFIN, ERICA L OT	12/17/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	21864	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	UNIT A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
341851	Ordering, Referring, Prescribing	N/A	1669066148	0	0	GABAIE, ISRAEL MEIR NP	6/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017108	N/A	N/A	N/A	N/A	N/A	10300 COMPTON	None	LOS ANGELES	CA	90002	0000	00	06000	33.94274917	-118.2461916	Los Angeles County
341859	Ordering, Referring, Prescribing	N/A	1669137402	0	0	GO, ADRIEL J NP	8/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022431	N/A	N/A	N/A	N/A	N/A	809 SYLVAN AVENUE	500A	MODESTO	CA	95350	1500	00	06000	37.68900616	-120.9836976	Stanislaus County
341872	Ordering, Referring, Prescribing	N/A	1669164190	0	0	GUTHRIE, MARIE E NP	5/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025281	N/A	N/A	N/A	N/A	N/A	30 EASTER AVE.	None	WEAVERVILLE	CA	96093	1229	00	06000	40.73769388	-122.9396312	Trinity County
341924	Ordering, Referring, Prescribing	N/A	1669519310	0	0	GOOD, JACQUELINE C LMFT	1/6/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43442	N/A	N/A	N/A	N/A	N/A	825 COLLEGE AVENUE	SUITE 1	SANTA ROSA	CA	95404	4108	00	06000	38.445705	-122.712534	Sonoma County
341932	Ordering, Referring, Prescribing	N/A	1669536421	0	0	GILL, SWARANJIT S NP	4/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15071	N/A	N/A	N/A	N/A	N/A	209 E 7TH STREET	None	MADERA	CA	93638	1288	00	06000	36.96069768	-120.0559841	Madera County
341947	Ordering, Referring, Prescribing	N/A	1669580114	0	0	GRIFFIN, PAUL A MD	4/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A51583	N/A	N/A	N/A	N/A	N/A	216 E FRESNO ST	None	AVENAL	CA	93204	1525	00	06000	36.00349612	-120.1355935	Kings County
341998	Ordering, Referring, Prescribing	N/A	1669721890	0	0	GONZALEZ, JESSICA Y CCC-SLP	4/19/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	21094	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
342015	Ordering, Referring, Prescribing	N/A	1669744272	0	0	GARCIA, JANICE R LCSW	2/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93731	N/A	N/A	N/A	N/A	N/A	3244 E GREEN ST	None	PASADENA	CA	91107	3836	00	06000	34.14516727	-118.0834352	Los Angeles County
342039	Ordering, Referring, Prescribing	N/A	1669799979	0	0	GILMAN-SHORT, SARAH J MD	7/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C173938	N/A	N/A	N/A	N/A	N/A	101 OLD MCCLOUD RD	None	MOUNT SHASTA	CA	96067	2796	00	06000	41.30516006	-122.3104613	Siskiyou County
342051	Ordering, Referring, Prescribing	N/A	1669812350	0	0	GARFIAS MARCUS, JANETTE LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94243	N/A	N/A	N/A	N/A	N/A	2629 CLARENDON AVE 2ND F	None	HUNTINGTON PARK	CA	90255	4119	00	06000	33.98356476	-118.2241387	Los Angeles County
342113	Ordering, Referring, Prescribing	N/A	1669933115	0	0	GUADARRAMA KOBAYASHI, SAORI LCSW	8/1/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75352	N/A	N/A	N/A	N/A	N/A	41840 ENTERPRISE CIR N	None	TEMECULA	CA	92590	5654	00	06000	33.51730799	-117.1697125	Riverside County
342119	Ordering, Referring, Prescribing	N/A	1669940789	0	0	GARCIA, LEONEL PHARMD	10/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	79633	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
342122	Ordering, Referring, Prescribing	N/A	1669944948	0	0	GUY, LESLIE LMFT	11/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108238	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
342137	Ordering, Referring, Prescribing	N/A	1669982609	0	0	GIGLIO, LINDA NP	4/15/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007598	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
342156	Ordering, Referring, Prescribing	N/A	1679005854	0	0	GIANCATERINO, SHAUN MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159239	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
342180	Ordering, Referring, Prescribing	N/A	1679045330	0	0	GRESS, NICOLE L CNM	8/20/2019	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	NMW236055	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
342181	Ordering, Referring, Prescribing	N/A	1679044523	0	0	GOITIA, ARIEL J MD	4/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178197	N/A	N/A	N/A	N/A	N/A	229 MAIN ST	None	BRAWLEY	CA	92227	2305	00	06000	32.97865447	-115.5387915	Imperial County
342199	Ordering, Referring, Prescribing	N/A	1679068977	0	0	GARCIA, BRIANNA G LCSW	8/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109601	N/A	N/A	N/A	N/A	N/A	1126 N GRAND AVE	None	COVINA	CA	91724	1551	00	06000	34.100082	-117.8724825	Los Angeles County
342203	Ordering, Referring, Prescribing	N/A	1679071971	0	0	GREEN, MERCEDES LMFT	1/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123958	N/A	N/A	N/A	N/A	N/A	11951 HESPERIA RD	None	HESPERIA	CA	92345	1855	00	06000	34.46842866	-117.2924286	San Bernardino County
342220	Ordering, Referring, Prescribing	N/A	1679091680	0	0	GASTON, DANIELLE LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119328	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	SUITE 107	LAKE ELSINORE	CA	92530	4400	00	06000	33.66201142	-117.3001906	Riverside County
342222	Ordering, Referring, Prescribing	N/A	1679095582	0	0	GO, HANA LMFT	6/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126395	N/A	N/A	N/A	N/A	N/A	3756 SANTA ROSALIA DR	None	LOS ANGELES	CA	90008	3606	00	06000	34.00888336	-118.3389334	Los Angeles County
342225	Ordering, Referring, Prescribing	N/A	1679098776	0	0	GOMEZ-BOULWARE, SALENA	4/16/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139138	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
342238	Ordering, Referring, Prescribing	N/A	1679128094	0	0	GILL RAI, JASJIT NP	7/5/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012124	N/A	N/A	N/A	N/A	N/A	9235 E BROADWAY ST	None	PLANADA	CA	95365	8088	00	06000	37.29049953	-120.3207705	Merced County
342253	Ordering, Referring, Prescribing	N/A	1679150957	0	0	GUERRERO PEREZ, ROBERTO P MD	5/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196098	N/A	N/A	N/A	N/A	N/A	8426 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3436	00	06000	34.22405394	-118.3655745	Los Angeles County
342282	Ordering, Referring, Prescribing	N/A	1679239156	0	0	GAUL, KIMBERLY LCSW	2/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100281	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
342301	Ordering, Referring, Prescribing	N/A	1679350896	0	0	GONZALEZ, ELIDA PA	11/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63747	N/A	N/A	N/A	N/A	N/A	430 S BLOSSER RD	None	SANTA MARIA	CA	93458	4908	00	06000	34.94869196	-120.4537258	Santa Barbara County
342303	Ordering, Referring, Prescribing	N/A	1679383384	0	0	GONGORA, LUISA F DDS	12/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	111127	N/A	N/A	N/A	N/A	N/A	820 W BROADWAY ST	None	NEEDLES	CA	92363	2729	00	06000	34.83897407	-114.6052958	San Bernardino County
342319	Ordering, Referring, Prescribing	N/A	1679604417	0	0	GALDAMEZ, LUIS MD	8/23/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A48644	N/A	N/A	N/A	N/A	N/A	6831 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4805	00	06000	33.97706276	-118.2225577	Los Angeles County
342325	Ordering, Referring, Prescribing	N/A	1679610174	0	0	GIUSTINO, MARJORY J LMFT	8/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44232	N/A	N/A	N/A	N/A	N/A	2551 SAN RAMON VALLEY BL	None	SAN RAMON	CA	94583	1614	00	06000	37.77143928	-121.9737192	Contra Costa County
342329	Ordering, Referring, Prescribing	N/A	1679613012	0	0	GRIFFITHS, PATRICK D LMFT	4/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46445	N/A	N/A	N/A	N/A	N/A	42007 FOX FARM RD	SUITE 2A	BIG BEAR LAKE	CA	92315	2192	00	06000	34.24849629	-116.8859456	San Bernardino County
342370	Ordering, Referring, Prescribing	N/A	1679711790	0	0	GONZALES, ALICIA LCSW	2/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	105748	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA STREET	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
342407	Ordering, Referring, Prescribing	N/A	1679762512	0	0	GUERRERO, JESSICA LCSW	12/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99035	N/A	N/A	N/A	N/A	N/A	5110 W GOLDLEAF CIR	None	LOS ANGELES	CA	90056	1282	00	06000	33.98790164	-118.367233	Los Angeles County
342427	Ordering, Referring, Prescribing	N/A	1679816888	0	0	GARCIA-RODRIGUEZ, LUCI M LMFT	2/10/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124286	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
342446	Ordering, Referring, Prescribing	N/A	1679858450	0	0	GONZALES, LOIDA G	8/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56787	N/A	N/A	N/A	N/A	N/A	4495 MACK RD	None	SACRAMENTO	CA	95823	4545	00	06000	38.474874	-121.451292	Sacramento County
342470	Ordering, Referring, Prescribing	N/A	1679916019	0	0	GOUSSE, FERISHTA N MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149004	N/A	N/A	N/A	N/A	N/A	1945 N FINE, SUITE 100	None	FRESNO	CA	93727	1528	00	06000	36.76832721	-119.7290143	Fresno County
342479	Ordering, Referring, Prescribing	N/A	1679932933	0	0	GUERRA, KARINA J LCSW	10/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97860	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
342501	Ordering, Referring, Prescribing	N/A	1679961106	0	0	GARCIA, JULIO C LMFT	6/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108163	N/A	N/A	N/A	N/A	N/A	1212 NORTH CALIFORNIA ST	None	STOCKTON	CA	95202	1111	00	06000	37.96681769	-121.2881382	San Joaquin County
342511	Ordering, Referring, Prescribing	N/A	1679974950	0	0	GUAN, KAREN PHD	6/28/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31394	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
342524	Ordering, Referring, Prescribing	N/A	1679998629	0	0	GEARY, SEAN M LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101198	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
342536	Ordering, Referring, Prescribing	N/A	1689009649	0	0	GONZALES, ORNELLA PSYD	2/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27652	N/A	N/A	N/A	N/A	N/A	1933 S BROADWAY	6TH FLOOR	LOS ANGELES	CA	90007	4501	00	06000	34.03102377	-118.2660738	Los Angeles County
342546	Ordering, Referring, Prescribing	N/A	1689027252	0	0	GRACE, JACKLINE MD	3/7/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159411	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	SUITE # A	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
342551	Ordering, Referring, Prescribing	N/A	1689043903	0	0	GAN, KEVIN K PHARMD	3/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73375	N/A	N/A	N/A	N/A	N/A	13507 CARNABY ST	None	CERRITOS	CA	90703	8905	00	06000	33.86717149	-118.043937	Los Angeles County
342573	Ordering, Referring, Prescribing	N/A	1689075764	0	0	GONZALEZ, GABRIEL A	9/7/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D45864	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
342578	Ordering, Referring, Prescribing	N/A	1689087017	0	0	GONZALEZ, MARICELA LCSW	8/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96564	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
342600	Ordering, Referring, Prescribing	N/A	1689132011	0	0	GARCIA, RACHAEL S LAC	3/9/2019	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC18039	N/A	N/A	N/A	N/A	N/A	604 ROSE AVE	None	VENICE	CA	90291	2767	00	06000	33.99891527	-118.4714129	Los Angeles County
342661	Ordering, Referring, Prescribing	N/A	1689209538	0	0	GRIGORYAN, LORANNA PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79552	N/A	N/A	N/A	N/A	N/A	9750 WOODMAN AVE	None	ARLETA	CA	91331	6422	00	06000	34.24797121	-118.448713	Los Angeles County
342713	Ordering, Referring, Prescribing	N/A	1689338196	0	0	GRAZIANI, SARAH E	10/29/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019009	N/A	N/A	N/A	N/A	N/A	1520 NUTMEG PLACE	None	COSTA MESA	CA	92626	2502	00	06000	33.68196448	-117.920322	Orange County
342723	Ordering, Referring, Prescribing	N/A	1689362519	0	0	GLYNN, NANCY NP	6/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95024898	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
342737	Ordering, Referring, Prescribing	N/A	1689426140	0	0	GHANI, SAODAT NP	4/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95029661	N/A	N/A	N/A	N/A	N/A	27800 MEDICAL CENTER RD	110	MISSION VIEJO	CA	92691	6410	00	06000	33.55952733	-117.6645199	Orange County
342780	Ordering, Referring, Prescribing	N/A	1689746976	0	0	GRIFFIN, ANNE M LMFT	5/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47243	N/A	N/A	N/A	N/A	N/A	1086 E. GRANDE AVE	None	ARROYO GRANDE	CA	93420	2505	00	06000	35.11933967	-120.5958538	San Luis Obispo County
342806	Ordering, Referring, Prescribing	N/A	1689802472	0	0	GIBBON, AMANDA E LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51387	N/A	N/A	N/A	N/A	N/A	30 PROFESSIONAL CENTER P	None	SAN RAFAEL	CA	94903	2757	00	06000	38.00989519	-122.5391142	Marin County
342841	Ordering, Referring, Prescribing	N/A	1689893497	0	0	GORDON, GAIL S LMFT	8/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48622	N/A	N/A	N/A	N/A	N/A	1532 SOLANO AVE.	None	ALBANY	CA	94707	2120	00	06000	37.89096546	-122.2860103	Alameda County
342842	Ordering, Referring, Prescribing	N/A	1689890303	0	0	GRANDI-NIKANDER, DONNA M CNP	8/20/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	7047	N/A	N/A	N/A	N/A	N/A	2695 S 4TH ST	SUITE B	EL CENTRO	CA	92243	6012	00	06000	32.76973509	-115.5520629	Imperial County
342844	Ordering, Referring, Prescribing	N/A	1689906711	0	0	GASTELLUM, MELISSA K	1/5/2015	Taxonomy not applicable	NA	n/a	000	Unknown	384	N/A	N/A	N/A	N/A	N/A	740 N LAKE AVE	None	PASADENA	CA	91104	4557	00	06000	34.158762	-118.132432	Los Angeles County
342857	Ordering, Referring, Prescribing	N/A	1689924201	0	0	GRACE, STACY L PSYD	1/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27996	N/A	N/A	N/A	N/A	N/A	4060 WATSON PLAZA DR	3-070	LAKEWOOD	CA	90712	4033	00	06000	33.831945	-118.1550105	Los Angeles County
342873	Ordering, Referring, Prescribing	N/A	1689953804	0	0	GRAMMY, KATE A PSYD	12/18/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26497	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	MS 10-300	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
342891	Ordering, Referring, Prescribing	N/A	1689974172	0	0	GU, CHENQING PHARMD	3/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	62209	N/A	N/A	N/A	N/A	N/A	2355 E COLORADO BLVD	None	PASADENA	CA	91107	3644	00	06000	34.14762	-118.102077	Los Angeles County
342896	Ordering, Referring, Prescribing	N/A	1689980476	0	0	GARCIA, CHRISTINE M	5/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81089	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
342923	Ordering, Referring, Prescribing	N/A	1699048017	0	0	GERDAU, JENNIFER PT	4/1/2020	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	38723	N/A	N/A	N/A	N/A	N/A	1311 SANGUINETTI ROAD	C	SONORA	CA	95370	6210	00	06000	37.97447385	-120.3613052	Tuolumne County
342926	Ordering, Referring, Prescribing	N/A	1699054510	0	0	GENNETTE, DAISY LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83409	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	SUITE 300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
342932	Ordering, Referring, Prescribing	N/A	1699058859	0	0	GEIGER, JEFFREY D PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	32591	N/A	N/A	N/A	N/A	N/A	3507 CANNON RD	None	OCEANSIDE	CA	92056	4977	00	06000	33.17113905	-117.2546316	San Diego County
342952	Ordering, Referring, Prescribing	N/A	1699083816	0	0	GARCIA, BRENDA A LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97322	N/A	N/A	N/A	N/A	N/A	210 E ENOS DR	SUITE A	SANTA MARIA	CA	93454	7215	00	06000	34.9340215	-120.4343968	Santa Barbara County
342958	Ordering, Referring, Prescribing	N/A	1699088716	0	0	GARCIA RUACHO, CRYSTAL Y LCSW	3/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW72552	N/A	N/A	N/A	N/A	N/A	3924 RIVERVIEW DR	None	JURUPA VALLEY	CA	92509	6611	00	06000	33.99857971	-117.4142203	Riverside County
342971	Ordering, Referring, Prescribing	N/A	1699109207	0	0	GOWAN, ELIZABETH C LMFT	10/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT32342	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD, SUIT	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
342972	Ordering, Referring, Prescribing	N/A	1699110635	0	0	GHANBARI, YASSI MD	11/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C175403	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8506	00	06000	33.91695337	-117.2672536	Riverside County
343023	Ordering, Referring, Prescribing	N/A	1699206896	0	0	GRAIES, NANCY PSYD	12/26/2024	Taxonomy not applicable	NA	n/a	000	Unknown	35591	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
343042	Ordering, Referring, Prescribing	N/A	1699247973	0	0	GARROVILLO, EVA C NP	12/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010733	N/A	N/A	N/A	N/A	N/A	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	00	06000	35.37461686	-119.020062	Kern County
343065	Ordering, Referring, Prescribing	N/A	1699288167	0	0	GUMERA, CATHERINE M NP	4/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017223	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
343069	Ordering, Referring, Prescribing	N/A	1699293027	0	0	GUMATAOTAO, CLAUDIA LCSW	9/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103835	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN STE 200	STE 200	CONCORD	CA	94520	4886	00	06000	37.98393807	-122.0466953	Contra Costa County
343088	Ordering, Referring, Prescribing	N/A	1699326629	0	0	GIANG, SUSAN PHARMD	7/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	77497	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE	None	SAN JOSE	CA	95128	0000	00	06000	37.313433	-121.9318385	Santa Clara County
343112	Ordering, Referring, Prescribing	N/A	1699386730	0	0	GRIGORE, EMILIAN PA	10/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58375	N/A	N/A	N/A	N/A	N/A	209 C ST	None	LEMOORE	CA	93245	2930	00	06000	36.30089987	-119.7833254	Kings County
343121	Ordering, Referring, Prescribing	N/A	1699394676	0	0	GUTENSOHN, SHELLY A LMFT	6/20/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115296	N/A	N/A	N/A	N/A	N/A	10400 FRICOT CITY RD	None	SAN ANDREAS	CA	95249	9642	00	06000	38.17354088	-120.5345257	Calaveras County
343145	Ordering, Referring, Prescribing	N/A	1699446492	0	0	GASTELLE, MARISSA L PHD	7/25/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34270	N/A	N/A	N/A	N/A	N/A	2325 CRENSHAW BLVD	None	TORRANCE	CA	90501	3325	00	06000	33.82457516	-118.3285598	Los Angeles County
343167	Ordering, Referring, Prescribing	N/A	1699597757	0	0	GIOVANINI, JENINE M NP	11/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012634	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD.	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
343177	Ordering, Referring, Prescribing	N/A	1699728410	0	0	GHODSIAN, SHAHRIAR Y MD	9/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A72696	N/A	N/A	N/A	N/A	N/A	375 ROLLING OAKS DRIVE	140	THOUSAND OAKS	CA	91361	0000	00	06000	34.17433197	-118.8706258	Ventura County
343199	Ordering, Referring, Prescribing	N/A	1699808188	0	0	GUINANE, JANEL M LCSW	5/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70118	N/A	N/A	N/A	N/A	N/A	600 A STREET	None	DAVIS	CA	95616	3648	00	06000	38.5479381	-121.7477157	Yolo County
343213	Ordering, Referring, Prescribing	N/A	1699831255	0	0	GIRGIS, JACKIE N LCSW	2/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24895	N/A	N/A	N/A	N/A	N/A	23461 S POINTE DR	220	LAGUNA HILLS	CA	92653	1547	00	06000	33.62535142	-117.7206568	Orange County
343252	Ordering, Referring, Prescribing	N/A	1699916056	0	0	GUTIERREZ, PAULINA LCSW	7/3/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW116244	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
343256	Ordering, Referring, Prescribing	N/A	1699925750	0	0	GONZALEZ, ERICA E LMFT	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84747	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
343270	Ordering, Referring, Prescribing	N/A	1699954966	0	0	GAVIN, SARA R LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48348	N/A	N/A	N/A	N/A	N/A	215 W. BEAMER STREET	None	WOODLAND	CA	95695	0000	00	06000	38.68483629	-121.7937301	Yolo County
343280	Ordering, Referring, Prescribing	N/A	1699979062	0	0	GERALDE, CECILIA DO	3/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	7706	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
343283	Ordering, Referring, Prescribing	N/A	1700012481	0	0	GUTIERREZ, JOSE D LCSW	3/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94940	N/A	N/A	N/A	N/A	N/A	3281 E GUASTI RD	SUITE 450	ONTARIO	CA	91761	7622	00	06000	34.065063	-117.5799015	San Bernardino County
343336	Ordering, Referring, Prescribing	N/A	1700117405	0	0	GAGNEJA, ARVINDER P MD	2/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C155107	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
343344	Ordering, Referring, Prescribing	N/A	1700137056	0	0	GONZALVES, LAUREN C LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93608	N/A	N/A	N/A	N/A	N/A	747 52ND STREET	None	OAKLAND	CA	94609	0121	00	06000	37.83734639	-122.2672128	Alameda County
343348	Ordering, Referring, Prescribing	N/A	1700136967	0	0	GUZELYAN, KLEONIKI F PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH 67870	N/A	N/A	N/A	N/A	N/A	311 W.LOS FELIZ BLVD	None	GLENDALE	CA	91204	2513	00	06000	34.12866049	-118.2585153	Los Angeles County
343372	Ordering, Referring, Prescribing	N/A	1700170404	0	0	GREER, DAVID PSYD	11/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80076	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
343376	Ordering, Referring, Prescribing	N/A	1700176005	0	0	GORDON, CHRISTOPHER J PHARMD	12/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	36847	N/A	N/A	N/A	N/A	N/A	1020 JOHNSON BLVD	None	SOUTH LAKE TAHOE	CA	96150	8214	00	06000	38.94495373	-119.9665232	El Dorado County
343379	Ordering, Referring, Prescribing	N/A	1700180742	0	0	GONZALEZ ORTIZ, GABRIELA LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108722	N/A	N/A	N/A	N/A	N/A	1885 LUNDY AVE	STE 223	SAN JOSE	CA	95131	1887	00	06000	37.39329538	-121.8907367	Santa Clara County
343385	Ordering, Referring, Prescribing	N/A	1700184124	0	0	GUSTAFSON, JYOTI LMFT	9/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122101	N/A	N/A	N/A	N/A	N/A	615 W CIVIC CENTER DR	200	SANTA ANA	CA	92701	4006	00	06000	33.75157048	-117.8744355	Orange County
343392	Ordering, Referring, Prescribing	N/A	1700195260	0	0	GARMUR, KELLY J NP	2/5/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN774781	N/A	N/A	N/A	N/A	N/A	1866 B STREET	None	HAYWARD	CA	94541	3139	00	06000	37.68271803	-122.0657206	Alameda County
343408	Ordering, Referring, Prescribing	N/A	1700212925	0	0	GARCIA, PRISCILA	2/28/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107121	N/A	N/A	N/A	N/A	N/A	11741 E. TELEGRAPH RD.	None	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
343410	Ordering, Referring, Prescribing	N/A	1700214038	0	0	GOUGEON, NATALIE LCSW	3/26/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81205	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	None	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
343419	Ordering, Referring, Prescribing	N/A	1700236122	0	0	GILBERT, CHERYLL B LCSW	1/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88683	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
343427	Ordering, Referring, Prescribing	N/A	1700247012	0	0	GAINES, BROOKE A LMFT	9/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134992	N/A	N/A	N/A	N/A	N/A	3545 LONG BEACH BLVD	None	LONG BEACH	CA	90807	3941	00	06000	33.82086796	-118.18938	Los Angeles County
343429	Ordering, Referring, Prescribing	N/A	1700251857	0	0	GARCIA, GABRIELA	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112005	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
343434	Ordering, Referring, Prescribing	N/A	1700261286	0	0	GERMANOZASHVILI, TEONA LMFT	12/22/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105390	N/A	N/A	N/A	N/A	N/A	45111 FERN AVE	None	LANCASTER	CA	93534	0000	00	06000	34.70150394	-118.1452081	Los Angeles County
343466	Ordering, Referring, Prescribing	N/A	1700316601	0	0	GUILFOYLE, CARRIE A NP	10/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95144690	N/A	N/A	N/A	N/A	N/A	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0000	00	06000	39.68781544	-123.4842982	Mendocino County
343468	Ordering, Referring, Prescribing	N/A	1700310174	0	0	GUTIERREZ, MELISSA	4/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146574	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
343495	Ordering, Referring, Prescribing	N/A	1700354263	0	0	GUERRERO, ALEJANDRA LCSW	10/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104670	N/A	N/A	N/A	N/A	N/A	1300 17TH ST	None	BAKERSFIELD	CA	93301	4504	00	06000	35.37476047	-119.016774	Kern County
343508	Ordering, Referring, Prescribing	N/A	1700370889	0	0	GERHARDT, THOMAS E MD	10/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A175232	N/A	N/A	N/A	N/A	N/A	138 S ORCHARD AVE	None	VACAVILLE	CA	95688	3636	00	06000	38.35771239	-122.0046879	Solano County
343530	Ordering, Referring, Prescribing	N/A	1700396553	0	0	GONZALEZ, ESDRAS LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102419	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
343536	Ordering, Referring, Prescribing	N/A	1700409836	0	0	GUTIERREZ, JENNIFER PA	1/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62180	N/A	N/A	N/A	N/A	N/A	3772 TIBBETTS ST	None	RIVERSIDE	CA	92506	2605	00	06000	33.94720849	-117.399204	Riverside County
343562	Ordering, Referring, Prescribing	N/A	1700449600	0	0	GONZALEZ, JESICA K	1/27/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	104560	N/A	N/A	N/A	N/A	N/A	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	00	06000	35.20895551	-118.839294	Kern County
343563	Ordering, Referring, Prescribing	N/A	1700452356	0	0	GILL, NISHA PA-C	9/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA59601	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
343621	Ordering, Referring, Prescribing	N/A	1700812765	0	0	GREEN, HARRIETTE D MD	4/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144317	N/A	N/A	N/A	N/A	N/A	1055 W HENDERSON AVE	None	PORTERVILLE	CA	93257	1490	00	06000	36.08036906	-119.0410926	Tulare County
343654	Ordering, Referring, Prescribing	N/A	1700935103	0	0	GROSSI, TERESA A NP	7/19/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15948	N/A	N/A	N/A	N/A	N/A	2438 N. PONDEROSA DR	C-105	CAMARILLO	CA	93010	2465	00	06000	34.24219545	-119.0227012	Ventura County
343670	Ordering, Referring, Prescribing	N/A	1700955457	0	0	GLOVER, SUSAN L LCSW	8/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23872	N/A	N/A	N/A	N/A	N/A	919 1ST STREET	None	SAN FERNANDO	CA	91340	2957	00	06000	34.28328995	-118.4389224	Los Angeles County
343681	Ordering, Referring, Prescribing	N/A	1700981271	0	0	GILBERT, NATHAN R DO	9/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	1612	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
343690	Ordering, Referring, Prescribing	N/A	1710008735	0	0	GARCIA, JUAN L LCSW	4/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69500	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
343694	Ordering, Referring, Prescribing	N/A	1710012281	0	0	GREGORY, MARIANNA LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42768	N/A	N/A	N/A	N/A	N/A	3200 LONG BEACH BLVD	None	LONG BEACH	CA	90807	5062	00	06000	33.815637	-118.1892215	Los Angeles County
343699	Ordering, Referring, Prescribing	N/A	1710017264	0	0	GARCIA-CRISANTO, SONIA M	11/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52110	N/A	N/A	N/A	N/A	N/A	5100 S EASTERN AVE	110	COMMERCE	CA	90040	2950	00	06000	33.98882955	-118.1615175	Los Angeles County
343702	Ordering, Referring, Prescribing	N/A	1710019922	0	0	GILES, CHRISTINA L LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	30828	N/A	N/A	N/A	N/A	N/A	11565 LAUREL CANYON BLVD	101	MISSION HILLS	CA	91340	1165	00	06000	34.27976725	-118.4545386	Los Angeles County
343728	Ordering, Referring, Prescribing	N/A	1710093935	0	0	GREENE, PAIGE LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23611	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
343746	Ordering, Referring, Prescribing	N/A	1710151196	0	0	GESSEL, MARIE MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C192247	N/A	N/A	N/A	N/A	N/A	1680 PAUL BUNYAN RD	None	SUSANVILLE	CA	96130	3133	00	06000	40.42141164	-120.6468171	Lassen County
343767	Ordering, Referring, Prescribing	N/A	1710188701	0	0	GOMEZ, DULCE R LMFT	7/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96203	N/A	N/A	N/A	N/A	N/A	370 9TH STREET	None	CRESCENT CITY	CA	95531	3432	00	06000	41.7541885	-124.2055122	Del Norte County
343810	Ordering, Referring, Prescribing	N/A	1710263322	0	0	GILL, HARWINDER PHARMD	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	54095	N/A	N/A	N/A	N/A	N/A	7100 N ABBY ST	None	FRESNO	CA	93720	2920	00	06000	36.838962	-119.7874125	Fresno County
343879	Ordering, Referring, Prescribing	N/A	1710369657	0	0	GERMAN DE LA CRUZ, MARGARET T MD	4/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161775	N/A	N/A	N/A	N/A	N/A	2760 S ELM AVE	None	FRESNO	CA	93706	5435	00	06000	36.700542	-119.790868	Fresno County
343897	Ordering, Referring, Prescribing	N/A	1710395884	0	0	GONZALEZ, DENISE LCSW	10/30/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86973	N/A	N/A	N/A	N/A	N/A	3939 13TH ST	None	RIVERSIDE	CA	92501	3505	00	06000	33.97849414	-117.3806754	Riverside County
343910	Ordering, Referring, Prescribing	N/A	1710410980	0	0	GARCIA, ROSEMARIE LMFT	6/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123590	N/A	N/A	N/A	N/A	N/A	1130 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
343912	Ordering, Referring, Prescribing	N/A	1710420807	0	0	GREAVES, PENNY D NP	1/14/2018	Taxonomy not applicable	NA	n/a	000	Unknown	95005526	N/A	N/A	N/A	N/A	N/A	1130 6TH ST	None	MODESTO	CA	95354	2203	00	06000	37.63941918	-121.0062006	Stanislaus County
343955	Ordering, Referring, Prescribing	N/A	1710483094	0	0	GONZALES, KAREN PHARMD	9/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	60090	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC 2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
343956	Ordering, Referring, Prescribing	N/A	1710484977	0	0	GUNAWAN, LINDY DO	8/28/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18081	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
344032	Ordering, Referring, Prescribing	N/A	1710735857	0	0	GREEN, WILLIAM NP	4/30/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029487	N/A	N/A	N/A	N/A	N/A	220 S AKERS ST	D	VISALIA	CA	93291	5179	00	06000	36.328095	-119.3489685	Tulare County
344033	Ordering, Referring, Prescribing	N/A	1710901004	0	0	GUTIERREZ, ANACLETO OD	6/6/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	5532TLG	N/A	N/A	N/A	N/A	N/A	2615 CAPITOL AVE	None	SACRAMENTO	CA	95816	5904	00	06000	38.571399	-121.472532	Sacramento County
344053	Ordering, Referring, Prescribing	N/A	1720010226	0	0	GLASSIE, LORI PA-C	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	16115	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
344073	Ordering, Referring, Prescribing	N/A	1720100316	0	0	GUZMAN, ANDREA F LMFT	8/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45958	N/A	N/A	N/A	N/A	N/A	4452 PARK BLVD	None	SAN DIEGO	CA	92116	1000	00	06000	32.758281	-117.1462795	San Diego County
344084	Ordering, Referring, Prescribing	N/A	1720119837	0	0	GRAY, STACY L LMFT	3/5/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39974	N/A	N/A	N/A	N/A	N/A	670 CARNEGIE DR	None	SAN BERNARDINO	CA	92408	3519	00	06000	34.0695464	-117.2707822	San Bernardino County
344100	Ordering, Referring, Prescribing	N/A	1720148067	0	0	GARDNER, BARBARA S MD	3/13/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G73415	N/A	N/A	N/A	N/A	N/A	487 S MAIN ST	None	LAKEPORT	CA	95453	5315	00	06000	39.03874681	-122.9152741	Lake County
344125	Ordering, Referring, Prescribing	N/A	1720198674	0	0	GALLEGO, IAIN S NP	5/3/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	481865	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
344128	Ordering, Referring, Prescribing	N/A	1720201627	0	0	GOMEZ, CESAR A LCSW	12/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24166	N/A	N/A	N/A	N/A	N/A	2934 EAST GARVEY AVENUE	SUITE 100	WEST COVINA	CA	91791	2190	00	06000	34.07157499	-117.8836824	Los Angeles County
344130	Ordering, Referring, Prescribing	N/A	1720205487	0	0	GIRON, KARLA E LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53165	N/A	N/A	N/A	N/A	N/A	5800 S EASTERN AVE	270	COMMERCE	CA	90040	4016	00	06000	33.98534547	-118.1620372	Los Angeles County
344144	Ordering, Referring, Prescribing	N/A	1720247802	0	0	GOLESKI, MARK MD	9/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119406	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
344147	Ordering, Referring, Prescribing	N/A	1720248727	0	0	GARCIA, MARLENE J LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29866	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
344150	Ordering, Referring, Prescribing	N/A	1720261985	0	0	GRASER, JEANETTE LCSW	4/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78146	N/A	N/A	N/A	N/A	N/A	1861 SILVERWOOD DR	None	CONCORD	CA	94519	1352	00	06000	37.98555372	-122.0030109	Contra Costa County
344162	Ordering, Referring, Prescribing	N/A	1720270168	0	0	GRANDI, ADAM J PSYD	5/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	20919	N/A	N/A	N/A	N/A	N/A	3801 3RD ST	SUITE 400	SAN FRANCISCO	CA	94124	0000	00	06000	37.74208019	-122.3880422	San Francisco County
344198	Ordering, Referring, Prescribing	N/A	1720340748	0	0	GUO, MANDY PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64572	N/A	N/A	N/A	N/A	N/A	4131 GEARY BLVD	B23	SAN FRANCISCO	CA	94118	3101	00	06000	37.78096053	-122.4637512	San Francisco County
344228	Ordering, Referring, Prescribing	N/A	1720385578	0	0	GOH, GLORIA	12/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64773	N/A	N/A	N/A	N/A	N/A	6100 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	2503	00	06000	34.181325	-118.463634	Los Angeles County
344281	Ordering, Referring, Prescribing	N/A	1720451479	0	0	GUZIK, SCOTT R PHARMD	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73725	N/A	N/A	N/A	N/A	N/A	3331 W CENTURY BLVD	None	INGLEWOOD	CA	90303	1366	00	06000	33.94550091	-118.3301957	Los Angeles County
344322	Ordering, Referring, Prescribing	N/A	1720499452	0	0	GARIBALDO, RUBEN LCSW	7/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81635	N/A	N/A	N/A	N/A	N/A	3798 GRAND AVE	SUITE 2	OAKLAND	CA	94610	1527	00	06000	37.81740011	-122.2451341	Alameda County
344342	Ordering, Referring, Prescribing	N/A	1720525926	0	0	GUTIERREZ, ELYSE MD	12/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153450	N/A	N/A	N/A	N/A	N/A	1574 LINDEN AVE	None	LONG BEACH	CA	90813	2032	00	06000	33.786486	-118.1866335	Los Angeles County
344393	Ordering, Referring, Prescribing	N/A	1720602550	0	0	GHOBADI, AHMAD PHARMD	4/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84330	N/A	N/A	N/A	N/A	N/A	2955 N TEGNER RD	None	TURLOCK	CA	95380	9530	00	06000	37.518768	-120.888963	Stanislaus County
344415	Ordering, Referring, Prescribing	N/A	1720637028	0	0	GLASPELL, JENNIFER LP	9/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	2915	N/A	N/A	N/A	N/A	N/A	4675 MISSOURI FLAT RD	None	PLACERVILLE	CA	95667	6816	00	06000	38.69478233	-120.823793	El Dorado County
344427	Ordering, Referring, Prescribing	N/A	1720671662	0	0	GEIL, NICOLE NP	4/22/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029890	N/A	N/A	N/A	N/A	N/A	2930 2ND AVE	STE 200	MARINA	CA	93933	6244	00	06000	36.66646512	-121.8075702	Monterey County
344466	Ordering, Referring, Prescribing	N/A	1720771413	0	0	GIFFEN, LISA B NP	7/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95026318	N/A	N/A	N/A	N/A	N/A	800 SOUTH CENTRAL AVE	NONE	GLENDALE	CA	91204	0000	00	06000	34.13654729	-118.2578243	Los Angeles County
344467	Ordering, Referring, Prescribing	N/A	1720780034	0	0	GONZALEZ LOPEZ, JOCELYN MD	7/15/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197738	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
344489	Ordering, Referring, Prescribing	N/A	1730136607	0	0	GAO, XIAO-KE MD	5/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C154340	N/A	N/A	N/A	N/A	N/A	102 SHEEPHILL RD	None	RIVERSIDE	CT	06878	1121	00	06000	41.04901091	-73.58233104	Western Connecticut Planning Region
344521	Ordering, Referring, Prescribing	N/A	1730226523	0	0	GUTZMER, ANGELA LCSW	3/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25415	N/A	N/A	N/A	N/A	N/A	7474 EL CAJON BLVD	None	LA MESA	CA	91942	7420	00	06000	32.76850004	-117.036802	San Diego County
344554	Ordering, Referring, Prescribing	N/A	1730268442	0	0	GARCIA, GRISELDA LCSW	11/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60578	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
344565	Ordering, Referring, Prescribing	N/A	1730314428	0	0	GRANADOS, SELENA M PSYD	3/29/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33248	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
344572	Ordering, Referring, Prescribing	N/A	1730327933	0	0	GALES, MICHAEL L PA-C	9/21/2019	Taxonomy not applicable	NA	n/a	000	Unknown	11119	N/A	N/A	N/A	N/A	N/A	45104 10TH STREET WEST	None	LANCASTER	CA	93534	4134	00	06000	34.702929	-118.1480935	Los Angeles County
344601	Ordering, Referring, Prescribing	N/A	1730410705	0	0	GONZALES, EVA P LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53479	N/A	N/A	N/A	N/A	N/A	43 QUAIL CT	SUITE 105	WALNUT CREEK	CA	94596	8728	00	06000	37.88807861	-122.0553842	Contra Costa County
344648	Ordering, Referring, Prescribing	N/A	1730482555	0	0	GROFF, LYNN LPCC	4/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC1787	N/A	N/A	N/A	N/A	N/A	248 REDWOOD AVE	None	REDWOOD CITY	CA	94061	3074	00	06000	37.47466127	-122.2250368	San Mateo County
344653	Ordering, Referring, Prescribing	N/A	1730480005	0	0	GOMEZ, ANGELA M LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT95015	N/A	N/A	N/A	N/A	N/A	1830 S. CENTRAL ST.	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
344658	Ordering, Referring, Prescribing	N/A	1730491317	0	0	GRAKOV, STOYAN MD	8/13/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	57078	N/A	N/A	N/A	N/A	N/A	941 SPRING CREEK ROAD	None	CHATTANOOGA	TN	37412	3909	00	06000	34.99885642	-85.21785667	Hamilton County
344659	Ordering, Referring, Prescribing	N/A	1730500620	0	0	GLASSER, WILLIAM D NP	1/11/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003691	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
344666	Ordering, Referring, Prescribing	N/A	1730515131	0	0	GABOIAN, SHUSHANIK LCSW	1/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77193	N/A	N/A	N/A	N/A	N/A	10605 BALBOA BLVD	100	GRANADA HILLS	CA	91344	9139	00	06000	34.263378	-118.5022965	Los Angeles County
344672	Ordering, Referring, Prescribing	N/A	1730523929	0	0	GAMEROS-GARCIA, SUSAN LMFT	1/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99811	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD	None	IRWINDALE	CA	91731	0000	00	06000	34.07969659	-117.9895641	Los Angeles County
344704	Ordering, Referring, Prescribing	N/A	1730582404	0	0	GUEVARA, LUZ E LCSW	2/14/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98611	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	FLOOR 2	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
344705	Ordering, Referring, Prescribing	N/A	1730580705	0	0	GOMEZ, MONET D NP	9/24/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN732248	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
344706	Ordering, Referring, Prescribing	N/A	1730591835	0	0	GONICK-HALLOWS, JONATHAN PHD	10/1/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY11183	N/A	N/A	N/A	N/A	N/A	576 B STREET	1B	SANTA ROSA	CA	95401	5274	00	06000	38.44377	-122.718393	Sonoma County
344756	Ordering, Referring, Prescribing	N/A	1730673542	0	0	GARCIA, SIXTO B LMFT	7/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140673	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
344787	Ordering, Referring, Prescribing	N/A	1730727041	0	0	GUTIERREZ, MARIA A NP	11/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012617	N/A	N/A	N/A	N/A	N/A	6327 N FRESNO ST	101	FRESNO	CA	93710	5236	00	06000	36.82875536	-119.781417	Fresno County
344806	Ordering, Referring, Prescribing	N/A	1730755992	0	0	GARLAND, CARRIE S NP	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95016424	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
344809	Ordering, Referring, Prescribing	N/A	1730761628	0	0	GROVEMAN, HANNAH MD	10/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7656	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
344831	Ordering, Referring, Prescribing	N/A	1730834490	0	0	GASPAR, MARILYN LMFT	9/21/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150006	N/A	N/A	N/A	N/A	N/A	1600 W IMPERIAL HWY	None	LOS ANGELES	CA	90047	4810	00	06000	33.9308427	-118.3046609	Los Angeles County
344834	Ordering, Referring, Prescribing	N/A	1730840661	0	0	GOSAL, JASLIN K PHARMD	12/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85725	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
344851	Ordering, Referring, Prescribing	N/A	1730896424	0	0	GARCIA-DANEWALIA, JESSICA K DMD	11/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108337	N/A	N/A	N/A	N/A	N/A	311 W NOBLE AVE	None	VISALIA	CA	93277	2669	00	06000	36.326304	-119.295477	Tulare County
344861	Ordering, Referring, Prescribing	N/A	1730951419	0	0	GELERA, ANA SAYURI B NP	6/12/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025580	N/A	N/A	N/A	N/A	N/A	12362 BEACH BLVD	10	STANTON	CA	90680	3935	00	06000	33.78298855	-117.9927453	Orange County
344896	Ordering, Referring, Prescribing	N/A	1740304104	0	0	GOMEZ, JOSE LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53980	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
344905	Ordering, Referring, Prescribing	N/A	1740311380	0	0	GALITZ, DANIELLE T LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45328	N/A	N/A	N/A	N/A	N/A	14515 HAMLIN STREET	200	VAN NUYS	CA	91411	1694	00	06000	34.18869729	-118.4492498	Los Angeles County
344956	Ordering, Referring, Prescribing	N/A	1740443175	0	0	GHUMAN, RUPAUL S	8/9/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D57080	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE	STE 500	MARYSVILLE	CA	95901	7119	00	06000	39.12014523	-121.5659991	Yuba County
344964	Ordering, Referring, Prescribing	N/A	1740446509	0	0	GOLDSMITH, MIJA P MD	3/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	309701	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
345047	Ordering, Referring, Prescribing	N/A	1740623420	0	0	GREENBERG, MEGAN NP	3/25/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23030	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY STREET	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
345090	Ordering, Referring, Prescribing	N/A	1740690783	0	0	GOODERMONT, NATALIE R NP	1/17/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000675	N/A	N/A	N/A	N/A	N/A	540 N. SAN JACINTO STREE	P	HEMET	CA	92543	3154	00	06000	33.755229	-116.9586405	Riverside County
345092	Ordering, Referring, Prescribing	N/A	1740696426	0	0	GANDHI, VISHA H LMFT	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106072	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
345094	Ordering, Referring, Prescribing	N/A	1740697556	0	0	GULYAS, CHLOE M LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79630	N/A	N/A	N/A	N/A	N/A	2275 ARLINGTON DRIVE	None	SAN LEANDRO	CA	94578	1132	00	06000	37.70851907	-122.1117036	Alameda County
345098	Ordering, Referring, Prescribing	N/A	1740699867	0	0	GOMEZ, MATTHEW R LMFT	2/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137696	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	STE 280	SAN MATEO	CA	94403	1289	00	06000	37.54524373	-122.3205511	San Mateo County
345104	Ordering, Referring, Prescribing	N/A	1740706977	0	0	GAGLIASSO, NICOLE A LMFT	6/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119725	N/A	N/A	N/A	N/A	N/A	485 N 1ST STREET	None	SAN JOSE	CA	95112	4067	00	06000	37.34444033	-121.8968517	Santa Clara County
345110	Ordering, Referring, Prescribing	N/A	1740717966	0	0	GUPTA, VIDHI	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83125	N/A	N/A	N/A	N/A	N/A	630 MAIN ST	None	BRAWLEY	CA	92227	2548	00	06000	32.97860253	-115.53138	Imperial County
345119	Ordering, Referring, Prescribing	N/A	1740725696	0	0	GOLDSCHMIDT, LILIANA S	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115138	N/A	N/A	N/A	N/A	N/A	2325 CLEMENT AVE	None	ALAMEDA	CA	94501	7061	00	06000	37.77017367	-122.2389726	Alameda County
345124	Ordering, Referring, Prescribing	N/A	1740737592	0	0	GRUNDEMANN, DANIKA L LMFT	8/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121212	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
345148	Ordering, Referring, Prescribing	N/A	1740763291	0	0	GARZA, GABRIELLA NP	7/3/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009371	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
345171	Ordering, Referring, Prescribing	N/A	1740808583	0	0	GONG, KYRA A	2/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82626	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
345173	Ordering, Referring, Prescribing	N/A	1740816958	0	0	GUO, CHANG V	1/7/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	105271	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
345175	Ordering, Referring, Prescribing	N/A	1740806975	0	0	GONZALEZ, ELVIRA S MD	9/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184558	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
345206	Ordering, Referring, Prescribing	N/A	1740873652	0	0	GAMO, REYNALDO M NP	8/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026561	N/A	N/A	N/A	N/A	N/A	250 S G ST	None	SAN BERNARDINO	CA	92410	3320	00	06000	34.09693522	-117.2986838	San Bernardino County
345256	Ordering, Referring, Prescribing	N/A	1750042727	0	0	GONG, EMILY PHARMD	12/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85680	N/A	N/A	N/A	N/A	N/A	2141 CHESTNUT ST	None	SAN FRANCISCO	CA	94123	2708	00	06000	37.80049399	-122.4385695	San Francisco County
345258	Ordering, Referring, Prescribing	N/A	1750049144	0	0	GASTELUM, ROSEMARY LMFT	11/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142688	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
345259	Ordering, Referring, Prescribing	N/A	1750045712	0	0	GARDNER, SHALESSE NP	2/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015664	N/A	N/A	N/A	N/A	N/A	121 S. LONG BEACH BLVD.	None	COMPTON	CA	90221	3243	00	06000	33.89475493	-118.2080292	Los Angeles County
345263	Ordering, Referring, Prescribing	N/A	1750070173	0	0	GRIFFIN-MAXWELL, REBECCA LPCC	2/16/2024	Taxonomy not applicable	NA	n/a	000	Unknown	15846	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
345264	Ordering, Referring, Prescribing	N/A	1750082301	0	0	GARCIA, JASMIN NP	6/4/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030361	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
345281	Ordering, Referring, Prescribing	N/A	1750169777	0	0	GILL, PARDEEP DDS	10/8/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109332	N/A	N/A	N/A	N/A	N/A	20326 MAIN STREET	None	STRATFORD	CA	93266	0000	00	06000	36.18962048	-119.822823	Kings County
345283	Ordering, Referring, Prescribing	N/A	1750338091	0	0	GROSS, JONOTHON E MD	10/28/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G27229	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
345294	Ordering, Referring, Prescribing	N/A	1750392510	0	0	GALLARDO, NILSA	7/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	16013	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
345297	Ordering, Referring, Prescribing	N/A	1750354882	0	0	GILLIS, KATHLEEN NP	12/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	7266	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
345305	Ordering, Referring, Prescribing	N/A	1750412342	0	0	GARCIA, ANTONIO LMFT	12/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40058	N/A	N/A	N/A	N/A	N/A	200 N. GRAND AVE	STE 180	WEST COVINA	CA	91791	1711	00	06000	34.074828	-117.8723825	Los Angeles County
345306	Ordering, Referring, Prescribing	N/A	1750412375	0	0	GERDES, STEPHANIE A LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60400	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS ROAD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
345315	Ordering, Referring, Prescribing	N/A	1750415121	0	0	GEHLER, ELIZABETH T LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48833	N/A	N/A	N/A	N/A	N/A	1679 E MAIN ST	STE 102	EL CAJON	CA	92021	5212	00	06000	32.81117533	-116.9193178	San Diego County
345326	Ordering, Referring, Prescribing	N/A	1750439972	0	0	GRANADO, CATHREEN PA	8/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA14015	N/A	N/A	N/A	N/A	N/A	6501 SOUTH GARFIELD AVE	None	BELL GARDENS	CA	90201	1488	00	06000	33.97292523	-118.1475473	Los Angeles County
345349	Ordering, Referring, Prescribing	N/A	1750481594	0	0	GARIBOTTI, MARIO G	3/6/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D45366	N/A	N/A	N/A	N/A	N/A	500 1ST AVE	None	PORTOLA	CA	96122	9406	00	06000	39.80595392	-120.4626723	Plumas County
345377	Ordering, Referring, Prescribing	N/A	1750568051	0	0	GRAY, KEVIN A LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43420	N/A	N/A	N/A	N/A	N/A	1750 W WALNUT AVE	STE B	VISALIA	CA	93277	6233	00	06000	36.313335	-119.3114205	Tulare County
345413	Ordering, Referring, Prescribing	N/A	1750663308	0	0	GARTON, ALEXANDRA G LMFT	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84263	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
345416	Ordering, Referring, Prescribing	N/A	1750664140	0	0	GONG, VALERIE J PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH33036	N/A	N/A	N/A	N/A	N/A	3150 FOSTORIA WAY	None	DANVILLE	CA	94526	5553	00	06000	37.78145555	-121.9725562	Contra Costa County
345423	Ordering, Referring, Prescribing	N/A	1750675377	0	0	GALLACHER, VERONICA T LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84620	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
345425	Ordering, Referring, Prescribing	N/A	1750604617	0	0	GREYTAK, RYAN M MD	3/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126390	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	BLDG B	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
345438	Ordering, Referring, Prescribing	N/A	1750698981	0	0	GUTIERREZ, MICHELLE LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	84932	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
345463	Ordering, Referring, Prescribing	N/A	1750739934	0	0	GRANA, MATTHEW DO	11/5/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17675	N/A	N/A	N/A	N/A	N/A	1441 LIBERTY STREET	None	REDDING	CA	96001	0811	00	06000	40.5857177	-122.3870781	Shasta County
345475	Ordering, Referring, Prescribing	N/A	1750756268	0	0	GILLIGAN, JESSICA L LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108271	N/A	N/A	N/A	N/A	N/A	7200 SKYWAY	None	PARADISE	CA	95969	3280	00	06000	39.76584095	-121.6165325	Butte County
345491	Ordering, Referring, Prescribing	N/A	1750765616	0	0	GONZALEZ, AMBER M LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112046	N/A	N/A	N/A	N/A	N/A	45 FARALLONES ST	None	SAN FRANCISCO	CA	94112	3005	00	06000	37.71408691	-122.4538573	San Francisco County
345529	Ordering, Referring, Prescribing	N/A	1750830808	0	0	GOODRICH, JODY LMFT	10/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT94897	N/A	N/A	N/A	N/A	N/A	1401 W VALENCIA DR	None	FULLERTON	CA	92833	3938	00	06000	33.86655147	-117.9512235	Orange County
345539	Ordering, Referring, Prescribing	N/A	1750847745	0	0	GARING, BABYRUTH CNP	2/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011095	N/A	N/A	N/A	N/A	N/A	1800 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	3302	00	06000	35.383626	-118.967417	Kern County
345598	Ordering, Referring, Prescribing	N/A	1750967634	0	0	GRAY, KAILA LPCC	10/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC11415	N/A	N/A	N/A	N/A	N/A	35912 AVENUE H	None	YUCAIPA	CA	92399	5206	00	06000	34.01032324	-117.0223299	San Bernardino County
345657	Ordering, Referring, Prescribing	N/A	1760094692	0	0	GARCIA PORTALATIN, KARLA N DC	6/30/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36122	N/A	N/A	N/A	N/A	N/A	7210 MURRAY DR	None	STOCKTON	CA	95210	3339	00	06000	38.01572012	-121.3009247	San Joaquin County
345667	Ordering, Referring, Prescribing	N/A	1760128441	0	0	GHANBARZADEH, NICOLE LAC	1/17/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	19258	N/A	N/A	N/A	N/A	N/A	1735 MISSION STREET	None	SAN FRANCISCO	CA	94103	2417	00	06000	37.76957692	-122.4199811	San Francisco County
345685	Ordering, Referring, Prescribing	N/A	1760182737	0	0	GANGSHAR, DAWA PA	4/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA62645	N/A	N/A	N/A	N/A	N/A	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
345693	Ordering, Referring, Prescribing	N/A	1760246862	0	0	GUARDIA, RAQUEL J NP	1/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95028893	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
345714	Ordering, Referring, Prescribing	N/A	1760502389	0	0	GONZALEZ, TENISHA	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110065	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY STREET	E500	FREMONT	CA	94537	5006	00	06000	37.55123907	-121.9828956	Alameda County
345723	Ordering, Referring, Prescribing	N/A	1760503502	0	0	GONZALEZ, ELIZABETH H CPO	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49107	N/A	N/A	N/A	N/A	N/A	760 WEST MOUNTAIN VIEW S	None	ALTADENA	CA	91001	1400	00	06000	34.19178664	-118.1657029	Los Angeles County
345739	Ordering, Referring, Prescribing	N/A	1760545297	0	0	GRUNDLAND, HATTIE C	1/18/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP14228	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
345751	Ordering, Referring, Prescribing	N/A	1760556831	0	0	GROSSMAN, MARY P LMFT	7/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43788	N/A	N/A	N/A	N/A	N/A	1664 BROADWAY	None	EL CAJON	CA	92021	5201	00	06000	32.80772446	-116.9184375	San Diego County
345752	Ordering, Referring, Prescribing	N/A	1760563068	0	0	GRIFFITHS, KENNETH J MD	4/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C52451	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
345794	Ordering, Referring, Prescribing	N/A	1760679484	0	0	GHAZANFAR, KHATERA DO	10/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A10133	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
345800	Ordering, Referring, Prescribing	N/A	1760684286	0	0	GABBY, MARIA MD	6/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43101	N/A	N/A	N/A	N/A	N/A	1 ST VINCENT DRIVE	None	SAN RAFAEL	CA	94903	1504	00	06000	38.034216	-122.525199	Marin County
345805	Ordering, Referring, Prescribing	N/A	1760692859	0	0	GARCIA, MICHELLE R LCSW	1/2/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW112937	N/A	N/A	N/A	N/A	N/A	820 E GILBERT ST.	None	SAN BERNARDINO	CA	92415	0928	00	06000	34.1268333	-117.2687417	San Bernardino County
345808	Ordering, Referring, Prescribing	N/A	1760706527	0	0	GALLEGOS, LILIANA D LMFT	4/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46014	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
345809	Ordering, Referring, Prescribing	N/A	1760708465	0	0	GALLO, PHILIP	10/30/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC13480	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
345824	Ordering, Referring, Prescribing	N/A	1760736920	0	0	GAYTAN GAMIZ, ANYRA IORDANA LMFT	1/8/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98950	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
345852	Ordering, Referring, Prescribing	N/A	1760774632	0	0	GRIFFIN, KELLY C LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45841	N/A	N/A	N/A	N/A	N/A	401 E OCEAN AVE	None	LOMPOC	CA	93436	6828	00	06000	34.6389765	-120.4537095	Santa Barbara County
345882	Ordering, Referring, Prescribing	N/A	1760830467	0	0	GONZALEZ, LAUREN M LPCC	1/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC4096	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	None	LOS ANGELES	CA	90018	1353	00	06000	34.037415	-118.3176815	Los Angeles County
345888	Ordering, Referring, Prescribing	N/A	1760842447	0	0	GARCIA-CUEVAS, SANDY LCSW	4/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85973	N/A	N/A	N/A	N/A	N/A	82-632 HIGHWAY 111	SUITE A-3	INDIO	CA	92201	5626	00	06000	33.6790756	-116.1731941	Riverside County
345942	Ordering, Referring, Prescribing	N/A	1760902431	0	0	GOLIAN, KATRIN PHARMD	10/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63407	N/A	N/A	N/A	N/A	N/A	1125 S. BEVERLY DR	SUITE 100	LOS ANGELES	CA	90035	1149	00	06000	34.05696658	-118.3966613	Los Angeles County
345995	Ordering, Referring, Prescribing	N/A	1760979934	0	0	GHAMARI, DOMINIQUE PA	11/19/2017	Taxonomy not applicable	NA	n/a	000	Unknown	PA55049	N/A	N/A	N/A	N/A	N/A	743 PISMO ST	None	SAN LUIS OBISPO	CA	93401	3921	00	06000	35.27698063	-120.6618385	San Luis Obispo County
346018	Ordering, Referring, Prescribing	N/A	1770002990	0	0	GBADEBO, GANIAT A	7/24/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023808	N/A	N/A	N/A	N/A	N/A	1328 S MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
346024	Ordering, Referring, Prescribing	N/A	1770040164	0	0	GIRGIS, DANIEL	8/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140775	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
346038	Ordering, Referring, Prescribing	N/A	1770065294	0	0	GAO, SARAH C CNP	5/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95009090	N/A	N/A	N/A	N/A	N/A	7211 VAN NUYS BLVD	None	VAN NUYS	CA	91205	2256	00	06000	34.20181593	-118.4487631	Los Angeles County
346044	Ordering, Referring, Prescribing	N/A	1770080954	0	0	GARCHA, MANVEER MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166089	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
346096	Ordering, Referring, Prescribing	N/A	1770192668	0	0	GARCIA, MARCO E	11/2/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105082	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
346152	Ordering, Referring, Prescribing	N/A	1770612814	0	0	GOLDSTEIN-HIDALGO, CAROLYN LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52045	N/A	N/A	N/A	N/A	N/A	2975 TREAT BLVD.	STE C-5	CONCORD	CA	94518	3601	00	06000	37.93808829	-122.0263617	Contra Costa County
346168	Ordering, Referring, Prescribing	N/A	1770632614	0	0	GUEVARA, SUSAN C	6/12/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0462994	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
346242	Ordering, Referring, Prescribing	N/A	1770816183	0	0	GOMEZ, KERI N LCSW	3/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29421	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0004	00	06000	34.54007429	-117.2744761	San Bernardino County
346273	Ordering, Referring, Prescribing	N/A	1770863144	0	0	GARCIA, ROBYN D LMFT	6/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83228	N/A	N/A	N/A	N/A	N/A	815 DR. MARTIN LUTHER KI	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
346275	Ordering, Referring, Prescribing	N/A	1770876930	0	0	GUPTA, MINAKSHI (MEENA) P LCSW	6/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16656	N/A	N/A	N/A	N/A	N/A	2900 S. HARBOR BLVD	100	SANTA ANA	CA	92704	6429	00	06000	33.70816839	-117.9197655	Orange County
346278	Ordering, Referring, Prescribing	N/A	1770877060	0	0	GUSTAFSON, ERIN C MD MPH	12/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152755	N/A	N/A	N/A	N/A	N/A	606 E MILL ST	None	SAN BERNARDINO	CA	92415	0620	00	06000	34.09217051	-117.271935	San Bernardino County
346285	Ordering, Referring, Prescribing	N/A	1770895724	0	0	GUZMAN, IGNACIO MD	5/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113019	N/A	N/A	N/A	N/A	N/A	2505 MERCED ST	None	FRESNO	CA	93721	1811	00	06000	36.74081939	-119.7879808	Fresno County
346321	Ordering, Referring, Prescribing	N/A	1770947459	0	0	GARDEL, CHANTAL PHARMD	10/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71912	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
346322	Ordering, Referring, Prescribing	N/A	1770949307	0	0	GORDON, JACQUELINE LPCC	12/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC5007	N/A	N/A	N/A	N/A	N/A	700 W 22ND ST	None	MERCED	CA	95340	3638	00	06000	37.30752417	-120.4835788	Merced County
346370	Ordering, Referring, Prescribing	N/A	1780026336	0	0	GRAHAM, AMITA CNM	12/22/2021	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	NM236037	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
346373	Ordering, Referring, Prescribing	N/A	1780028548	0	0	GILBARG, MELISSA LCSW	7/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95634	N/A	N/A	N/A	N/A	N/A	1936 CARLOTTA DR	None	CONCORD	CA	94518	1358	00	06000	37.98614491	-122.0061167	Contra Costa County
346376	Ordering, Referring, Prescribing	N/A	1780024034	0	0	GOODE, RONALD D LMFT	1/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102322	N/A	N/A	N/A	N/A	N/A	7003 N FIGUEROA ST	None	LOS ANGELES	CA	90042	1247	00	06000	34.12951669	-118.1880773	Los Angeles County
346399	Ordering, Referring, Prescribing	N/A	1780058313	0	0	GOMEZ, ARIANA LMFT	1/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117216	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
346417	Ordering, Referring, Prescribing	N/A	1780093823	0	0	GRIFFIN, AMY E LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93722	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
346458	Ordering, Referring, Prescribing	N/A	1780143073	0	0	GOMEZ, TIMOTHY PHARMD	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80267	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
346481	Ordering, Referring, Prescribing	N/A	1780177733	0	0	GUERRA, BEATRIZ	6/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107506	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
346486	Ordering, Referring, Prescribing	N/A	1780215988	0	0	GONZALEZ, ALIZA LCSW	9/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104837	N/A	N/A	N/A	N/A	N/A	4455 W 117TH ST	300	HAWTHORNE	CA	90250	2241	00	06000	33.92825048	-118.3539285	Los Angeles County
346510	Ordering, Referring, Prescribing	N/A	1780293167	0	0	GEIGER, GREG PHARMD	10/16/2019	Taxonomy not applicable	NA	n/a	000	Unknown	41831	N/A	N/A	N/A	N/A	N/A	7140 W PERSHING CT	None	VISALIA	CA	93291	7941	00	06000	36.339669	-119.370834	Tulare County
346513	Ordering, Referring, Prescribing	N/A	1780294249	0	0	GARCIA, RACHEL LCSW	6/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122966	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
346527	Ordering, Referring, Prescribing	N/A	1780328997	0	0	GONZALEZ, REBECCA PA-C	10/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA60932	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
346542	Ordering, Referring, Prescribing	N/A	1780357939	0	0	GEYER ARRUSSUL WINKLER SANTOS, EDUARDO MD	11/12/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL8121	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
346573	Ordering, Referring, Prescribing	N/A	1780671073	0	0	GUTIERREZ, CARMEN R OD	6/25/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	SOL5896	N/A	N/A	N/A	N/A	N/A	13197 CENTRAL AVE	101	CHINO	CA	91710	4178	00	06000	34.013781	-117.689161	San Bernardino County
346626	Ordering, Referring, Prescribing	N/A	1780795930	0	0	GRUENEFELDT, ALAN MD	10/4/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G69052	N/A	N/A	N/A	N/A	N/A	3111 PROFESSIONAL DRIVE	None	AUBURN	CA	95602	2456	00	06000	38.940327	-121.1007585	Placer County
346647	Ordering, Referring, Prescribing	N/A	1780835066	0	0	GONZALEZ, KARLA M LMFT	3/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52952	N/A	N/A	N/A	N/A	N/A	11110 LOS ALAMITOS BLVD	211	LOS ALAMITOS	CA	90720	3602	00	06000	33.801516	-118.0717825	Orange County
346672	Ordering, Referring, Prescribing	N/A	1780905406	0	0	GODBY, MICHAEL LMFT	1/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96410	N/A	N/A	N/A	N/A	N/A	1227 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	2871	00	06000	34.27181352	-118.7762625	Ventura County
346701	Ordering, Referring, Prescribing	N/A	1780947291	0	0	GORHAM, JACK L LCSW	12/11/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80419	N/A	N/A	N/A	N/A	N/A	12021 WILMINGTON AVE	None	LOS ANGELES	CA	90059	3019	00	06000	33.922863	-118.2431655	Los Angeles County
346721	Ordering, Referring, Prescribing	N/A	1780984146	0	0	GHATTAS, NAZMY B	1/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	41595	N/A	N/A	N/A	N/A	N/A	7390 CHERRY AVE	None	FONTANA	CA	92336	4204	00	06000	34.12000116	-117.4886648	San Bernardino County
346742	Ordering, Referring, Prescribing	N/A	1790031979	0	0	GUTIERREZ, JUAN C DC	7/5/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	32058	N/A	N/A	N/A	N/A	N/A	2505 MERCED ST	None	FRESNO	CA	93721	1811	00	06000	36.74081939	-119.7879808	Fresno County
346764	Ordering, Referring, Prescribing	N/A	1790061364	0	0	GAE, DARREN D PHARMD	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63423	N/A	N/A	N/A	N/A	N/A	11440 WINDEMERE PKWY	None	SAN RAMON	CA	94582	5179	00	06000	37.76322364	-121.9047731	Contra Costa County
346782	Ordering, Referring, Prescribing	N/A	1790070712	0	0	GIBSON, NICOLE L RDH	4/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RDH23400	N/A	N/A	N/A	N/A	N/A	1360 E ANAHEIM ST	101	LONG BEACH	CA	90813	5514	00	06000	33.78258054	-118.1744415	Los Angeles County
346797	Ordering, Referring, Prescribing	N/A	1790090116	0	0	GINOSYAN, LILI S PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53257	N/A	N/A	N/A	N/A	N/A	18430 SHERMAN WAY	None	RESEDA	CA	91335	4942	00	06000	34.20105549	-118.534329	Los Angeles County
346800	Ordering, Referring, Prescribing	N/A	1790088714	0	0	GARCIA, SARAH A DO	11/4/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11425	N/A	N/A	N/A	N/A	N/A	1147 RED TAIL WAY	None	SIMI VALLEY	CA	93065	7232	00	06000	34.25942227	-118.7951311	Ventura County
346820	Ordering, Referring, Prescribing	N/A	1790129641	0	0	GANDHI, SAURABH B BCO	10/23/2018	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5425	N/A	N/A	N/A	N/A	N/A	4618 FOUNTAIN AVE	None	LOS ANGELES	CA	90029	1977	00	06000	34.095582	-118.290195	Los Angeles County
346826	Ordering, Referring, Prescribing	N/A	1790152692	0	0	GARCIA, LETICIA T LCSW	7/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102800	N/A	N/A	N/A	N/A	N/A	680 LANGSDORF DR	200	FULLERTON	CA	92831	3702	00	06000	33.87673088	-117.8824577	Orange County
346838	Ordering, Referring, Prescribing	N/A	1790129575	0	0	GOLD, DONNA M LCSW	5/30/2014	Taxonomy not applicable	NA	n/a	000	Unknown	28494	N/A	N/A	N/A	N/A	N/A	11835 CARMEL MOUNTAIN RO	STE. 1304-153	SAN DIEGO	CA	92128	4609	00	06000	32.98049062	-117.0778429	San Diego County
346841	Ordering, Referring, Prescribing	N/A	1790160042	0	0	GONZALEZ, MARIBEL LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115143	N/A	N/A	N/A	N/A	N/A	14600 SHERMAN WAY	100 D	VAN NUYS	CA	91405	2283	00	06000	34.20025916	-118.4500763	Los Angeles County
346864	Ordering, Referring, Prescribing	N/A	1790192169	0	0	GILARDI, DANIELLE M LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110814	N/A	N/A	N/A	N/A	N/A	2447 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	7815	00	06000	38.441403	-122.6637585	Sonoma County
346899	Ordering, Referring, Prescribing	N/A	1790244325	0	0	GONZALEZ, THERESITA LCSW	8/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110098	N/A	N/A	N/A	N/A	N/A	25910 ACERO, SUITE 160	None	MISSION VIEJO	CA	92691	6468	00	06000	33.61712389	-117.6780482	Orange County
346916	Ordering, Referring, Prescribing	N/A	1790263127	0	0	GARCIA, ALEXIS D LCSW	7/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123881	N/A	N/A	N/A	N/A	N/A	5350 MACHADO LN	None	CULVER CITY	CA	90230	8800	00	06000	33.99772397	-118.3961412	Los Angeles County
346968	Ordering, Referring, Prescribing	N/A	1790358422	0	0	GUEVARRA-SHAMS, GENELLE L	8/24/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106538	N/A	N/A	N/A	N/A	N/A	7777 SUNRISE BLVD	STE 2500	CITRUS HEIGHTS	CA	95610	2372	00	06000	38.706561	-121.2731145	Sacramento County
346971	Ordering, Referring, Prescribing	N/A	1790359339	0	0	GARZA, GRACEANNE NP	7/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026267	N/A	N/A	N/A	N/A	N/A	2 JAMES WAY	STE 2090	PISMO BEACH	CA	93449	4973	00	06000	35.13869436	-120.630734	San Luis Obispo County
346995	Ordering, Referring, Prescribing	N/A	1790423226	0	0	GILL, MANINDER K NP	5/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95021021	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
347000	Ordering, Referring, Prescribing	N/A	1790440261	0	0	GENERELLI, ALEXANDRA J CCC-SLP	12/7/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	36446	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
347010	Ordering, Referring, Prescribing	N/A	1790477834	0	0	GONZALES, VERONICA PHARMD	10/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62944	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
347026	Ordering, Referring, Prescribing	N/A	1790563815	0	0	GAMBLE, RYAN NP	7/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026083	N/A	N/A	N/A	N/A	N/A	711 W FLORENCE AVE	None	LOS ANGELES	CA	90044	6105	00	06000	33.9746755	-118.286415	Los Angeles County
347027	Ordering, Referring, Prescribing	N/A	1790477818	0	0	GONZALEZ, ANN DDS	9/12/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110765	N/A	N/A	N/A	N/A	N/A	7821 S AVALON BLVD	None	LOS ANGELES	CA	90003	2358	00	06000	33.969393	-118.265197	Los Angeles County
347057	Ordering, Referring, Prescribing	N/A	1790810588	0	0	GUTIERREZ, CHRISTIE L LCSW	11/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28756	N/A	N/A	N/A	N/A	N/A	501 N CRESCENT WAY	None	ANAHEIM	CA	92801	5401	00	06000	33.837174	-117.9473765	Orange County
347086	Ordering, Referring, Prescribing	N/A	1790864478	0	0	GRELL, YOLANDA Z PA	9/15/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA11306	N/A	N/A	N/A	N/A	N/A	1009 N AVALON BLVD	None	WILMINGTON	CA	90744	4505	00	06000	33.78320457	-118.2627263	Los Angeles County
347091	Ordering, Referring, Prescribing	N/A	1790873545	0	0	GRIEF, WILLIAM J MD	5/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	C54364	N/A	N/A	N/A	N/A	N/A	3425 S. BASCOM AVE.	SUITE 200	CAMPBELL	CA	95008	7300	00	06000	37.26303856	-121.943919	Santa Clara County
347094	Ordering, Referring, Prescribing	N/A	1790888998	0	0	GIBSON, AMANDA D LMSW	10/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25790	N/A	N/A	N/A	N/A	N/A	2617 K STREET	SUITE 125	SACRAMENTO	CA	95816	5133	00	06000	38.573595	-121.4715825	Sacramento County
347098	Ordering, Referring, Prescribing	N/A	1790892958	0	0	GARABEDIAN, RICHARD S DC	5/17/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	23652	N/A	N/A	N/A	N/A	N/A	2141 HIGH ST	STE E	SELMA	CA	93662	3065	00	06000	36.57049208	-119.6139528	Fresno County
347101	Ordering, Referring, Prescribing	N/A	1790909463	0	0	GONZALEZ, VANESSA LMFT	9/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110404	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
347107	Ordering, Referring, Prescribing	N/A	1790933372	0	0	GORSKI, LUKASZ A	5/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56488	N/A	N/A	N/A	N/A	N/A	7601 E. IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
347138	Ordering, Referring, Prescribing	N/A	1790982213	0	0	GARCIA, ERIKA LMFT	12/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41769	N/A	N/A	N/A	N/A	N/A	1061 TIERRA DEL REY	SUITE 200	CHULA VISTA	CA	91910	7881	00	06000	32.63799018	-117.017426	San Diego County
347147	Ordering, Referring, Prescribing	N/A	1801007497	0	0	GHANTOUS, TALA L LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25100	N/A	N/A	N/A	N/A	N/A	312 CLAY STREET	150	OAKLAND	CA	94607	3510	00	06000	37.79802567	-122.2780981	Alameda County
347168	Ordering, Referring, Prescribing	N/A	1801047675	0	0	GEORGE-BARBER, DEBRA A PHD	1/19/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15700	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
347169	Ordering, Referring, Prescribing	N/A	1801044524	0	0	GUZMAN, REGINA MSW LCSW	1/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28994	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
347176	Ordering, Referring, Prescribing	N/A	1801064480	0	0	GUERRA, RACHELL I LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92402	N/A	N/A	N/A	N/A	N/A	1800 SOLAR DR	3RD FLOOR	OXNARD	CA	93030	2655	00	06000	34.21748414	-119.1449177	Ventura County
347184	Ordering, Referring, Prescribing	N/A	1801082748	0	0	GRISWOLD, JENNIFER LMFT	11/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49572	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR.	STE 220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
347214	Ordering, Referring, Prescribing	N/A	1801141288	0	0	GORDON, LINDSAY PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67166	N/A	N/A	N/A	N/A	N/A	25821 S VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.78934581	-118.2936765	Los Angeles County
347239	Ordering, Referring, Prescribing	N/A	1801173042	0	0	GRIFFIN, VALERIE J NP	3/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	402313	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
347243	Ordering, Referring, Prescribing	N/A	1801178363	0	0	GILES, AMBER LMFT	11/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90004	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DRIVE	200	MARTINEZ	CA	94553	4189	00	06000	37.99250264	-122.0983907	Contra Costa County
347268	Ordering, Referring, Prescribing	N/A	1801208616	0	0	GOLI, LAUREN	6/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154583	N/A	N/A	N/A	N/A	N/A	1530 SOUTH OLIVE STREET	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
347327	Ordering, Referring, Prescribing	N/A	1801290077	0	0	GONZALEZ, KARINA M LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115848	N/A	N/A	N/A	N/A	N/A	500 WEST FOSTER ROAD	None	SANTA MARIA	CA	93455	3620	00	06000	34.88351329	-120.4428974	Santa Barbara County
347331	Ordering, Referring, Prescribing	N/A	1801297460	0	0	GRABER, AMY M MSW LCSW	10/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79385	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
347341	Ordering, Referring, Prescribing	N/A	1801311543	0	0	GODINEZ, ROBERTO NP	5/1/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029983	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
347364	Ordering, Referring, Prescribing	N/A	1801346069	0	0	GARCIA, MARIA A NP	7/5/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	584996	N/A	N/A	N/A	N/A	N/A	3748 E SHIELDS AVE	None	FRESNO	CA	93726	7028	00	06000	36.77950149	-119.7622755	Fresno County
347367	Ordering, Referring, Prescribing	N/A	1801338793	0	0	GUEVARRA, MARIANNE NP	11/13/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005339	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
347379	Ordering, Referring, Prescribing	N/A	1801376538	0	0	GUERRERO, DIGNA	1/30/2025	Taxonomy not applicable	NA	n/a	000	Unknown	138395	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
347381	Ordering, Referring, Prescribing	N/A	1801367081	0	0	GONZALEZ, CECILIA NP	7/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030905	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
347384	Ordering, Referring, Prescribing	N/A	1801374939	0	0	GARRETT, SUZANNE LCSW	6/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101450	N/A	N/A	N/A	N/A	N/A	408 PANTHER CREEK RD.	None	WILLOW CREEK	CA	95573	0151	00	06000	40.93399555	-123.6298372	Humboldt County
347419	Ordering, Referring, Prescribing	N/A	1801453220	0	0	GUTIERREZ, MICHELLE	4/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139024	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
347422	Ordering, Referring, Prescribing	N/A	1801470992	0	0	GARG, SUNAKSHI DPM	5/12/2024	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E6054	N/A	N/A	N/A	N/A	N/A	2802 SAINT DENIS DR	None	SAN RAMON	CA	94583	2732	00	06000	37.74679016	-121.9541307	Contra Costa County
347430	Ordering, Referring, Prescribing	N/A	1801485891	0	0	GARCIA, GWENDOLYN DMD	3/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	105930	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
347459	Ordering, Referring, Prescribing	N/A	1801583984	0	0	GUZMAN, MICHAEL J RDH	9/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RDH23275	N/A	N/A	N/A	N/A	N/A	100 CITADEL DR.	101	COMMERCE	CA	90040	1579	00	06000	34.00670012	-118.1528359	Los Angeles County
347486	Ordering, Referring, Prescribing	N/A	1801890405	0	0	GALA, KIRIT V MD	5/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A35360	N/A	N/A	N/A	N/A	N/A	941 S ATLANTIC BLVD	101	MONTEREY PARK	CA	91754	7220	00	06000	34.04918291	-118.1391218	Los Angeles County
347495	Ordering, Referring, Prescribing	N/A	1801914296	0	0	GARAY, OLGA	3/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62400	N/A	N/A	N/A	N/A	N/A	11600 ELDRIDGE AVENUE	None	LAKE VIEW TERRACE	CA	91342	6506	00	06000	34.28038404	-118.3838708	Los Angeles County
347512	Ordering, Referring, Prescribing	N/A	1801944715	0	0	GARCIA, MARIA I LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60750	N/A	N/A	N/A	N/A	N/A	2719 N. AIR FRESNO DRIVE	None	FRESNO	CA	93727	1546	00	06000	36.77448139	-119.7281325	Fresno County
347525	Ordering, Referring, Prescribing	N/A	1801984679	0	0	GARRETT, LIANA NP	1/4/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	4574	N/A	N/A	N/A	N/A	N/A	7277 CENTER AVE	None	HUNTINGTON BEACH	CA	92647	3074	00	06000	33.73380643	-118.0003031	Orange County
347532	Ordering, Referring, Prescribing	N/A	1801998133	0	0	GARCIA ARISTIZABAL, LUZ A MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80314	N/A	N/A	N/A	N/A	N/A	337 E KINGS ST	None	AVENAL	CA	93204	1630	00	06000	36.00253508	-120.1335979	Kings County
347583	Ordering, Referring, Prescribing	N/A	1811085467	0	0	GOTTLIEB, JILL L LCSW	8/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	14338	N/A	N/A	N/A	N/A	N/A	3303 N. BROADWAY	4TH FLOOR	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
347597	Ordering, Referring, Prescribing	N/A	1811131139	0	0	GUVERCINCI, OZGE LMFT	11/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83216	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
347599	Ordering, Referring, Prescribing	N/A	1811138159	0	0	GRANNICK, DEBRA R PHARMD	4/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	42880	N/A	N/A	N/A	N/A	N/A	951 PALOMAR AIRPORT RD	None	CARLSBAD	CA	92011	1110	00	06000	33.12192014	-117.3157437	San Diego County
347608	Ordering, Referring, Prescribing	N/A	1811171994	0	0	GREENE, MAAYAN S MSW LCSW	7/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24515	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
347620	Ordering, Referring, Prescribing	N/A	1811194897	0	0	GOUBAUD-REYNA, ROLANDO E LCSW	5/10/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17993	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	280A	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
347622	Ordering, Referring, Prescribing	N/A	1811203474	0	0	GADE, RAKESH	6/14/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	60539	N/A	N/A	N/A	N/A	N/A	129 N MCKINLEY ST	STE 102	CORONA	CA	92879	6593	00	06000	33.88332497	-117.5153721	Riverside County
347635	Ordering, Referring, Prescribing	N/A	1811222128	0	0	GOODMAN, LAUREN R LCSW	8/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64235	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD.	FLOOR 8	LOS ANGELES	CA	90010	2315	00	06000	34.06170677	-118.302787	Los Angeles County
347693	Ordering, Referring, Prescribing	N/A	1811315641	0	0	GHASEM, ALEXANDER MD	8/6/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A169674	N/A	N/A	N/A	N/A	N/A	14860 ROSCOE BLVD	200	PANORAMA CITY	CA	91402	4093	00	06000	34.2214515	-118.4573205	Los Angeles County
347700	Ordering, Referring, Prescribing	N/A	1811328263	0	0	GENTILE, NICOLE LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103047	N/A	N/A	N/A	N/A	N/A	855 CANYON RD	None	REDDING	CA	96001	5544	00	06000	40.48978049	-122.3926387	Shasta County
347708	Ordering, Referring, Prescribing	N/A	1811323793	0	0	GIULIANI, LISA C PHD	9/2/2016	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27678	N/A	N/A	N/A	N/A	N/A	659 S CENTRAL VALLEY HWY	None	SHAFTER	CA	93263	2790	00	06000	35.49514829	-119.264618	Kern County
347733	Ordering, Referring, Prescribing	N/A	1811378557	0	0	GROSS, MAGAN A DO	4/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19198	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
347737	Ordering, Referring, Prescribing	N/A	1811384225	0	0	GARCIA, AENRI LMFT	9/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121903	N/A	N/A	N/A	N/A	N/A	600 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92401	1164	00	06000	34.110486	-117.2896755	San Bernardino County
347772	Ordering, Referring, Prescribing	N/A	1811430192	0	0	GANDARA CUELLAR, EVELYN MD	9/20/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157239	N/A	N/A	N/A	N/A	N/A	4129 E GAGE AVE	None	BELL	CA	90201	1128	00	06000	33.97868838	-118.1928157	Los Angeles County
347847	Ordering, Referring, Prescribing	N/A	1811571045	0	0	GERENRAICH, ANDREW	7/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23190	N/A	N/A	N/A	N/A	N/A	1119 PACIFIC AVE	200	SANTA CRUZ	CA	95060	7503	00	06000	36.9722444	-122.0256836	Santa Cruz County
347856	Ordering, Referring, Prescribing	N/A	1811601024	0	0	GILKEY, CHANTAL A LMFT	10/14/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150604	N/A	N/A	N/A	N/A	N/A	801 AGAJANIAN WAY	None	MONTEBELLO	CA	90640	3789	00	06000	34.02066193	-118.0863392	Los Angeles County
347886	Ordering, Referring, Prescribing	N/A	1811670532	0	0	GRIGSBY, JOHN S PHARMD	7/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	86336	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
347893	Ordering, Referring, Prescribing	N/A	1811713118	0	0	GRIFFIN, SHUN L LCSW	3/11/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121497	N/A	N/A	N/A	N/A	N/A	17500 FOOTHILL BLVD	#A-2	FONTANA	CA	92335	3798	00	06000	34.1067065	-117.4218885	San Bernardino County
347908	Ordering, Referring, Prescribing	N/A	1811921174	0	0	GARDNER, MARK L MD	2/20/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	73337	N/A	N/A	N/A	N/A	N/A	475 N FORBES ST	None	LAKEPORT	CA	95453	4725	00	06000	39.04516616	-122.9161302	Lake County
347910	Ordering, Referring, Prescribing	N/A	1811924491	0	0	GUZMAN, ERNIE	7/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G61703	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	5000	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
347934	Ordering, Referring, Prescribing	N/A	1821054594	0	0	GAGAN, SOHAIL A MD	12/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84615	N/A	N/A	N/A	N/A	N/A	3800 DALE RD	None	MODESTO	CA	95356	8627	00	06000	37.69395556	-121.0499498	Stanislaus County
347955	Ordering, Referring, Prescribing	N/A	1821126616	0	0	GREEN, DANIELLE F LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48607	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
347970	Ordering, Referring, Prescribing	N/A	1821150657	0	0	GOLDBERG, MICHAEL MD	6/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C167572	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	K	SACRAMENTO	CA	95820	4717	00	06000	38.526282	-121.471398	Sacramento County
347999	Ordering, Referring, Prescribing	N/A	1821201963	0	0	GRANADOS, FERNANDO LCSW	6/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22618	N/A	N/A	N/A	N/A	N/A	642 W MAIN ST	None	MERCED	CA	95340	4718	00	06000	37.3023305	-120.4858296	Merced County
348009	Ordering, Referring, Prescribing	N/A	1821236530	0	0	GARROVILLAS, FLORENCE C MD	7/18/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A77326	N/A	N/A	N/A	N/A	N/A	1215 JEFFERSON STREET	None	DELANO	CA	93215	2203	00	06000	35.77250027	-119.2451029	Kern County
348045	Ordering, Referring, Prescribing	N/A	1821308818	0	0	GONSMAN, PATRICIA H NP	10/6/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	414762	N/A	N/A	N/A	N/A	N/A	25555 HESPERIAN BLVD	None	HAYWARD	CA	94545	2447	00	06000	37.64243568	-122.1038935	Alameda County
348055	Ordering, Referring, Prescribing	N/A	1821323379	0	0	GONZALEZ, JACQUELINE LMFT	3/15/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131797	N/A	N/A	N/A	N/A	N/A	3576 ARLINGTON	STE. 307	RIVERSIDE	CA	92506	3907	00	06000	33.94625192	-117.3913739	Riverside County
348083	Ordering, Referring, Prescribing	N/A	1821376146	0	0	GOODIN, SOQUEL NP	1/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21069	N/A	N/A	N/A	N/A	N/A	292 POSADA LN	None	TEMPLETON	CA	93465	4054	00	06000	35.5531447	-120.7214979	San Luis Obispo County
348084	Ordering, Referring, Prescribing	N/A	1821371477	0	0	GEE, HOLLY	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65758	N/A	N/A	N/A	N/A	N/A	2238 GEARY ST	None	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
348089	Ordering, Referring, Prescribing	N/A	1821392002	0	0	GOODMAN, OLGA Y LCSW	10/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69810	N/A	N/A	N/A	N/A	N/A	1000 EUCLID AVE	None	NATIONAL CITY	CA	91950	3856	00	06000	32.68067201	-117.0804893	San Diego County
348137	Ordering, Referring, Prescribing	N/A	1821464272	0	0	GOMEZ, KARINA LCSW	5/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115272	N/A	N/A	N/A	N/A	N/A	1945 N FINE AVE	None	FRESNO	CA	93727	1528	00	06000	36.76832721	-119.7290143	Fresno County
348177	Ordering, Referring, Prescribing	N/A	1821526732	0	0	GUMM, HEATHER LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94077	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
348231	Ordering, Referring, Prescribing	N/A	1821605791	0	0	GASTON, DIANE F LCSW	6/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19064	N/A	N/A	N/A	N/A	N/A	9815 CARROLL CANYON RD.	STE 101	SAN DIEGO	CA	92131	1123	00	06000	32.90339916	-117.1154328	San Diego County
348251	Ordering, Referring, Prescribing	N/A	1821651779	0	0	GANDHI, ANAND D MD	9/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	A178494	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
348266	Ordering, Referring, Prescribing	N/A	1821685934	0	0	GUERENA, ANTHONY B LMFT	9/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51710	N/A	N/A	N/A	N/A	N/A	2270 HOTEL CIR N	None	SAN DIEGO	CA	92108	2810	00	06000	32.76002431	-117.1859978	San Diego County
348273	Ordering, Referring, Prescribing	N/A	1821705138	0	0	GONZALEZ AMBROSINO, BARBARA E DDS	1/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108528	N/A	N/A	N/A	N/A	N/A	1215 JEFFERSON ST	None	DELANO	CA	93215	2203	00	06000	35.77250027	-119.2451029	Kern County
348291	Ordering, Referring, Prescribing	N/A	1821768060	0	0	GALVEZ, MIGUEL	1/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85149	N/A	N/A	N/A	N/A	N/A	1099 E HOSPITALITY LN	None	SAN BERNARDINO	CA	92408	2813	00	06000	34.06887134	-117.2625206	San Bernardino County
348308	Ordering, Referring, Prescribing	N/A	1821867201	0	0	GOSWAMI, KARANVIR PHARMD	12/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88984	N/A	N/A	N/A	N/A	N/A	103 W AMERICAN CANYON RD	None	AMERICAN CANYON	CA	94503	1112	00	06000	38.16553476	-122.2545326	Napa County
348321	Ordering, Referring, Prescribing	N/A	1831188291	0	0	GOODMAN, REBECCA S PHD	5/27/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY14559	N/A	N/A	N/A	N/A	N/A	5266 HOLLISTER AVE	A-104	GOLETA	CA	93111	2037	00	06000	34.43497016	-119.8071895	Santa Barbara County
348322	Ordering, Referring, Prescribing	N/A	1831178334	0	0	GILLERAN, LOUIS G MD	6/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51060	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS ST	None	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
348324	Ordering, Referring, Prescribing	N/A	1831174184	0	0	GAILIUNAS, PAUL MD	3/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A103027	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	5000	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
348326	Ordering, Referring, Prescribing	N/A	1831200591	0	0	GROSZ, DANIEL E MD	11/23/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A49772	N/A	N/A	N/A	N/A	N/A	15305 RAYEN ST	None	NORTH HILLS	CA	91343	5117	00	06000	34.23191048	-118.4657625	Los Angeles County
348328	Ordering, Referring, Prescribing	N/A	1831213792	0	0	GUTHMAN, ALEX N LCSW	8/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28238	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
348332	Ordering, Referring, Prescribing	N/A	1831216712	0	0	GONZALEZ, JOE LMFT	5/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126214	N/A	N/A	N/A	N/A	N/A	232 E CANON PERDIDO ST	None	SANTA BARBARA	CA	93101	2242	00	06000	34.42349188	-119.6973758	Santa Barbara County
348351	Ordering, Referring, Prescribing	N/A	1831237114	0	0	GROSSMAN, MARC L	3/10/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	D26311	N/A	N/A	N/A	N/A	N/A	228 GREEN VALLEY RD	None	FREEDOM	CA	95019	3136	00	06000	36.93777813	-121.7711905	Santa Cruz County
348395	Ordering, Referring, Prescribing	N/A	1831353275	0	0	GOODMAN, CAMMI MD	12/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A93878	N/A	N/A	N/A	N/A	N/A	319 N SOTO ST	None	LOS ANGELES	CA	90033	1837	00	06000	34.04738335	-118.2074729	Los Angeles County
348429	Ordering, Referring, Prescribing	N/A	1831445139	0	0	GUNSALUS, LESLIE E LCSW	3/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26101	N/A	N/A	N/A	N/A	N/A	391 TAYLOR BLVD.	100	PLEASANT HILL	CA	94523	2289	00	06000	37.96119614	-122.070409	Contra Costa County
348456	Ordering, Referring, Prescribing	N/A	1831487438	0	0	GOENJIAN, HAIG A MD	12/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123098	N/A	N/A	N/A	N/A	N/A	43807 10TH ST W	D	LANCASTER	CA	93534	4805	00	06000	34.6788	-118.1479295	Los Angeles County
348515	Ordering, Referring, Prescribing	N/A	1831576289	0	0	GUTIERREZ, CLAUDIA P LMFT	1/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124159	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
348518	Ordering, Referring, Prescribing	N/A	1831583392	0	0	GENG, YIFAN MD	5/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144139	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
348526	Ordering, Referring, Prescribing	N/A	1831592500	0	0	GOMEZ, KEITY LCSW	6/3/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95170	N/A	N/A	N/A	N/A	N/A	957 S VILLAGE OAKS DR	None	COVINA	CA	91724	3696	00	06000	34.07216025	-117.8631234	Los Angeles County
348528	Ordering, Referring, Prescribing	N/A	1831596485	0	0	GUTIERREZ, YESENIA LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105811	N/A	N/A	N/A	N/A	N/A	6301 BEACH BLVD	245	BUENA PARK	CA	90621	2840	00	06000	33.86880928	-117.9983013	Orange County
348531	Ordering, Referring, Prescribing	N/A	1831605666	0	0	GHORBANDI, ABDUL S PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76912	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
348539	Ordering, Referring, Prescribing	N/A	1831616069	0	0	GATZLAFF, MORGAN PHARMD	2/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	75940	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
348540	Ordering, Referring, Prescribing	N/A	1831614890	0	0	GOLPER, NATASHA LCSW	12/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99036	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
348562	Ordering, Referring, Prescribing	N/A	1831649482	0	0	GONZALEZ, PRISCILLA B LMFT	5/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125837	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
348577	Ordering, Referring, Prescribing	N/A	1831664085	0	0	GO, CLEMROSE G NP	10/3/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010209	N/A	N/A	N/A	N/A	N/A	101 E BEVERLY BLVD	STE 404	MONTEBELLO	CA	90640	4317	00	06000	34.01556395	-118.0983878	Los Angeles County
348581	Ordering, Referring, Prescribing	N/A	1831671726	0	0	GRAVES, KATHERINE A LMFT	9/19/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41134	N/A	N/A	N/A	N/A	N/A	5801 SUNDALE AVE	None	BAKERSFIELD	CA	93309	2924	00	06000	35.34387226	-119.0654328	Kern County
348595	Ordering, Referring, Prescribing	N/A	1831682400	0	0	GERMER, CHRISTOPHER D LCSW	2/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106853	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
348629	Ordering, Referring, Prescribing	N/A	1831723519	0	0	GONZALES, PATRINELLA RN CPNP	3/2/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	604056	N/A	N/A	N/A	N/A	N/A	81-833 DOCTOR CARREON BL	SUITE 6	INDIO	CA	92201	5590	00	06000	33.70743317	-116.2302643	Riverside County
348637	Ordering, Referring, Prescribing	N/A	1831745298	0	0	GROSCOST, KAILEE LMFT	5/29/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147133	N/A	N/A	N/A	N/A	N/A	3545 LONG BEACH BLVD	None	LONG BEACH	CA	92708	5019	00	06000	33.82086796	-118.18938	Los Angeles County
348657	Ordering, Referring, Prescribing	N/A	1831791060	0	0	GARCIA, LILLIAN OT	6/30/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT21325	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
348674	Ordering, Referring, Prescribing	N/A	1831848191	0	0	GUILLERY, NICOLE J MD	12/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189577	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
348725	Ordering, Referring, Prescribing	N/A	1841233590	0	0	GILKISON, RICHARD OD	12/10/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	9247	N/A	N/A	N/A	N/A	N/A	14550 MONO WAY	None	SONORA	CA	95370	8852	00	06000	37.97776041	-120.3258633	Tuolumne County
348837	Ordering, Referring, Prescribing	N/A	1841492915	0	0	GABBUR, GOPAL K MD	12/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A103073	N/A	N/A	N/A	N/A	N/A	2677 ZOE AVE	301	HUNTINGTON PARK	CA	90255	4195	00	06000	33.9793143	-118.2230319	Los Angeles County
348838	Ordering, Referring, Prescribing	N/A	1841491834	0	0	GUERRERO, BROOKE E PSYD	4/28/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23648	N/A	N/A	N/A	N/A	N/A	3301 EAST 12TH STREET	SUITE 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
348860	Ordering, Referring, Prescribing	N/A	1841541455	0	0	GAITER, RICHELLE M PA-C	4/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	52956	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
348864	Ordering, Referring, Prescribing	N/A	1841542677	0	0	GONZALEZ, VERONICA LMFT	11/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53162	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
348875	Ordering, Referring, Prescribing	N/A	1841551033	0	0	GAMBLE, JUSTINE NP	7/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031365	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
348878	Ordering, Referring, Prescribing	N/A	1841552197	0	0	GALLEGO, CHARMAINE B PHARMD	10/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	52827	N/A	N/A	N/A	N/A	N/A	976 LENZEN AVE	None	SAN JOSE	CA	95126	2737	00	06000	37.33463902	-121.9121497	Santa Clara County
348886	Ordering, Referring, Prescribing	N/A	1841566007	0	0	GIDVANI, VINITA K MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129621	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
348919	Ordering, Referring, Prescribing	N/A	1841604048	0	0	GOPALAKRISHNAN, KHUSHBU A	3/31/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	D64815	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
348936	Ordering, Referring, Prescribing	N/A	1841646619	0	0	GOMEZ, RAFAEL LMFT	7/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113350	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
348977	Ordering, Referring, Prescribing	N/A	1841707775	0	0	GONZALEZ, ROY M LMFT	5/5/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139464	N/A	N/A	N/A	N/A	N/A	1720 MARCO POLO WAY	SUITE E	BURLINGAME	CA	94010	4512	00	06000	37.58986055	-122.3842811	San Mateo County
349038	Ordering, Referring, Prescribing	N/A	1841787116	0	0	GALERKIN, STEVEN PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77943	N/A	N/A	N/A	N/A	N/A	1301 FRANKLIN ST	None	SAN FRANCISCO	CA	94109	0000	00	06000	37.78660422	-122.4232673	San Francisco County
349048	Ordering, Referring, Prescribing	N/A	1841804564	0	0	GARCIA, DEBORAH C PHARMD	2/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83111	N/A	N/A	N/A	N/A	N/A	2355 E COLORADO BLVD	None	PASADENA	CA	91107	1104	00	06000	34.14762	-118.102077	Los Angeles County
349055	Ordering, Referring, Prescribing	N/A	1841823119	0	0	GIRGIS, MINA W PHARMD	11/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82100	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
349067	Ordering, Referring, Prescribing	N/A	1841852498	0	0	GOU, DEBBY PHARMD	10/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77386	N/A	N/A	N/A	N/A	N/A	143 N MAIN STREET	None	MILPITAS	CA	95035	4322	00	06000	37.43224087	-121.9073351	Santa Clara County
349071	Ordering, Referring, Prescribing	N/A	1841857729	0	0	GONZALEZ, ANDRES CA	3/19/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	15708	N/A	N/A	N/A	N/A	N/A	1130 2ND ST	None	ENCINITAS	CA	92024	5008	00	06000	33.03747413	-117.2936839	San Diego County
349124	Ordering, Referring, Prescribing	N/A	1851026959	0	0	GONZALEZ, CELENE	10/5/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150389	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	STE 101-180	OJAI	CA	93023	9998	00	06000	34.44760276	-119.2488095	Ventura County
349125	Ordering, Referring, Prescribing	N/A	1851024772	0	0	GONZALES, GILLIAN PHARMD	8/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	87992	N/A	N/A	N/A	N/A	N/A	5755 COTTLE RD	BLDG 20	SAN JOSE	CA	95123	3640	00	06000	37.246896	-121.8040865	Santa Clara County
349137	Ordering, Referring, Prescribing	N/A	1851050512	0	0	GLUECK, SIMONE LCSW	9/5/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74512	N/A	N/A	N/A	N/A	N/A	15301 TYLER FOOTE RD	None	NEVADA CITY	CA	95959	9318	00	06000	39.36622661	-121.0368658	Nevada County
349145	Ordering, Referring, Prescribing	N/A	1851138465	0	0	GOLLIHER, CECILIA M CNP	7/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031024	N/A	N/A	N/A	N/A	N/A	5427 E WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	00	06000	34.01965704	-118.1535896	Los Angeles County
349176	Ordering, Referring, Prescribing	N/A	1851420335	0	0	GONZALEZ, MARIBEL MD	3/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A62736	N/A	N/A	N/A	N/A	N/A	7600 GRAVES AVE	None	ROSEMEAD	CA	91770	3414	00	06000	34.05533251	-118.1034315	Los Angeles County
349182	Ordering, Referring, Prescribing	N/A	1851423677	0	0	GONZALEZ, CESAR E LMFT	12/22/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107149	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
349219	Ordering, Referring, Prescribing	N/A	1851458194	0	0	GREVE, ROBERT DC	3/3/2024	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	23825	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	8000	00	06000	0	0	None
349221	Ordering, Referring, Prescribing	N/A	1851476840	0	0	GARCIA, PAUL A LCSW	2/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	19007	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
349224	Ordering, Referring, Prescribing	N/A	1851484794	0	0	GILL, HARPREET K	7/11/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D52859	N/A	N/A	N/A	N/A	N/A	12150 NEW YORK RANCH RD	None	JACKSON	CA	95642	9407	00	06000	38.38476766	-120.7396521	Amador County
349227	Ordering, Referring, Prescribing	N/A	1851494959	0	0	GUMP-NOSS, MARCIA R LMFT	9/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43608	N/A	N/A	N/A	N/A	N/A	3161 DWIGHT RD.	None	ELK GROVE	CA	95758	6456	00	06000	38.427372	-121.4606025	Sacramento County
349241	Ordering, Referring, Prescribing	N/A	1851523955	0	0	GRAYSON, LOURDES MD	8/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111804	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	250	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
349266	Ordering, Referring, Prescribing	N/A	1851605521	0	0	GALLAGHER, DIANA F	5/20/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0733218	N/A	N/A	N/A	N/A	N/A	2100 CAPITOL AVE	None	SACRAMENTO	CA	95816	5721	00	06000	38.572722	-121.479849	Sacramento County
349267	Ordering, Referring, Prescribing	N/A	1851603328	0	0	GUTIERREZ, ALICIA LCSW	8/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109849	N/A	N/A	N/A	N/A	N/A	4500 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	3275	00	06000	33.78808863	-118.1399827	Los Angeles County
349272	Ordering, Referring, Prescribing	N/A	1851607691	0	0	GUTIERREZ, SENOVIA LCSW	7/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95883	N/A	N/A	N/A	N/A	N/A	476 E WASHINGTON ST	None	EARLIMART	CA	93219	9694	00	06000	35.88432304	-119.2715669	Tulare County
349290	Ordering, Referring, Prescribing	N/A	1851639827	0	0	GONZALES, ANGELICA PSYD	2/3/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	33160	N/A	N/A	N/A	N/A	N/A	17777 CENTER COURT DRIVE	None	CERRITOS	CA	90703	8575	00	06000	33.8693357	-118.0609689	Los Angeles County
349338	Ordering, Referring, Prescribing	N/A	1851707954	0	0	GREEN, ASHLEY LMFT	9/28/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112738	N/A	N/A	N/A	N/A	N/A	2030 HARTNELL AVE	D	REDDING	CA	96002	5070	00	06000	40.56375148	-122.333535	Shasta County
349351	Ordering, Referring, Prescribing	N/A	1851718498	0	0	GUZMAN, MAYRA I PHARMD	1/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70264	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
349354	Ordering, Referring, Prescribing	N/A	1851724504	0	0	GALICIA-MARTINEZ, ELVIA P LCSW	3/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78743	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
349374	Ordering, Referring, Prescribing	N/A	1851753263	0	0	GRANADOS VELEZ, DIANA LCSW	2/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120901	N/A	N/A	N/A	N/A	N/A	840 N. AVENUE 66	None	LOS ANGELES	CA	90042	0000	00	06000	34.12110842	-118.1725545	Los Angeles County
349387	Ordering, Referring, Prescribing	N/A	1851768154	0	0	GARCIA, NANCI LCSW	9/29/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118343	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
349388	Ordering, Referring, Prescribing	N/A	1851771497	0	0	GREIDER-SIDERIS, KELSI L MD	11/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147131	N/A	N/A	N/A	N/A	N/A	2067 W VISTA WAY	120	VISTA	CA	92083	6032	00	06000	33.18505594	-117.285958	San Diego County
349398	Ordering, Referring, Prescribing	N/A	1851781173	0	0	GONSALVES, DESANNE PA	4/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53611	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVE	STE 475	LOS ANGELES	CA	90017	0449	00	06000	34.04532806	-118.258462	Los Angeles County
349413	Ordering, Referring, Prescribing	N/A	1851806301	0	0	GREGOR, ADINA R NP	8/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008081	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	0000	00	06000	34.42887662	-119.7237878	Santa Barbara County
349419	Ordering, Referring, Prescribing	N/A	1851820716	0	0	GONZALES, REBEKAH A LMFT	8/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121295	N/A	N/A	N/A	N/A	N/A	1000 GOODRICH BLVD	None	COMMERCE	CA	90022	5103	00	06000	34.01730604	-118.1549572	Los Angeles County
349433	Ordering, Referring, Prescribing	N/A	1851834873	0	0	GONZALEZ, JUSTINE ARIEL G PT	2/5/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	292482	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
349449	Ordering, Referring, Prescribing	N/A	1851856728	0	0	GHACHA, SHAHINAZ PHARMD	12/15/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80036	N/A	N/A	N/A	N/A	N/A	1212 FOREST AVE	None	PACIFIC GROVE	CA	93950	5123	00	06000	36.60510796	-121.9208349	Monterey County
349497	Ordering, Referring, Prescribing	N/A	1851943831	0	0	GREEN, SARAH PA-C	12/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA57520	N/A	N/A	N/A	N/A	N/A	10956 DONNER PASS ROAD	None	TRUCKEE	CA	96161	4861	00	06000	39.32625521	-120.2012059	Nevada County
349503	Ordering, Referring, Prescribing	N/A	1851959365	0	0	GUZMAN, JANETH M LMFT	3/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125033	N/A	N/A	N/A	N/A	N/A	1051 PICADOR BLVD	None	SAN DIEGO	CA	92154	3548	00	06000	32.57614401	-117.0562098	San Diego County
349518	Ordering, Referring, Prescribing	N/A	1861011959	0	0	GOLOMB, DANIELLE MD	9/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	189932	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
349536	Ordering, Referring, Prescribing	N/A	1861044240	0	0	GELBER, LINDSEY A	7/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57128	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
349566	Ordering, Referring, Prescribing	N/A	1861133969	0	0	GORRAIZ, GREGORY MD	12/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189205	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
349636	Ordering, Referring, Prescribing	N/A	1861550238	0	0	GROEN, MELANIE K LCSW	1/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29350	N/A	N/A	N/A	N/A	N/A	2275 S. MAIN ST.	STE 201	CORONA	CA	92882	5303	00	06000	33.85511663	-117.5694892	Riverside County
349652	Ordering, Referring, Prescribing	N/A	1861586570	0	0	GANDY, MELISSA A LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45414	N/A	N/A	N/A	N/A	N/A	855 CANYON ROAD	None	REDDING	CA	96001	5544	00	06000	40.48978049	-122.3926387	Shasta County
349657	Ordering, Referring, Prescribing	N/A	1861613614	0	0	GOGTE, PRIYA G	11/30/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D49101	N/A	N/A	N/A	N/A	N/A	55 E JULIAN ST	None	SAN JOSE	CA	95112	4007	00	06000	37.34118198	-121.8925795	Santa Clara County
349660	Ordering, Referring, Prescribing	N/A	1861619223	0	0	GORDON, YVONNE A LMFT	4/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49038	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
349662	Ordering, Referring, Prescribing	N/A	1861630568	0	0	GROSS, ZERRI A LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94267	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
349663	Ordering, Referring, Prescribing	N/A	1861630998	0	0	GRAY, NICOLE C PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67168	N/A	N/A	N/A	N/A	N/A	3009 BROADWAY	None	OAKLAND	CA	94611	5712	00	06000	37.81907291	-122.2621457	Alameda County
349678	Ordering, Referring, Prescribing	N/A	1861662702	0	0	GMOSER, MARK PSYD	10/1/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30893	N/A	N/A	N/A	N/A	N/A	954 W. FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
349746	Ordering, Referring, Prescribing	N/A	1861786311	0	0	GALLONIO, DENISE PSYD	1/8/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30070	N/A	N/A	N/A	N/A	N/A	532 E COLORADO BLVD	None	PASADENA	CA	91101	2044	00	06000	34.14582052	-118.139274	Los Angeles County
349751	Ordering, Referring, Prescribing	N/A	1861792921	0	0	GHARAHBEGI, VARTOO PHARMD	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	48883	N/A	N/A	N/A	N/A	N/A	3233 FOOTHILL BLVD	None	LA CRESCENTA	CA	91214	2636	00	06000	34.23076721	-118.2505251	Los Angeles County
349798	Ordering, Referring, Prescribing	N/A	1861862633	0	0	GUAJARDO, ALICIA LCSW	1/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100759	N/A	N/A	N/A	N/A	N/A	970 EMBARCADERO DEL MAR	None	ISLA VISTA	CA	93117	4869	00	06000	34.411707	-119.857011	Santa Barbara County
349799	Ordering, Referring, Prescribing	N/A	1861868697	0	0	GUERRA, JENNIFER S LCSW	9/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96876	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
349863	Ordering, Referring, Prescribing	N/A	1861963043	0	0	GOSS-MARR, LAUREN-JOY R LMFT	9/22/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128266	N/A	N/A	N/A	N/A	N/A	1625 W OLYMPIC BLVD	SUITE 600	LOS ANGELES	CA	90015	3809	00	06000	34.04957404	-118.2750068	Los Angeles County
349886	Ordering, Referring, Prescribing	N/A	1871002063	0	0	GE, XIFAN PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77134	N/A	N/A	N/A	N/A	N/A	1761 BROADWAY	SUITE 209	VALLEJO	CA	94589	0000	00	06000	38.13049234	-122.2522422	Solano County
349892	Ordering, Referring, Prescribing	N/A	1871010728	0	0	GUTIERREZ, REBECCA R LCSW	7/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123880	N/A	N/A	N/A	N/A	N/A	515 COLUMBIA AVE	200	LOS ANGELES	CA	90017	1209	00	06000	34.05683109	-118.265995	Los Angeles County
349895	Ordering, Referring, Prescribing	N/A	1871014621	0	0	GIMELBERG, YELENA PA-C	7/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	54678	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
349930	Ordering, Referring, Prescribing	N/A	1871065045	0	0	GOMEZ, BRENDA LMFT	1/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130863	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	BUILDING F	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
349940	Ordering, Referring, Prescribing	N/A	1871078444	0	0	GARRETT, JAMIE A	9/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	95010165	N/A	N/A	N/A	N/A	N/A	1008 N CHERRY ST	None	TULARE	CA	93274	2212	00	06000	36.22217583	-119.3376171	Tulare County
349970	Ordering, Referring, Prescribing	N/A	1871119701	0	0	GUERRA, CARINA NP	9/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014540	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
349998	Ordering, Referring, Prescribing	N/A	1871175422	0	0	GUALY, SEBASTIAN MD	10/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7636	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
350012	Ordering, Referring, Prescribing	N/A	1871219204	0	0	GILL, PRABHDEEP CNP	7/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019846	N/A	N/A	N/A	N/A	N/A	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	00	06000	35.37461686	-119.020062	Kern County
350021	Ordering, Referring, Prescribing	N/A	1871229203	0	0	GONZALEZ, DALANA C NP	6/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021288	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3243	00	06000	33.89475493	-118.2080292	Los Angeles County
350035	Ordering, Referring, Prescribing	N/A	1871266890	0	0	GESTOPA, ISMAEL NP	3/17/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017403	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
350037	Ordering, Referring, Prescribing	N/A	1871318063	0	0	GACIAS, MICHAEL A DDS	9/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110831	N/A	N/A	N/A	N/A	N/A	5153 HOLT BLVD	None	MONTCLAIR	CA	91763	4837	00	06000	34.0631015	-117.692694	San Bernardino County
350045	Ordering, Referring, Prescribing	N/A	1871347773	0	0	GALINATO, MELISSA NP	8/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031924	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
350050	Ordering, Referring, Prescribing	N/A	1871371021	0	0	GRAY, ERICA D PHARMD	11/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88517	N/A	N/A	N/A	N/A	N/A	361 E LELAND RD	None	PITTSBURG	CA	94565	4911	00	06000	38.01117823	-121.886514	Contra Costa County
350052	Ordering, Referring, Prescribing	N/A	1871376582	0	0	GRANADOS, JONATHAN	12/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63812	N/A	N/A	N/A	N/A	N/A	430 S BLOSSER RD	None	SANTA MARIA	CA	93458	4908	00	06000	34.94869196	-120.4537258	Santa Barbara County
350073	Ordering, Referring, Prescribing	N/A	1871569855	0	0	GRANT, KIMBERLY G PA-C	4/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57990	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
350104	Ordering, Referring, Prescribing	N/A	1871654566	0	0	GIANNETTA, TEREA A CNP	2/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	335	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	FC62	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
350164	Ordering, Referring, Prescribing	N/A	1871787119	0	0	GALLEGOS-MARTIN, MARIA E LMFT	2/4/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116110	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
350167	Ordering, Referring, Prescribing	N/A	1871790386	0	0	GOMEZ, DIANA LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51629	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
350172	Ordering, Referring, Prescribing	N/A	1871807131	0	0	GARCIA, PERLA M LMFT	6/5/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139832	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
350207	Ordering, Referring, Prescribing	N/A	1871847913	0	0	GEROLAMO, MATTHEW E LCSW	12/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106337	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
350266	Ordering, Referring, Prescribing	N/A	1871926535	0	0	GALDAMEZ, VIANEY M LCSW	1/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96232	N/A	N/A	N/A	N/A	N/A	14659 OLIVE VIEW DR	None	SYLMAR	CA	91342	1652	00	06000	34.32412624	-118.4525494	Los Angeles County
350305	Ordering, Referring, Prescribing	N/A	1871987131	0	0	GUINNESS, RYAN R MD	7/3/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144158	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
350366	Ordering, Referring, Prescribing	N/A	1881068096	0	0	GONZALES, ELIZABETH LMFT	12/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136398	N/A	N/A	N/A	N/A	N/A	730 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6618	00	06000	32.61881028	-117.0245596	San Diego County
350384	Ordering, Referring, Prescribing	N/A	1881087062	0	0	GONZALES, BRITTANY L	10/8/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64267	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
350393	Ordering, Referring, Prescribing	N/A	1881110195	0	0	GALARZA, NAYELI S LMFT	9/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123052	N/A	N/A	N/A	N/A	N/A	1350 ARNOLD DR	102	MARTINEZ	CA	94553	0000	00	06000	37.99217145	-122.0982508	Contra Costa County
350399	Ordering, Referring, Prescribing	N/A	1881118255	0	0	GARCIA, JANET M LMFT	8/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121252	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
350419	Ordering, Referring, Prescribing	N/A	1881153583	0	0	GOMEZ, MIGUEL A LMFT	9/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135015	N/A	N/A	N/A	N/A	N/A	1910 OLYMPIC BLVD	365	WALNUT CREEK	CA	94596	5096	00	06000	37.89453628	-122.0662326	Contra Costa County
350423	Ordering, Referring, Prescribing	N/A	1881155943	0	0	GENIE, DANIEL LMFT	11/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135930	N/A	N/A	N/A	N/A	N/A	6301 BEACH BLVD	245	BUENA PARK	CA	90621	2840	00	06000	33.86880928	-117.9983013	Orange County
350429	Ordering, Referring, Prescribing	N/A	1881170421	0	0	GUERRERO, JESSICA J	2/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100294	N/A	N/A	N/A	N/A	N/A	710 E 111TH PL	None	LOS ANGELES	CA	90059	1518	00	06000	33.93454026	-118.2626368	Los Angeles County
350450	Ordering, Referring, Prescribing	N/A	1881197200	0	0	GENTRY, TANYA N DO	12/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20574	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVE	300	MORENO VALLEY	CA	92555	3901	00	06000	33.91013953	-117.193383	Riverside County
350451	Ordering, Referring, Prescribing	N/A	1881189975	0	0	GANGE, KAREN D NP	4/29/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008986	N/A	N/A	N/A	N/A	N/A	2237 W. BALL ROAD	None	ANAHEIM	CA	92804	5314	00	06000	33.817798	-117.9610599	Orange County
350452	Ordering, Referring, Prescribing	N/A	1881198554	0	0	GARCIA, RICHARD R LCSW	8/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28742	N/A	N/A	N/A	N/A	N/A	2630 FIRST AVE	None	SAN DIEGO	CA	92103	6599	00	06000	32.73288727	-117.1639712	San Diego County
350458	Ordering, Referring, Prescribing	N/A	1881199230	0	0	GREEN, JONI M LMFT	12/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102767	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH ST	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
350472	Ordering, Referring, Prescribing	N/A	1881237303	0	0	GANN, EMILY LCSW	4/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121970	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
350495	Ordering, Referring, Prescribing	N/A	1881278687	0	0	GONZALES, WAIDE H PA-C	9/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60135	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
350498	Ordering, Referring, Prescribing	N/A	1881279131	0	0	GARZA, MATTHEW A LMFT	4/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146655	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
350499	Ordering, Referring, Prescribing	N/A	1881290252	0	0	GUZMAN, EDWIN J PA-C	2/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59113	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
350501	Ordering, Referring, Prescribing	N/A	1881293595	0	0	GOLDRING, LIRON M LCSW	10/10/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW126698	N/A	N/A	N/A	N/A	N/A	7290 EL CAJON BOULEVARD	None	SAN DIEGO	CA	92115	1829	00	06000	32.76884635	-117.0406752	San Diego County
350517	Ordering, Referring, Prescribing	N/A	1881381465	0	0	GUTIERREZ, ARACELI NP	4/17/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024875	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
350533	Ordering, Referring, Prescribing	N/A	1881469435	0	0	GONZALEZ, MAIELY O CCC-SLP	9/19/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	35920	N/A	N/A	N/A	N/A	N/A	18200 MOUNTAIN VIEW ROAD	None	BOONVILLE	CA	95415	0457	00	06000	39.01069417	-123.3768102	Mendocino County
350558	Ordering, Referring, Prescribing	N/A	1881718781	0	0	GORHAM, NICCI C LCSW	5/20/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29846	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
350599	Ordering, Referring, Prescribing	N/A	1881777167	0	0	GUTHRIE, ANDREA C	11/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49387	N/A	N/A	N/A	N/A	N/A	2725 LOYOLA DR	None	DAVIS	CA	95618	1554	00	06000	38.55793835	-121.7185658	Yolo County
350606	Ordering, Referring, Prescribing	N/A	1881784049	0	0	GUTIERREZ, HUMBERTO A DO	5/15/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7232	N/A	N/A	N/A	N/A	N/A	1818 N ORANGE GROVE AVE	None	POMONA	CA	91767	3028	00	06000	34.07694934	-117.7489598	Los Angeles County
350611	Ordering, Referring, Prescribing	N/A	1881795763	0	0	GLADSTEIN, ANDREA B MD	3/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	G60217	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
350635	Ordering, Referring, Prescribing	N/A	1881863496	0	0	GARRO, BRENDA L MD	7/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A121624	N/A	N/A	N/A	N/A	N/A	180 NEWPORT CENTER DR	235	NEWPORT BEACH	CA	92660	0903	00	06000	33.61250509	-117.8753746	Orange County
350645	Ordering, Referring, Prescribing	N/A	1881906642	0	0	GIANG, NGAN PHARMD	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62513	N/A	N/A	N/A	N/A	N/A	1 KAISER PLZ	None	OAKLAND	CA	94612	3610	00	06000	37.81002645	-122.2645032	Alameda County
350653	Ordering, Referring, Prescribing	N/A	1881927820	0	0	GUIDERA, BENET E LCSW	11/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96514	N/A	N/A	N/A	N/A	N/A	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	00	06000	39.5205105	-122.2082775	Glenn County
350665	Ordering, Referring, Prescribing	N/A	1881945178	0	0	GONZALES, LISA R LPCC	2/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC9211	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
350677	Ordering, Referring, Prescribing	N/A	1881959575	0	0	GARCIA, IRMA LMFT	8/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134334	N/A	N/A	N/A	N/A	N/A	370 S CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
350721	Ordering, Referring, Prescribing	N/A	1891040135	0	0	GLEASON, ANNE B NP	11/5/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN838269	N/A	N/A	N/A	N/A	N/A	711 W. FLORENCE AVENUE	None	LOS ANGELES	CA	90044	6105	00	06000	33.9746755	-118.286415	Los Angeles County
350741	Ordering, Referring, Prescribing	N/A	1891076329	0	0	GREEN, MARCEL MD	7/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C163703	N/A	N/A	N/A	N/A	N/A	592 RIO LINDO AVE	None	CHICO	CA	95926	1817	00	06000	39.75427022	-121.8482553	Butte County
350758	Ordering, Referring, Prescribing	N/A	1891096871	0	0	GADDAM, KALYAN	11/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	420	N/A	N/A	N/A	N/A	N/A	1510 E MAIN ST	STE 104B	SANTA MARIA	CA	93454	4825	00	06000	34.95282793	-120.4100798	Santa Barbara County
350770	Ordering, Referring, Prescribing	N/A	1891115507	0	0	GREENE, DANIELLE M LMFT	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97554	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
350776	Ordering, Referring, Prescribing	N/A	1891126264	0	0	GAYOSO, ERIKA M LMFT	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91195	N/A	N/A	N/A	N/A	N/A	1420 S MILLIKEN AVE	508	ONTARIO	CA	91761	2336	00	06000	34.047684	-117.55872	San Bernardino County
350802	Ordering, Referring, Prescribing	N/A	1891163374	0	0	GONZALEZ BARAJAS, BRENDA MSW LCSW	12/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99236	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
350809	Ordering, Referring, Prescribing	N/A	1891169033	0	0	GOMEZ, MARICELA LMFT	11/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123206	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
350815	Ordering, Referring, Prescribing	N/A	1891178091	0	0	GONZALES, AARON J LMFT	5/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118103	N/A	N/A	N/A	N/A	N/A	802 BREWSTER AVE	None	REDWOOD CITY	CA	94063	1510	00	06000	37.48873991	-122.2339433	San Mateo County
350833	Ordering, Referring, Prescribing	N/A	1891203105	0	0	GLASCOX, ZACH PA	3/13/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64241	N/A	N/A	N/A	N/A	N/A	728 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3052	00	06000	33.12769389	-117.0730873	San Diego County
350867	Ordering, Referring, Prescribing	N/A	1891264198	0	0	GHOMAN, SONAM NP	2/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029652	N/A	N/A	N/A	N/A	N/A	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	00	06000	37.36514449	-121.8292446	Santa Clara County
350868	Ordering, Referring, Prescribing	N/A	1891253662	0	0	GEIS, JAMIE M RN	7/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	834826	N/A	N/A	N/A	N/A	N/A	7311 ROSEDALE HWY	None	BAKERSFIELD	CA	93308	5738	00	06000	35.38329551	-119.083689	Kern County
350876	Ordering, Referring, Prescribing	N/A	1891281085	0	0	GALVEZ, JONATHAN P	3/21/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102695	N/A	N/A	N/A	N/A	N/A	1845 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
350880	Ordering, Referring, Prescribing	N/A	1891292470	0	0	GARCIA, KAOMA Y LCSW	8/14/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117388	N/A	N/A	N/A	N/A	N/A	3576 ARLINGTON AVE	STE 100	RIVERSIDE	CA	92506	3907	00	06000	33.94625192	-117.3913739	Riverside County
350888	Ordering, Referring, Prescribing	N/A	1891314464	0	0	GARCIA, MICHAEL MD	2/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176743	N/A	N/A	N/A	N/A	N/A	555 TECHNOLOGY CT	None	RIVERSIDE	CA	92507	2155	00	06000	34.00024862	-117.32403	Riverside County
350896	Ordering, Referring, Prescribing	N/A	1891339354	0	0	GIL, SARAH L NP	2/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020002	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
350905	Ordering, Referring, Prescribing	N/A	1891346136	0	0	GOODROAD, NICOLE CNP	1/14/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	CP001646	N/A	N/A	N/A	N/A	N/A	911 E 20TH ST	SUITE 700	SIOUX FALLS	SD	57105	1049	00	06000	43.534557	-96.7141485	Minnehaha County
350954	Ordering, Referring, Prescribing	N/A	1891463782	0	0	GILL, PAVNEET K PHARMD	8/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	84993	N/A	N/A	N/A	N/A	N/A	4500 COFFEE RD	None	BAKERSFIELD	CA	93308	5025	00	06000	35.400177	-119.092101	Kern County
350986	Ordering, Referring, Prescribing	N/A	1891814901	0	0	GOMEZ, GLORIA J LMFT	11/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129464	N/A	N/A	N/A	N/A	N/A	11429 VALLEY BLVD	None	EL MONTE	CA	91731	3229	00	06000	34.06953065	-118.0288485	Los Angeles County
351002	Ordering, Referring, Prescribing	N/A	1891826178	0	0	GUILLERMO, LORENA F LMFT	1/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46774	N/A	N/A	N/A	N/A	N/A	6305 WOODMAN AVE	None	VAN NUYS	CA	91401	0001	00	06000	34.185132	-118.4312985	Los Angeles County
351008	Ordering, Referring, Prescribing	N/A	1891831582	0	0	GRANT, MARY L NP	3/12/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	683944	N/A	N/A	N/A	N/A	N/A	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	00	06000	34.1035953	-117.2563723	San Bernardino County
351050	Ordering, Referring, Prescribing	N/A	1891947297	0	0	GALINDO, JOEL LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82454	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
351070	Ordering, Referring, Prescribing	N/A	1891980561	0	0	GALLO, ANN K LCSW	5/23/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65668	N/A	N/A	N/A	N/A	N/A	205 SOUTH ST	None	FORT BRAGG	CA	95437	5540	00	06000	39.43009931	-123.8032471	Mendocino County
351073	Ordering, Referring, Prescribing	N/A	1891989356	0	0	GARCIA, ALEX T LMFT	2/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91257	N/A	N/A	N/A	N/A	N/A	460 E CARSON PLAZA DR	100	CARSON	CA	90746	3228	00	06000	33.84594175	-118.2663997	Los Angeles County
351107	Ordering, Referring, Prescribing	N/A	1902060957	0	0	GOLDMAN, AUDREY LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC16074	N/A	N/A	N/A	N/A	N/A	14600 SHERMAN WAY	SUITE 100D	VAN NUYS	CA	91405	2283	00	06000	34.20025916	-118.4500763	Los Angeles County
351110	Ordering, Referring, Prescribing	N/A	1902058944	0	0	GONZALEZ, MARYHELEN LMFT	10/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116209	N/A	N/A	N/A	N/A	N/A	819 S. BRIDGE ST	None	VISALIA	CA	93277	0004	00	06000	36.320706	-119.2891095	Tulare County
351118	Ordering, Referring, Prescribing	N/A	1902091481	0	0	GESSESSE, HIRUY H MD	9/9/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101106	N/A	N/A	N/A	N/A	N/A	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	00	06000	33.8102385	-118.3441185	Los Angeles County
351124	Ordering, Referring, Prescribing	N/A	1902106370	0	0	GRAY, HEIDI E LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84787	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE.	None	OAKLAND	CA	94602	3399	00	06000	37.8007257	-122.2064578	Alameda County
351168	Ordering, Referring, Prescribing	N/A	1902172042	0	0	GILANI, MORGAN L MD	7/19/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128217	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
351174	Ordering, Referring, Prescribing	N/A	1902180441	0	0	GILMORE, LESLIE M LCSW	12/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66151	N/A	N/A	N/A	N/A	N/A	4400 ALMA AVE	None	CASTRO VALLEY	CA	94546	0146	00	06000	37.7077439	-122.0718725	Alameda County
351256	Ordering, Referring, Prescribing	N/A	1902310543	0	0	GONG, JIAN PHARMD	4/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	77645	N/A	N/A	N/A	N/A	N/A	9000 MING AVE	None	BAKERSFIELD	CA	93311	1318	00	06000	35.33989328	-119.1034715	Kern County
351257	Ordering, Referring, Prescribing	N/A	1902308307	0	0	GARCIA-GUZMAN, SUSANA LMFT	11/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT143107	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
351258	Ordering, Referring, Prescribing	N/A	1902310071	0	0	GOSPARINI, GINA OT	12/9/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	20618	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
351301	Ordering, Referring, Prescribing	N/A	1902391717	0	0	GUTIERREZ, JACOB J MD	3/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163989	N/A	N/A	N/A	N/A	N/A	631A MAPLE AVENUE	None	LOS ANGELES	CA	90014	2211	00	06000	34.04327665	-118.2485423	Los Angeles County
351338	Ordering, Referring, Prescribing	N/A	1902506892	0	0	GIESE, AMY CNP	10/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016876	N/A	N/A	N/A	N/A	N/A	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
351359	Ordering, Referring, Prescribing	N/A	1902673445	0	0	GUO, SOPHIA DMD	2/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	109651	N/A	N/A	N/A	N/A	N/A	1870 LUNDY AVE	None	SAN JOSE	CA	95131	1826	00	06000	37.39271022	-121.8903238	Santa Clara County
351365	Ordering, Referring, Prescribing	N/A	1902679988	0	0	GANDHI, SWETA R NP	4/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020267	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
351367	Ordering, Referring, Prescribing	N/A	1902687767	0	0	GHOBADI, TAHMEENEH PHARMD	9/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88410	N/A	N/A	N/A	N/A	N/A	2955 N TEGNER RD	None	TURLOCK	CA	95380	9401	00	06000	37.518768	-120.888963	Stanislaus County
351378	Ordering, Referring, Prescribing	N/A	1902830060	0	0	GONZALEZ, AIMEE MD	4/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51815	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
351391	Ordering, Referring, Prescribing	N/A	1902910649	0	0	GORELIK, ASHER MD	6/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G88993	N/A	N/A	N/A	N/A	N/A	928 BROADWAY	None	SAN DIEGO	CA	92101	5514	00	06000	32.71575045	-117.1560915	San Diego County
351401	Ordering, Referring, Prescribing	N/A	1902926587	0	0	GARZA-RODRIGUEZ, MICHELLE I LCSW	6/19/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24798	N/A	N/A	N/A	N/A	N/A	954 W. FOOTHILL BLVD.	SUITE A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
351403	Ordering, Referring, Prescribing	N/A	1902929078	0	0	GALLAGHER, JAMIE A LMFT	12/31/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111518	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
351447	Ordering, Referring, Prescribing	N/A	1902994122	0	0	GREWAL, MANINDER P PHARMD	3/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53984	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	None	MODESTO	CA	95356	5357	00	06000	37.706508	-121.052457	Stanislaus County
351451	Ordering, Referring, Prescribing	N/A	1912013533	0	0	GAITAN, SCOTT A MD	5/27/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A65333	N/A	N/A	N/A	N/A	N/A	23521 PASEO DE VALENCIA	STE 200	LAGUNA HILLS	CA	92653	3101	00	06000	33.61113028	-117.7126684	Orange County
351479	Ordering, Referring, Prescribing	N/A	1912062274	0	0	GIARDINA, FRANK V OD	5/5/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	8725	N/A	N/A	N/A	N/A	N/A	150 TEJAS PL	None	NIPOMO	CA	93444	9123	00	06000	35.02661565	-120.4990048	San Luis Obispo County
351482	Ordering, Referring, Prescribing	N/A	1912063108	0	0	GUERRA, KRISTINE M LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50115	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
351530	Ordering, Referring, Prescribing	N/A	1912188558	0	0	GILMORE, MELINDA S MD	5/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A42561	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2414	00	06000	33.99703164	-118.1499826	Los Angeles County
351554	Ordering, Referring, Prescribing	N/A	1912232059	0	0	GALLEGOS, LISA R	5/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65614	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
351581	Ordering, Referring, Prescribing	N/A	1912282922	0	0	GROSSMAN, ANGELA PSYD	1/4/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26412	N/A	N/A	N/A	N/A	N/A	11716 ENTERPRISE DR	None	AUBURN	CA	95603	3732	00	06000	38.90720197	-121.0838099	Placer County
351605	Ordering, Referring, Prescribing	N/A	1912293747	0	0	GEORGE, ALEXIS K LCSW	7/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66592	N/A	N/A	N/A	N/A	N/A	3132 JEFFERSON	None	SAN DIEGO	CA	92110	4421	00	06000	32.75567499	-117.203517	San Diego County
351610	Ordering, Referring, Prescribing	N/A	1912310376	0	0	GARCIA, JORGE LMFT	7/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126904	N/A	N/A	N/A	N/A	N/A	840 GUADALUPE PKWY	238	SAN JOSE	CA	95110	1714	00	06000	37.34957284	-121.9080687	Santa Clara County
351642	Ordering, Referring, Prescribing	N/A	1912344805	0	0	GREEN, LINDSEY M A NP	2/22/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	797839	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLAZA	STE 8501	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
351653	Ordering, Referring, Prescribing	N/A	1912370925	0	0	GUBSER, ASHLEY	1/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	72756	N/A	N/A	N/A	N/A	N/A	1900 SANTA ROSA AVE	None	SANTA ROSA	CA	95407	7621	00	06000	38.419911	-122.7114585	Sonoma County
351702	Ordering, Referring, Prescribing	N/A	1912438615	0	0	GAMACHE, JOEL T LMFT	11/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123327	N/A	N/A	N/A	N/A	N/A	1679 E MAIN ST	STE 102	EL CAJON	CA	92021	5212	00	06000	32.81117533	-116.9193178	San Diego County
351705	Ordering, Referring, Prescribing	N/A	1912454083	0	0	GOMEZ AQUINO, GABRIELA E LCSW	4/5/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100388	N/A	N/A	N/A	N/A	N/A	10605 BALBOA BLVD	100	GRANADA HILLS	CA	91344	6342	00	06000	34.263378	-118.5022965	Los Angeles County
351812	Ordering, Referring, Prescribing	N/A	1912673450	0	0	GOMEZ, YAZMIN	7/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	P2	N/A	N/A	N/A	N/A	N/A	351 FELICE DRIVE	None	HOLLISTER	CA	95023	3361	00	06000	36.85325269	-121.4170104	San Benito County
351821	Ordering, Referring, Prescribing	N/A	1912686387	0	0	GARCIA, PATRICIA NP	3/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024456	N/A	N/A	N/A	N/A	N/A	8902 WOODMAN AVE	None	ARLETA	CA	91331	6401	00	06000	34.23141203	-118.4374526	Los Angeles County
351869	Ordering, Referring, Prescribing	N/A	1922132042	0	0	GREWAL, NAVJOT K	8/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68545	N/A	N/A	N/A	N/A	N/A	3451 W SHAW AVE	101	FRESNO	CA	93711	3242	00	06000	36.805293	-119.855214	Fresno County
351871	Ordering, Referring, Prescribing	N/A	1922133594	0	0	GUERRERO, MARISSA D LMFT	1/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96653	N/A	N/A	N/A	N/A	N/A	401 S STREET	None	SACRAMENTO	CA	95811	6919	00	06000	38.572677	-121.5050805	Sacramento County
351888	Ordering, Referring, Prescribing	N/A	1922170075	0	0	GONG, CINDY F PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49037	N/A	N/A	N/A	N/A	N/A	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3119	00	06000	37.78096053	-122.4637512	San Francisco County
351907	Ordering, Referring, Prescribing	N/A	1922209873	0	0	GUSTAFSON, KATRINA G LMFT	7/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53302	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	None	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
351913	Ordering, Referring, Prescribing	N/A	1922215169	0	0	GLICKSMAN, MICHELLE S LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102829	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DRIVE	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
351923	Ordering, Referring, Prescribing	N/A	1922267111	0	0	GOMEZ, JORGE LMFT	1/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53626	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	1029	00	06000	33.85486409	-118.2905603	Los Angeles County
351924	Ordering, Referring, Prescribing	N/A	1922263128	0	0	GAMBINO, ELISA L PSYD	7/28/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27413	N/A	N/A	N/A	N/A	N/A	21081 S. WESTERN AVE	None	TORRANCE	CA	90501	1707	00	06000	33.83886841	-118.3093605	Los Angeles County
351938	Ordering, Referring, Prescribing	N/A	1922305192	0	0	GONZALEZ, MARCO A OD	3/6/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15034	N/A	N/A	N/A	N/A	N/A	1560 E MANNING AVE	None	REEDLEY	CA	93654	2346	00	06000	36.6041643	-119.4322861	Fresno County
351993	Ordering, Referring, Prescribing	N/A	1922392828	0	0	GORINSTEIN, ERIC MD	11/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155268	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST.	None	CHATSWORTH	CA	91311	0000	00	06000	34.23182352	-118.572948	Los Angeles County
351996	Ordering, Referring, Prescribing	N/A	1922393503	0	0	GRACIANO, MURIEL LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108944	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD	BUILDING A	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94629336	-118.0832752	Los Angeles County
352037	Ordering, Referring, Prescribing	N/A	1922461557	0	0	GOLDBLATT, ARIELLA S MD	6/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168334	N/A	N/A	N/A	N/A	N/A	200 UCLA MEDICAL PLZ	114	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
352072	Ordering, Referring, Prescribing	N/A	1922497478	0	0	GALVAN, TATIANA LCSW	12/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85600	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
352073	Ordering, Referring, Prescribing	N/A	1922499128	0	0	GOLDBERG, ARYEH L MD	1/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152371	N/A	N/A	N/A	N/A	N/A	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	0000	00	06000	34.05373818	-118.3839685	Los Angeles County
352108	Ordering, Referring, Prescribing	N/A	1922553403	0	0	GARAY, JOANNA LPCC	12/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC18265	N/A	N/A	N/A	N/A	N/A	629 THIRD AVE	B	CHULA VISTA	CA	91910	5740	00	06000	32.62977394	-117.0753589	San Diego County
352138	Ordering, Referring, Prescribing	N/A	1922593987	0	0	GARDNER-HOAG, JACQUELINE PT	12/8/2020	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT293971	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	A	REDLANDS	CA	92374	0100	00	06000	34.06427678	-117.2416506	San Bernardino County
352147	Ordering, Referring, Prescribing	N/A	1922619634	0	0	GORITSKAIA, ANNA V	12/28/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105260	N/A	N/A	N/A	N/A	N/A	517 S MADERA AVE	None	KERMAN	CA	93630	1523	00	06000	36.72710606	-120.060325	Fresno County
352151	Ordering, Referring, Prescribing	N/A	1922620657	0	0	GONZALEZ, BETHANIA NP	2/14/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013977	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
352154	Ordering, Referring, Prescribing	N/A	1922647668	0	0	GARNETT, OLIVE N	1/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010798	N/A	N/A	N/A	N/A	N/A	2710 W MANCHESTER	None	INGELWOOD	CA	90305	2436	00	06000	33.9598587	-118.3237499	Los Angeles County
352194	Ordering, Referring, Prescribing	N/A	1922770874	0	0	GRANT, ZANE CNP	9/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018267	N/A	N/A	N/A	N/A	N/A	437 N HOOVER ST	None	LOS ANGELES	CA	90004	2306	00	06000	34.0787811	-118.2844378	Los Angeles County
352206	Ordering, Referring, Prescribing	N/A	1922871136	0	0	GAMI, AMI DDS	10/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109631	N/A	N/A	N/A	N/A	N/A	198 N. G STREET	None	EMPIRE	CA	95319	5132	00	06000	37.64084134	-120.9011164	Stanislaus County
352262	Ordering, Referring, Prescribing	N/A	1932257995	0	0	GARCIA, NELSON A MD	9/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G34864	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
352270	Ordering, Referring, Prescribing	N/A	1932265600	0	0	GUSS, JEE H MD	10/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A108519	N/A	N/A	N/A	N/A	N/A	1420 WILLOW PASS RD	None	CONCORD	CA	94520	5823	00	06000	37.96956948	-122.0507563	Contra Costa County
352293	Ordering, Referring, Prescribing	N/A	1932332699	0	0	GARNER, EMILY C PSY	7/23/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27119	N/A	N/A	N/A	N/A	N/A	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	00	06000	38.95005226	-122.6264492	Lake County
352370	Ordering, Referring, Prescribing	N/A	1932493913	0	0	GUNJA, MURTUZA MD	9/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157402	N/A	N/A	N/A	N/A	N/A	275 THE CROSSROADS BLVD	None	CARMEL	CA	93923	8684	00	06000	36.53645751	-121.9089649	Monterey County
352379	Ordering, Referring, Prescribing	N/A	1932518198	0	0	GARCIA, ALETHEA	4/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97791	N/A	N/A	N/A	N/A	N/A	1486 HUNTINGTON AVE. SUI	None	SOUTH SAN FRANCIS	CA	94080	5971	00	06000	37.64441633	-122.4219331	San Mateo County
352385	Ordering, Referring, Prescribing	N/A	1932526795	0	0	GARCIA, BRIDGET V LMFT	11/13/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115637	N/A	N/A	N/A	N/A	N/A	370 S CRENSHAW BLVD	SUITE E-100	TORRANCE	CA	90503	1001	00	06000	33.84549	-118.3287415	Los Angeles County
352394	Ordering, Referring, Prescribing	N/A	1932535283	0	0	GILBERT, SARAH M	12/19/2013	Taxonomy not applicable	NA	n/a	000	Unknown	RN0849977	N/A	N/A	N/A	N/A	N/A	2185 PACHECO STREET	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
352403	Ordering, Referring, Prescribing	N/A	1932555075	0	0	GIRGIS, JOSEPH	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74438	N/A	N/A	N/A	N/A	N/A	8610 FIRESTONE BLVD	None	DOWNEY	CA	90241	5243	00	06000	33.93682278	-118.1267273	Los Angeles County
352406	Ordering, Referring, Prescribing	N/A	1932561925	0	0	GOLDSTEIN, ZACHARY M MD	10/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149661	N/A	N/A	N/A	N/A	N/A	2420 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3907	00	06000	37.25107191	-121.946105	Santa Clara County
352472	Ordering, Referring, Prescribing	N/A	1932653797	0	0	GALL, JACQUELINE LMFT	9/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121927	N/A	N/A	N/A	N/A	N/A	11 PEACH DR	None	SALINAS	CA	93901	3714	00	06000	36.68011966	-121.6478372	Monterey County
352501	Ordering, Referring, Prescribing	N/A	1932703675	0	0	GARCIA, JOHN D LMFT	3/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145505	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
352513	Ordering, Referring, Prescribing	N/A	1932721040	0	0	GINSBURG, JACOB S DO	8/31/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20272	N/A	N/A	N/A	N/A	N/A	1080 EMELINE AVENUE	None	SANTA CRUZ	CA	95060	1966	00	06000	36.99191102	-122.0176744	Santa Cruz County
352558	Ordering, Referring, Prescribing	N/A	1932803475	0	0	GOUPIL, JULIA M MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197236	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
352578	Ordering, Referring, Prescribing	N/A	1932887361	0	0	GONZALEZ, BLANCA E LCSW	2/13/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112858	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2414	00	06000	33.99703164	-118.1499826	Los Angeles County
352595	Ordering, Referring, Prescribing	N/A	1932982733	0	0	GONZALEZ, ZEENAT NP	7/28/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026350	N/A	N/A	N/A	N/A	N/A	1300 N DUTTON AVE	None	SANTA ROSA	CA	95401	7112	00	06000	38.449791	-122.733027	Sonoma County
352657	Ordering, Referring, Prescribing	N/A	1942353602	0	0	GURLEY, GIA N LMFT	4/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39599	N/A	N/A	N/A	N/A	N/A	4785 N FIRST ST	None	FRESNO	CA	93726	0100	00	06000	36.80478	-119.7724585	Fresno County
352666	Ordering, Referring, Prescribing	N/A	1942378310	0	0	GAMUROT, SUSAN MSW LCSW	2/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23020	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST 280	None	SAN JOSE	CA	95112	3939	00	06000	37.32582868	-121.8777868	Santa Clara County
352702	Ordering, Referring, Prescribing	N/A	1942473301	0	0	GONZALEZ, STELLA C	5/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D50466	N/A	N/A	N/A	N/A	N/A	5701 S HOOVER ST	None	LOS ANGELES	CA	90037	4045	00	06000	33.9903	-118.2871595	Los Angeles County
352715	Ordering, Referring, Prescribing	N/A	1942496617	0	0	GENTINI, RAUL MD	12/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110785	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
352722	Ordering, Referring, Prescribing	N/A	1942507116	0	0	GURITZ, CONSTANCE L PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH 35038	N/A	N/A	N/A	N/A	N/A	311 W.LOS FELIZ BLVD	None	GLENDALE	CA	91204	2513	00	06000	34.12866049	-118.2585153	Los Angeles County
352726	Ordering, Referring, Prescribing	N/A	1942538491	0	0	GORE, SUSAN D LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT32818	N/A	N/A	N/A	N/A	N/A	10 DOUGLAS DR.	SUITE 140	MARTINEZ	CA	94553	4078	00	06000	37.99546221	-122.1222474	Contra Costa County
352771	Ordering, Referring, Prescribing	N/A	1942616909	0	0	GUZMAN, MICHELL E	1/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	51752	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
352803	Ordering, Referring, Prescribing	N/A	1942655527	0	0	GILMORE, AARON M DO	9/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16352	N/A	N/A	N/A	N/A	N/A	1686 BARTON RD	None	REDLANDS	CA	92373	1488	00	06000	34.04833901	-117.2120103	San Bernardino County
352884	Ordering, Referring, Prescribing	N/A	1942783741	0	0	GUTIERREZ, LILIANA LCSW	9/13/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126040	N/A	N/A	N/A	N/A	N/A	4001 MISSION OAKS BLVD	SUITE I	CAMARILLO	CA	93012	5103	00	06000	34.21641579	-119.0166203	Ventura County
352892	Ordering, Referring, Prescribing	N/A	1942791207	0	0	GUEVARA, DORA P DDS	12/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	48809	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
352935	Ordering, Referring, Prescribing	N/A	1942892815	0	0	GWILLIAM, SCOTT D NP	2/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95016644	N/A	N/A	N/A	N/A	N/A	22044 CEDAR ROAD	None	SONORA	CA	95370	5342	00	06000	37.98532934	-120.3651951	Tuolumne County
352966	Ordering, Referring, Prescribing	N/A	1942998455	0	0	GALINDO, LINH M NP	4/20/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024906	N/A	N/A	N/A	N/A	N/A	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	00	06000	33.65258952	-117.9121545	Orange County
352974	Ordering, Referring, Prescribing	N/A	1952027369	0	0	GODFREY, KATHERINE L NP	9/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95022819	N/A	N/A	N/A	N/A	N/A	915 N MILPAS ST	None	SANTA BARBARA	CA	93103	2331	00	06000	34.43040726	-119.6909855	Santa Barbara County
352980	Ordering, Referring, Prescribing	N/A	1952057655	0	0	GIBSON, SUSANNA A NP	4/21/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020268	N/A	N/A	N/A	N/A	N/A	3225 TIMBER FALL CT	SUITE B	EUREKA	CA	95503	4892	00	06000	40.778955	-124.1356445	Humboldt County
352981	Ordering, Referring, Prescribing	N/A	1952056350	0	0	GRAY, KRISTINA M CNP	2/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	49402	N/A	N/A	N/A	N/A	N/A	2521 E 15TH STREET	None	CASPER	WY	82609	4126	00	06000	42.834753	-106.2938295	Natrona County
353010	Ordering, Referring, Prescribing	N/A	1952328437	0	0	GERBER, BRET R MD	10/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G79213	N/A	N/A	N/A	N/A	N/A	420 HEFFERNAN AVE	SUITE D	CALEXICO	CA	92231	4718	00	06000	32.6691	-115.494863	Imperial County
353023	Ordering, Referring, Prescribing	N/A	1952411043	0	0	GARDNER, PAULA R	5/19/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D45705	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	4734	00	06000	40.89808837	-124.0923819	Humboldt County
353035	Ordering, Referring, Prescribing	N/A	1952428088	0	0	GOLDSTEIN, DARREN F LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47826	N/A	N/A	N/A	N/A	N/A	6001 CLARA ST	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
353040	Ordering, Referring, Prescribing	N/A	1952432056	0	0	GIBBS, CRAIG W LCSW	2/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27635	N/A	N/A	N/A	N/A	N/A	1750 CIRBY WAY	None	ROSEVILLE	CA	95661	0000	00	06000	38.72953047	-121.258368	Placer County
353061	Ordering, Referring, Prescribing	N/A	1952475709	0	0	GRIER, JENNIFER R LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27722	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE.	None	GILROY	CA	95020	2504	00	06000	37.01377513	-121.5685719	Santa Clara County
353063	Ordering, Referring, Prescribing	N/A	1952471500	0	0	GARCIA, ADOLFO E LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48811	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST.	None	SANTA BARBARA	CA	93101	2556	00	06000	34.42310529	-119.7066629	Santa Barbara County
353133	Ordering, Referring, Prescribing	N/A	1952641953	0	0	GIBBONS, HOPE R	3/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138836	N/A	N/A	N/A	N/A	N/A	14181 TELEGRAPH ROAD	None	WHITTIER	CA	90604	3059	00	06000	33.92892082	-118.0299538	Los Angeles County
353139	Ordering, Referring, Prescribing	N/A	1952657439	0	0	GABRIEL, JESSICA K PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65615	N/A	N/A	N/A	N/A	N/A	5874 HUNTERS LN	None	EL SOBRANTE	CA	94803	3502	00	06000	37.95312242	-122.2746803	Contra Costa County
353158	Ordering, Referring, Prescribing	N/A	1952684797	0	0	GRUSECKI, BRIDGET M	11/3/2014	Taxonomy not applicable	NA	n/a	000	Unknown	576	N/A	N/A	N/A	N/A	N/A	6741 SEBASTOPOL AVE	STE 160	SEBASTOPOL	CA	95472	3857	00	06000	38.40277333	-122.819659	Sonoma County
353164	Ordering, Referring, Prescribing	N/A	1952700957	0	0	GIATTI, ELIZABETH I PHARMD	8/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58516	N/A	N/A	N/A	N/A	N/A	4051 DOUGLAS BLVD	None	GRANITE BAY	CA	95746	5901	00	06000	38.74390645	-121.2244714	Placer County
353166	Ordering, Referring, Prescribing	N/A	1952706525	0	0	GAO, HANNAH EIREENE L LMFT	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120040	N/A	N/A	N/A	N/A	N/A	901 S MYRTLE AVE	None	MONROVIA	CA	91016	3426	00	06000	34.14237971	-118.0009196	Los Angeles County
353172	Ordering, Referring, Prescribing	N/A	1952719742	0	0	GAVRILOVA, HELEN PHARMD	8/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70710	N/A	N/A	N/A	N/A	N/A	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	00	06000	37.33773494	-122.0043395	Santa Clara County
353173	Ordering, Referring, Prescribing	N/A	1952718769	0	0	GONZALEZ, ALEXANDRA LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116987	N/A	N/A	N/A	N/A	N/A	951 B-BLANCO CIRCLE	None	SALINAS	CA	93901	4491	00	06000	36.65589725	-121.6366313	Monterey County
353228	Ordering, Referring, Prescribing	N/A	1952794752	0	0	GARDNER, KELLIE LMFT	4/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104748	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	100	LONG BEACH	CA	90804	3311	00	06000	33.7831762	-118.1333125	Los Angeles County
353252	Ordering, Referring, Prescribing	N/A	1952836025	0	0	GOMEZ, ELSA NP	6/30/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005057	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
353277	Ordering, Referring, Prescribing	N/A	1952864936	0	0	GARZA, ROSALINDA LPCC	5/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	16603	N/A	N/A	N/A	N/A	N/A	823 W LACEY BLVD	None	HANFORD	CA	93230	4328	00	06000	36.32802448	-119.657205	Kings County
353292	Ordering, Referring, Prescribing	N/A	1952884678	0	0	GUIRGUIS, IBRAHIM A PHARMD	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76351	N/A	N/A	N/A	N/A	N/A	3300 BUENA VISTA RD	None	BAKERSFIELD	CA	93311	9701	00	06000	35.322642	-119.1278625	Kern County
353333	Ordering, Referring, Prescribing	N/A	1952972358	0	0	GROTHE, DESTINI D LCSW	7/18/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124266	N/A	N/A	N/A	N/A	N/A	1904 RICHLAND AVENUE	SUITE C2	CERES	CA	95307	4512	00	06000	37.60031128	-120.9658226	Stanislaus County
353384	Ordering, Referring, Prescribing	N/A	1962069625	0	0	GUZMAN, JOANNE M LMFT	9/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	141372	N/A	N/A	N/A	N/A	N/A	6001 CLARA ST	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
353430	Ordering, Referring, Prescribing	N/A	1962415489	0	0	GOLD, BRIAN D PHD	12/7/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY10601	N/A	N/A	N/A	N/A	N/A	9100 WILSHIRE BLVD	844 W.	BEVERLY HILLS	CA	90212	3415	00	06000	34.06703047	-118.390212	Los Angeles County
353508	Ordering, Referring, Prescribing	N/A	1962635664	0	0	GRANDI, SHYANNE N LMFT	11/12/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT81244	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
353534	Ordering, Referring, Prescribing	N/A	1962691709	0	0	GALVAN-PERRY, MARIA I LMFT	8/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52708	N/A	N/A	N/A	N/A	N/A	6061 EAST AVENUE	None	ETIWANDA	CA	91739	2218	00	06000	34.14421719	-117.514554	San Bernardino County
353550	Ordering, Referring, Prescribing	N/A	1962702258	0	0	GONZALEZ, ROSEMARY LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112520	N/A	N/A	N/A	N/A	N/A	1830.S. CENTRAL STREET	None	VISALIA	CA	93618	8012	00	06000	36.314271	-119.311362	Tulare County
353593	Ordering, Referring, Prescribing	N/A	1962779041	0	0	GILL, KIRANJOT K NP	10/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	756488	N/A	N/A	N/A	N/A	N/A	8920 WILSHIRE BLVD	425	BEVERLY HILLS	CA	90211	2004	00	06000	34.06703599	-118.3863456	Los Angeles County
353594	Ordering, Referring, Prescribing	N/A	1962772699	0	0	GORDY, WHITNEY J LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116670	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
353603	Ordering, Referring, Prescribing	N/A	1962786236	0	0	GLASER, MATTHEW PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80402	N/A	N/A	N/A	N/A	N/A	5900 CALLE REAL	None	GOLETA	CA	93117	2312	00	06000	34.44152999	-119.8281048	Santa Barbara County
353614	Ordering, Referring, Prescribing	N/A	1962800706	0	0	GONZALEZ, CLAUDIA M LCSW	4/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114873	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
353634	Ordering, Referring, Prescribing	N/A	1962826495	0	0	GONZALEZ, MICAELA LMFT	9/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102669	N/A	N/A	N/A	N/A	N/A	6244 EL CAJON BLVD	STE 17	SAN DIEGO	CA	92115	3918	00	06000	32.76342577	-117.0636924	San Diego County
353637	Ordering, Referring, Prescribing	N/A	1962829879	0	0	GONZALEZ, SANDRA LMFT	1/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104755	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DRIVE	None	HANFORD	CA	93230	5922	00	06000	36.32726257	-119.6663418	Kings County
353730	Ordering, Referring, Prescribing	N/A	1962981670	0	0	GARLINGTON, JENNIFER NP	8/16/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031737	N/A	N/A	N/A	N/A	N/A	2400 GLENDALE LANE	None	SACRAMENTO	CA	95825	2431	00	06000	38.597355	-121.405212	Sacramento County
353748	Ordering, Referring, Prescribing	N/A	1972001790	0	0	GALLO, RUTH PSYD	6/21/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29231	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE SUITE	None	OAKLAND	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
353770	Ordering, Referring, Prescribing	N/A	1972038198	0	0	GOODMAN, ANIKKA L LMFT	2/5/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131001	N/A	N/A	N/A	N/A	N/A	350 90TH STREET	2ND FLOOR	DALY CITY	CA	94015	1880	00	06000	37.69111548	-122.473143	San Mateo County
353797	Ordering, Referring, Prescribing	N/A	1972079671	0	0	GRAHAM, ALAINA R PA-C	11/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63772	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
353847	Ordering, Referring, Prescribing	N/A	1972218832	0	0	GILL, JASPREET NP	5/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95025274	N/A	N/A	N/A	N/A	N/A	1820 J ST	None	SACRAMENTO	CA	95811	3010	00	06000	38.57688	-121.4816625	Sacramento County
353850	Ordering, Referring, Prescribing	N/A	1972196970	0	0	GUIDO, NOEL CHRISTIAN PA-C	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59372	N/A	N/A	N/A	N/A	N/A	201 E LAKEVIEW AVE	None	WOODLAKE	CA	93286	1301	00	06000	36.4172997	-119.0975768	Tulare County
353862	Ordering, Referring, Prescribing	N/A	1972250702	0	0	GARCIA, JESSICA LPCC	2/18/2025	Taxonomy not applicable	NA	n/a	000	Unknown	18749	N/A	N/A	N/A	N/A	N/A	1236 CHAPALA ST	None	SANTA BARBARA	CA	93101	3116	00	06000	34.42310529	-119.7066629	Santa Barbara County
353879	Ordering, Referring, Prescribing	N/A	1972323848	0	0	GOR, VANI DDS	10/7/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110907	N/A	N/A	N/A	N/A	N/A	329 W 8TH ST	STE 103	HANFORD	CA	93230	4533	00	06000	36.32698307	-119.6503466	Kings County
353889	Ordering, Referring, Prescribing	N/A	1972385235	0	0	GYODAKYAN, KNARIK DDS	8/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109225	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
353900	Ordering, Referring, Prescribing	N/A	1972596963	0	0	GUERRERO, VICTOR M MD	12/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A50302	N/A	N/A	N/A	N/A	N/A	430 S BLOSSER RD	None	SANTA MARIA	CA	93458	4908	00	06000	34.94869196	-120.4537258	Santa Barbara County
353908	Ordering, Referring, Prescribing	N/A	1972619997	0	0	GLASGOW, GORDON A MD	2/26/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G38908	N/A	N/A	N/A	N/A	N/A	2401 E. KATELLA AVE	STE 440	ANAHEIM	CA	92086	0000	00	06000	33.80588529	-117.8828675	Orange County
353917	Ordering, Referring, Prescribing	N/A	1972627776	0	0	GUTERMUTH, ANGELA M PT	6/27/2017	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT25862	N/A	N/A	N/A	N/A	N/A	31660 HIGHWAY 3	None	WEAVERVILLE	CA	96093	0000	00	06000	40.73956736	-122.9266898	Trinity County
353934	Ordering, Referring, Prescribing	N/A	1972657575	0	0	GARZA, ROBERT LCSW	9/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76744	N/A	N/A	N/A	N/A	N/A	4378 AUBURN BLVD	None	SACRAMENTO	CA	95841	4175	00	06000	38.645082	-121.3614315	Sacramento County
353966	Ordering, Referring, Prescribing	N/A	1972720712	0	0	GILL, JASVINDER K LMFT	5/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40731	N/A	N/A	N/A	N/A	N/A	1919 B ST	None	MARYSVILLE	CA	95901	3731	00	06000	39.15632344	-121.5882312	Yuba County
353967	Ordering, Referring, Prescribing	N/A	1972727246	0	0	GRECO-GREGORY, JUDETH M PHD	11/2/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20318	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	None	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
353978	Ordering, Referring, Prescribing	N/A	1972749919	0	0	GALLEGOS, ALEX J LMFT	11/13/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101393	N/A	N/A	N/A	N/A	N/A	43517 SAHUAYO ST.	None	LANCASTER	CA	93535	5005	00	06000	34.67312791	-118.1279511	Los Angeles County
353986	Ordering, Referring, Prescribing	N/A	1972756062	0	0	GARG, SUNITA MD	4/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A104898	N/A	N/A	N/A	N/A	N/A	1224 VINE ST	None	LOS ANGELES	CA	90038	1612	00	06000	34.093332	-118.326603	Los Angeles County
353987	Ordering, Referring, Prescribing	N/A	1972766848	0	0	GRAY, CAROLYNN M PSYD	3/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26218	N/A	N/A	N/A	N/A	N/A	26081 MOCINE AVE	None	HAYWARD	CA	94544	2923	00	06000	37.64800936	-122.0758633	Alameda County
353995	Ordering, Referring, Prescribing	N/A	1972786804	0	0	GORBY, NATASHA OT	11/12/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	9725	N/A	N/A	N/A	N/A	N/A	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	00	06000	34.02980528	-118.4786605	Los Angeles County
354011	Ordering, Referring, Prescribing	N/A	1972801066	0	0	GONZALEZ, IRMA R LCSW	1/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	61779	N/A	N/A	N/A	N/A	N/A	11731 E. TELEGRAPH ROAD	SUITE G	SANTA FE SPRINGS	CA	90670	3657	00	06000	33.94630253	-118.0832082	Los Angeles County
354016	Ordering, Referring, Prescribing	N/A	1972810810	0	0	GONZALEZ, ALMA L LCSW	8/29/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73221	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
354051	Ordering, Referring, Prescribing	N/A	1972881191	0	0	GEORGIEVA, RALITSA C LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84809	N/A	N/A	N/A	N/A	N/A	1385 MISSION STREET	200	SAN FRANCISCO	CA	94103	3126	00	06000	37.77552014	-122.4155639	San Francisco County
354061	Ordering, Referring, Prescribing	N/A	1972889244	0	0	GANDHI, PINAK PHARMD	9/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55026	N/A	N/A	N/A	N/A	N/A	1693 FLANIGAN DRIVE	SUITE 104	SAN JOSE	CA	95121	1683	00	06000	37.31874246	-121.8234636	Santa Clara County
354062	Ordering, Referring, Prescribing	N/A	1972868669	0	0	GEORGE, MARJORIE LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50249	N/A	N/A	N/A	N/A	N/A	10221 S COMPTON BLVD	104	LOS ANGELES	CA	90002	2802	00	06000	33.943518	-118.246236	Los Angeles County
354074	Ordering, Referring, Prescribing	N/A	1972903482	0	0	GONZALEZ, ARLENE LMFT	6/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT133399	N/A	N/A	N/A	N/A	N/A	11721 EAST TELEGRAPH ROA	None	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
354075	Ordering, Referring, Prescribing	N/A	1972910016	0	0	GILL, SANDEEP MD	12/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145698	N/A	N/A	N/A	N/A	N/A	303 E VANDERBILT WAY	None	SAN BERNARDINO	CA	92415	0026	00	06000	34.06872265	-117.2775832	San Bernardino County
354088	Ordering, Referring, Prescribing	N/A	1972926400	0	0	GALARZA, REYNALDA C LCSW	12/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107910	N/A	N/A	N/A	N/A	N/A	149 PASADENA AVENUE	SUITE A	PASADENA	CA	91030	2947	00	06000	34.11188281	-118.1734374	Los Angeles County
354091	Ordering, Referring, Prescribing	N/A	1972928042	0	0	GARCIA-ENRIGHT, MARTHA LMFT	3/23/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131942	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	175	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
354096	Ordering, Referring, Prescribing	N/A	1972939247	0	0	GUERRA, BELEN LCSW	1/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87429	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
354129	Ordering, Referring, Prescribing	N/A	1972967008	0	0	GARDNER, IVY H MD	3/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185167	N/A	N/A	N/A	N/A	N/A	1020 29TH ST.,	350	SACRAMENTO	CA	95816	5173	00	06000	38.572803	-121.4685	Sacramento County
354130	Ordering, Referring, Prescribing	N/A	1972971422	0	0	GONZALEZ, MONICA NP	11/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003023	N/A	N/A	N/A	N/A	N/A	755 N SEQUOIA AVE	STE B	LINDSAY	CA	93247	1422	00	06000	36.21173551	-119.0961155	Tulare County
354131	Ordering, Referring, Prescribing	N/A	1972968592	0	0	GURRAM, NEERAJA PHARMD	8/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62250	N/A	N/A	N/A	N/A	N/A	4495 FIRST ST	None	LIVERMORE	CA	94551	4915	00	06000	37.69630144	-121.7443221	Alameda County
354148	Ordering, Referring, Prescribing	N/A	1972998193	0	0	GURYEV, IGOR MD	12/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145955	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
354172	Ordering, Referring, Prescribing	N/A	1982028338	0	0	GARCIA, DANIELLE A LCSW	12/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86805	N/A	N/A	N/A	N/A	N/A	1900 N SYCAMORE CANYON R	None	SAN DIMAS	CA	91773	1299	00	06000	34.13204802	-117.7975027	Los Angeles County
354179	Ordering, Referring, Prescribing	N/A	1982052809	0	0	GARBUTT, LUWANDA K PHARMD	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH71413	N/A	N/A	N/A	N/A	N/A	9031 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2046	00	06000	33.9038495	-118.1420904	Los Angeles County
354205	Ordering, Referring, Prescribing	N/A	1982082582	0	0	GRAHAM, KYLE A	6/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144228	N/A	N/A	N/A	N/A	N/A	204 EAST BEACH STREET	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
354212	Ordering, Referring, Prescribing	N/A	1982100772	0	0	GERNDT, CLAYTON H MD	3/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164927	N/A	N/A	N/A	N/A	N/A	4860 Y STREET	SUITE 3740	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
354227	Ordering, Referring, Prescribing	N/A	1982129870	0	0	GONZALEZ, PAMELA LCSW	3/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100507	N/A	N/A	N/A	N/A	N/A	2130 E 4TH ST	None	SANTA ANA	CA	92705	3818	00	06000	33.74808392	-117.836143	Orange County
354234	Ordering, Referring, Prescribing	N/A	1982138368	0	0	GUEST, CHRISTINA MD	11/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157271	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
354235	Ordering, Referring, Prescribing	N/A	1982138871	0	0	GEORGIOU, IRINA O PHARMD	11/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66263	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
354236	Ordering, Referring, Prescribing	N/A	1982139846	0	0	GRANT, REBECCA K NP	1/23/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007367	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
354277	Ordering, Referring, Prescribing	N/A	1982203097	0	0	GARCIA, REBECCA NP	6/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95015597	N/A	N/A	N/A	N/A	N/A	4575 COLLEGE AVE	None	SAN DIEGO	CA	92115	0000	00	06000	32.76023438	-117.0667611	San Diego County
354283	Ordering, Referring, Prescribing	N/A	1982223251	0	0	GOCO, TIMOTHY M NP	2/2/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014117	N/A	N/A	N/A	N/A	N/A	300 NORTH EUCLID AVENUE	STE B	UPLAND	CA	91786	8323	00	06000	34.097508	-117.6509735	San Bernardino County
354345	Ordering, Referring, Prescribing	N/A	1982470621	0	0	GURUNG, NABINTA NP	11/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028211	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
354356	Ordering, Referring, Prescribing	N/A	1982629986	0	0	GREENBERG, AMY LMFT	4/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT36752	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
354372	Ordering, Referring, Prescribing	N/A	1982696068	0	0	GOLDSWORTHY, MARK S MD	2/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71503	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
354378	Ordering, Referring, Prescribing	N/A	1982714143	0	0	GHAHERI, SHIRIN F MD	3/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67184	N/A	N/A	N/A	N/A	N/A	3161 DWIGHT RD	None	ELK GROVE	CA	95758	6456	00	06000	38.427372	-121.4606025	Sacramento County
354390	Ordering, Referring, Prescribing	N/A	1982733481	0	0	GONZALEZ, ANDREA	11/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22368	N/A	N/A	N/A	N/A	N/A	5100 S EASTERN AVE	None	COMMERCE	CA	90040	2950	00	06000	33.98882955	-118.1615175	Los Angeles County
354408	Ordering, Referring, Prescribing	N/A	1982760633	0	0	GOLDSMITH, MICHELLE D MD	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A103432	N/A	N/A	N/A	N/A	N/A	3490 THE ALAMEDA	None	SANTA CLARA	CA	95050	4333	00	06000	37.35380924	-121.9418703	Santa Clara County
354434	Ordering, Referring, Prescribing	N/A	1982789186	0	0	GUESS, KENNETH S	1/23/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	37953	N/A	N/A	N/A	N/A	N/A	2003 S MILLER ST	None	SANTA MARIA	CA	93454	7849	00	06000	34.92376708	-120.4317811	Santa Barbara County
354436	Ordering, Referring, Prescribing	N/A	1982829842	0	0	GARCIA, MARGARET A LCSW	2/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23458	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
354441	Ordering, Referring, Prescribing	N/A	1982840054	0	0	GERRY, SHARON E PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59166	N/A	N/A	N/A	N/A	N/A	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
354453	Ordering, Referring, Prescribing	N/A	1982855698	0	0	GASQUE, DOE D NP	3/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17731	N/A	N/A	N/A	N/A	N/A	1890 W MAIN ST	120	BARSTOW	CA	92311	3725	00	06000	34.89321455	-117.0507578	San Bernardino County
354479	Ordering, Referring, Prescribing	N/A	1982914024	0	0	GUERRERO, ANTHONY M LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117349	N/A	N/A	N/A	N/A	N/A	801 E CHAPMAN AVE	203	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
354522	Ordering, Referring, Prescribing	N/A	1982982138	0	0	GONICK-HALLOWS, GAIL LMFT	10/1/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT82442	N/A	N/A	N/A	N/A	N/A	576 B STREET	1B	SANTA ROSA	CA	95401	5274	00	06000	38.44377	-122.718393	Sonoma County
354530	Ordering, Referring, Prescribing	N/A	1982986584	0	0	GROSU, AMELIA N LCSW	2/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87638	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	259	OAKLAND	CA	94601	3424	00	06000	37.77617499	-122.2247899	Alameda County
354548	Ordering, Referring, Prescribing	N/A	1992026553	0	0	GUINTO, ELIZABETH DO	1/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17351	N/A	N/A	N/A	N/A	N/A	162 CARON ST	SUITE A	COLUSA	CA	95932	0152	00	06000	39.20587882	-122.0061518	Colusa County
354564	Ordering, Referring, Prescribing	N/A	1992055636	0	0	GARNER, BRIAN T PHARMD	1/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH53680	N/A	N/A	N/A	N/A	N/A	1902 ROYALTY DR STE 110	None	POMONA	CA	91767	3036	00	06000	34.07791925	-117.746146	Los Angeles County
354571	Ordering, Referring, Prescribing	N/A	1992070833	0	0	GAUR, SONAL M PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	50610	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
354603	Ordering, Referring, Prescribing	N/A	1992108724	0	0	GUILLEN, JESSICA E LCSW	12/11/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88600	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	2ND FLOOR	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
354608	Ordering, Referring, Prescribing	N/A	1992116552	0	0	GOTO, MAMI	4/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C176438	N/A	N/A	N/A	N/A	N/A	2032 MARENGO ST	None	LOS ANGELES	CA	90033	1319	00	06000	34.0566188	-118.2074593	Los Angeles County
354654	Ordering, Referring, Prescribing	N/A	1992192637	0	0	GUILLEN, JOSE NP	11/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001648	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
354659	Ordering, Referring, Prescribing	N/A	1992205686	0	0	GHANIMIAN, VASYL A	5/13/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81101	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
354665	Ordering, Referring, Prescribing	N/A	1992213508	0	0	GIRVAN, CHELSEA M LMFT	8/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120658	N/A	N/A	N/A	N/A	N/A	850 E. WARDLOW RD	None	LONG BEACH	CA	90807	4628	00	06000	33.81888054	-118.182069	Los Angeles County
354676	Ordering, Referring, Prescribing	N/A	1992228308	0	0	GILBERT, CALVIN L NP	3/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007414	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
354696	Ordering, Referring, Prescribing	N/A	1992278857	0	0	GRIFFIN, LATASHA NP	2/14/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011174	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
354722	Ordering, Referring, Prescribing	N/A	1992326573	0	0	GALUEGO, MIRAH-AIZZA R NP	11/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	60371	N/A	N/A	N/A	N/A	N/A	2240 W MONTE VISTA AVENU	None	TURLOCK	CA	95382	9667	00	06000	37.52173653	-120.8741705	Stanislaus County
354748	Ordering, Referring, Prescribing	N/A	1992369805	0	0	GOLDFIEN, GABRIEL MD	3/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	177399	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
354752	Ordering, Referring, Prescribing	N/A	1992364939	0	0	GOODLIN, GRANT NP	6/4/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011891	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
354755	Ordering, Referring, Prescribing	N/A	1992381206	0	0	GIVEN, JANA M PSYD	7/18/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29295	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
354762	Ordering, Referring, Prescribing	N/A	1992385785	0	0	GERENZ, MATTHEW MD	5/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183126	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	None	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
354766	Ordering, Referring, Prescribing	N/A	1992398432	0	0	GABRO, RAGHEED DDS	7/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS105997	N/A	N/A	N/A	N/A	N/A	1242 E MAIN ST	None	EL CAJON	CA	92021	7205	00	06000	32.79495945	-116.938566	San Diego County
354774	Ordering, Referring, Prescribing	N/A	1992448427	0	0	GAMBY WHITFIELD, ANGELA LCSW	1/20/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128214	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
354824	Ordering, Referring, Prescribing	N/A	1992807846	0	0	GONZALEZ, MIREYA I LMFT	3/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45772	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
354829	Ordering, Referring, Prescribing	N/A	1992824585	0	0	GOLDMAN, AMY S LCSW	4/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24417	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
354848	Ordering, Referring, Prescribing	N/A	1992848485	0	0	GARIBYAN, AILEEN PSYD	1/14/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22856	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	None	PACOIMA	CA	91331	1352	00	06000	34.27894489	-118.4044363	Los Angeles County
354876	Ordering, Referring, Prescribing	N/A	1992894307	0	0	GUDINO, SILVIA LCSW	9/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88264	N/A	N/A	N/A	N/A	N/A	9 KPC PKWY	None	CORONA	CA	92879	7102	00	06000	33.88634582	-117.514398	Riverside County
354884	Ordering, Referring, Prescribing	N/A	1992906457	0	0	GRIGGS, KIMBERLY LMFT	3/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84749	N/A	N/A	N/A	N/A	N/A	8192 SANCTUARY DR	None	CORONA	CA	92883	5954	00	06000	33.79539032	-117.5169164	Riverside County
354885	Ordering, Referring, Prescribing	N/A	1992900641	0	0	GOMEZ, ESTEBAN I MD	9/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116810	N/A	N/A	N/A	N/A	N/A	701 SOUTH PARKER STREET	SUITE 1000	ORANGE	CA	92868	4720	00	06000	33.77647082	-117.8595932	Orange County
354927	Ordering, Referring, Prescribing	N/A	1992998801	0	0	GARCIA, GIOVANNA A	4/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	59641	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